Editing Penis and Urethra Surgery (section)

== Circumcision ==

* '''See CUA Circumcision Guideline Notes'''
* In adults, circumcision can be done with local anesthesia, by blocking the dorsal nerves at the base of the penis and circumferentially infiltrating the superficial layers of the penile base.
* In men and older boys, we favor a sleeve circumcision.
** Summary of steps:
*** With the foreskin in its retracted position, a marking pen outlines an incision, leaving a small preputial cuff. This mark should go straight across the base of the frenulum. This incision is made and carried through the dartos fascia to the superficial lamina of the Buck fascia.
*** The foreskin is reduced, and a second incision is marked, following the outlines of the coronal margin and the V of the frenulum on the ventral side.
*** In some cases, the frenulum can be lengthened by closing the edges of the V in a longitudinal orientation for a short length (frenuloplasty). If frenuloplasty is done, the proximal incision does not need to follow the V of the retracted frenulum because the ventral skin is straight.
*** We make the skin incision and fulgurate bleeding vessels with bipolar cautery as the incision is deepened and the skin edge is mobilized. In older boys and men, the vessels are more substantial and not easily sealed by compression, no matter how vigorous.
*** After the sleeve of preputial skin has been removed, hemostasis is obtained, and the skin edges are reapproximated.
* Complications should be uncommon.
** Most common immediate complication: hematoma
** Most patients develop some hyperesthesia of the glans, which resolves.
** '''Minimal separation may be amenable to healing by secondary intention.'''
** Some patients notice minor cosmetic imperfections that are functionally insignificant.