INFO Besnijdenis Kind

Pre-operative (Preparations)

After the appointment for a treatment is confirmed, you will receive information about the circumcision of your child by e-mail. It contains everything you need to know about the circumcision and about the different methods, so please read this information carefully.

We have briefly summarized below what you should do before you visit our clinic:

• Wash your child in advance or make sure your child has showered.
• Give your child at least half an hour before you visit us a paracetamol suppository (we refer to the package for dosage information, which is depending on age).
• Always bring extra diapers and / or clean underwear.
• If applicable, bring bottle-feeding with you and bring along some favorite toys for distraction.
• Everyone is allowed to come to the clinic, but a maximum of 4 people (including parents) may be present in the treatment room.
• If one of the parents cannot be present, always include a signed consent statement/authorization form from the absent parent. This form is included in the information package we send by e-mail.

Perioperative (In the clinic)

When you arrive at the clinic, an anesthetic crème will be applied immediately to your child at the spot where the anesthetic will be injected. In the meantime, we hand out administrative forms such as the declaration of the informed consent for the circumcision. We check for the presence of both parents or the presence of an authorization form from the absent parent. After the payment is completed an intake interview follows.

During this interview we ask questions about the health of your child and you receive information about the care before, during and after the circumcision, including the possible complications (even though the chances are small). We will discuss which method is best for your child and you can indicate which method you prefer. Please feel free to ask any questions and if everything is clear, the informed consent form must be signed.

Children from the age of 1 get lightly sedated by means of a nasal spray to reduce anxiety and make the children as comfortable as possible. Children can become drowsy or sleepy, but they will remain conscious since it is not a deep sedation. In children between 6-12 months and children over 6 years, a nasal spray for sedation is only given in certain circumstances. Infants under 6 months are not sedated, however we distract them by means of sucrose (sugar water) or a bottle of milk.

After the anesthetic crème and (if applicable) the nasal spray have been absorbed, the local anesthetic will be applied and the penis will be completely numb after a few minutes. After the anesthesia is checked, the circumcision will take place. This takes about 10 to 15 minutes.

The method: Clamp (ring) or the Conventional method?

• At BesnijdenisPunt, the circumcision is carried out in both methods according to a religious (Islamic) and medically responsible manner with a cosmetically good result. Because of our extensive experience, the circumcision is easily performed with a minimal risk of complications.
• Both methods give the same cosmetic long-term results. There is no difference between the classic or the clamp method concerning pain after the circumcision.
• Certain clinics reject the use of the clamp (ring) method, however this is mostly because they are not able to apply the clamp method correctly. This method requires advanced skills. Additionally, an extra financial investment in the clamp is necessary, which causes certain clinics to only implement the Classic method. Also, scientific studies conclude that the clamp method is in many ways better and safer than the classic method, especially in young children. The classic method applied in our clinic is a minimally invasive method, ensuring that the safety is guaranteed and the blood loss is kept to a minimum
• We recommend the clamp method for diaper-wearing children. This method results in a lower chance of infections and bleeding after the circumcision.
• The clamp is firmly set in place; children cannot remove it.
• We as experienced doctors will advise and guide you in making a choice concerning which method to use. However, the choice is always up to the patient and/or parents.

There may be certain reasons, that become clear during the interview or physical examination, which makes it wiser not to have a circumcision at that point (eg fever, vomiting / diarrhea, too much pubic fat, certain allergies or other medical reasons). The circumcision has to be postponed in these cases. This is always in the interest of your child and even if you have already planned a party, your child's health always comes first. In rare cases urological birth defects can be detected (most common is hypospadias). This is usually observed after the anesthesia has been given and the adhesions of the foreskin have been released so the glans becomes visible. When urological abnormalities occur, a circumcision cannot take place or should be postponed. Sometimes you need the foreskin for the correction of a congenital abnormality of the penis. In these cases, instructions will be given and a referral to a pediatric urologist will follow.

Post-operative (Aftercare)

For the healing of the wound, it is important to follow the aftercare instructions carefully. However, we understand that you cannot remember everything on such an exciting day. All follow-up instructions are included on paper. This allows you to read everything at home. If you still have questions you can always contact BesnijdenisPunt during office hours through the general number. In case of emergency, you can always reach us 24/7 through the emergency number. Generally, a follow-up does not take place. However, if you prefer to have a follow-up, you can make an appointment by calling or e-mailing us.

Complications

A circumcision is basically a safe and minor surgical procedure, however, as with any surgical procedure, complications can occur even though this is rare. In the informed consent form all complications are described and during the interview these are pointed out again.

Listed below are the possible (and also very rare) complications:

• A little blood loss (a few drops), which stops eventually, is normal.
• If the penis is fiery red, painful and swollen after a few days along with a fever, this may indicate an infection.
• Difficult urination and a burning sense.
• Swelling: The penis can often be swollen a few days after the circumcision due to the anesthetic fluid and surgery and may be accompanied by pain. This is normal and will pass eventually. Sometimes there is a lot of swelling of the thin inner skin through which the foreskin can stretch and therefore possibly a second intervention is required.
• There may sometimes be adhesions between the foreskin and the glans border. This can be solved mostly manually.
• Sometimes a difficult wound healing can occur because the wound edges will recede, which means it will take longer for the wound to close and heal.
• If there is a lot of fat on the pubic bone (pubic fat) and/or the penis is below the skin level, the glans may reach under skin level due to the formation of adhesions or phimosis (narrowing of the foreskin), which may require a second intervention later on.
• There are rare complications described in literature, such as the meatus stenosis and urethrocutaneous fistulae (urethra problems).