Chapter 9 Scrotal and penile surgery

The difficulty of circumcision is underestimated. A poor circumcision has lifelong cosmetic and functional consequences for your patient. The newborn boy’s foreskin is adherent to the glans (such that in approximately 50% of newborns even the external urethral meatus cannot be visualized) and remains so in 80% at 3 months and in 10% at 3 years. By the early teens the foreskin has completely separated from the glans. Phimosis may respond to topical steroids (0.05% betamethasone ointment) applied to the area of phimosis twice daily for 2 months, combined with gentle daily retraction of the foreskin to encourage separation of the glans and foreskin. Prepare the skin of the penis, prepuce, and glans. If the prepuce is too tight to retract, keep some skin prep on the trolley and clean the glans once the prepuce has been excised. Hold the flaccid penis without tension and...