Download Circumcision - The Christie

Department of Urology
Circumcision
This information tells you what happens when you have a circumcision. It explains what is
involved and the benefits and risks. It may help you to think of things you would like to
discuss with your doctor/s.
What is a circumcision?
A circumcision is an operation to remove the foreskin leaving the head or glans of the penis
exposed.
Why do I need a circumcision?
This is normally done:
• if the foreskin has become tight making it difficult to pull back and wash underneath
• for recurrent inflammation or infection
• for pain or ballooning of the foreskin during the passage of urine
• for diseased foreskin
• for a tight foreskin that is causing pain during an erection.
What are the benefits of having a circumcision?
The benefits of having the operation are that you will now be able to clean around the glans of
the penis, reducing the risk of infection. It will resolve the problem of pain and discomfort
which you may have had due to the foreskin being tight. Also in some circumstances, if the
doctor is concerned, it can be used to show if any cancerous cells are present. This will help
your doctor to see if any further treatment is necessary.
Agreeing to treatment
The doctor will have explained the procedure and the reasons for it. This information is a
permanent record of what has been explained. We advise you to read the information before
you sign the consent form which states that you are prepared to go ahead with the procedure.
We will ask you to sign the consent form agreeing to accept the operation that you are being
offered. The basis of this agreement is that you have had The Christie’s written description of
the proposed treatment, and that you have been given an opportunity to discuss any
concerns.
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What are the risks of having a circumcision?
 Infection
If you notice pain, swelling or an offensive discharge and develop a fever you may have an
infection in the wound and you should seek advice from your GP or The Christie.
 Bleeding
You may initially notice some spotting of blood on your underwear which should settle within
the first few days. If the bleeding persists or becomes heavy you need to seek advice from
The Christie.
 Swelling
Your penis will swell a little; this is normal. If you feel the swelling is worrying you should
contact The Christie.
 Sensory changes
The end of the penis may be come oversensitive or undersensitive. In most cases this is not
troublesome, but can occasionally cause difficulty during sexual activity.
 Visual changes (Cosmoses)
You may feel that your penis physically looks shorter but this is not the case. As the skin has
been removed your penis will look cosmetically different.
 Pain
This is common but is usually easily treated with painkillers which you will take home with
you.
 Allergic reactions
You may have allergic reactions to medication which you have been given. These are rare
but if you are aware of any allergies please tell us before the operation.
 Heart irregularities
These may be due to the anaesthetic or the operation. Please contact your GP if you have
any problems.
What happens before my operation?
Before coming into hospital, we will ask you to attend a pre-operative assessment. The nurse
will assess your general medical condition and arrange any blood tests or other investigations
that are necessary. You will be given verbal and written information about your operation and
preparation needed before surgery and they will also answer any questions you may have.
Is there any preparation for the procedure?
Before you have your operation you need to tell your doctor or nurse if you are taking any
medications, in particular, aspirin/warfarin or clopidogrel (medication to prevent clots forming
and to thin your blood). You also need to tell us if you are allergic to any medications,
including anaesthetic. Also tell us if you have any bleeding or clotting conditions. It is
important you tell your Christie doctor about any medical conditions before you have
your operation.
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Are there any alternatives to the circumcision?
In most cases circumcision would have been advised for the above reasons. We usually only
remove enough skin to resolve your problem. Your doctor will discuss this with you before
the surgery. For some patients, for example, where cancer may be present, the circumcision
is necessary to help your doctor to determine if any further treatment is necessary.
If you are known to have early cancer changes on the end of the penis then a circumcision
will help to treat this.
What does the operation involve?
The operation can be done under either a local anaesthetic (numbs the area) or general
anaesthetic (where you are unconscious/asleep) or spinal/epidural (which numbs from the
waist down). The operation takes approximately 30 minutes. The foreskin is removed and
the remaining skin is stitched to the base of the glans. The tissue that is removed is usually
sent to the laboratories to be assessed.
The day of your operation
You will usually be admitted onto the Surgical Day Case Unit here at The Christie. You will
be advised which of your regular medication (tablets) you should or should not take before
your operation. Please ask if you are not advised. A nurse will accompany you to theatre,
and will collect you following your operation and bring you back to the unit.
After your circumcision
You can expect to stay for at least four hours after returning to the unit. However, everyone is
different and so recovery times do vary. Occasionally we may ask patients to stay overnight if
their recovery is slower that planned. You will also need to pass urine before you are
discharged.
You will need to arrange someone to collect you from hospital as you cannot drive yourself
home. We recommend that there should be an adult with you at home overnight and for 24
hours following a general anaesthetic.
When you are ready to go home, the nurses will complete all the necessary paperwork, a
follow up appointment will either be given to you before discharge or sent to you in the post.
You may have some discomfort/pain from the operation for the first few days; this can usually
be controlled with painkillers such as paracetamol.
When do the stitches have to be removed?
The stitches dissolve after about 3-4 weeks so you do not have to have them removed.
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Discharge information
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You can eat and drink as normal.
You should avoid any activities/exercise where you are likely to knock the penis.
Wear supportive underwear for the first 2 weeks; this will hopefully reduce any
swelling.
Keep the area clean. You can shower but pat dry the penis, do not rub until the
wound has healed completely.
Sexual intercourse should be avoided for 3-4 weeks or until the skin is completely
healed. You may notice some bleeding and altered sensitivity in the glans of the
penis. If sexual activity/erections are painful, you may need to wait a little longer for
things to heal. If discomfort or bleeding persists you should call the hospital or see
your GP.
You can drive whenever you feel that your pain level is low enough. You should not
drive if you are still taking strong painkillers.
You can return to work when you feel comfortable to do so, normally a week, although
if your work involves heavy lifting or manual work you may require a longer period of
time off work. Discuss this with your nurse or doctor before you are discharged.
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Contact numbers
If you have any other general worries when you are at home after your circumcision you can
contact:
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8am to 6pm Surgical Day Case Unit on 0161 918 7292
After hours (6pm-8am) Ward 10 on 0161 446 3860/3862
Alternatively you can contact your urology clinical nurse specialist on
Jane Booker
0161 446 8018
Cath Pettersen 0161 918 7328
Sharon Capper 0161 446 3856
Follow-up after your biopsy
We will give you an outpatient follow-up appointment following your operation. At this time we
will have the results of the histology – the analysis of the tissue which has been taken at the
time of your operation. This will help your doctors to decide if any further treatment is
necessary.
Details of the sources used are available, please contact [email protected]
The Christie Patient Information Service March 2012
Review March 2015 CHR/URO/895-01/21.02.12
www.christie.nhs.uk Tel: 0161 446 3000
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