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Does Lidocaine-Prilocaine Cream (EMLA) Decrease the Pain of Neonatal Circumcision? - FPIN's Clinical Inquiries
ABSTRACT: Circumcision performed using the Gomco clamp is usually quick and effective, and results in very little bleeding. However, every clinician performing circumcision occasionally has concerns or questions regarding the procedure. Some of the more common concerns regarding the use of the Gomco clamp are technique-related, including choosing the correct size of the Gomco bell and clamp for the procedure, choosing the right method of getting the foreskin properly through the hole of the Gomco base plate, and assessing how much foreskin to remove. Other concerns include poor cosmetic results, contraindications to routine circumcision, and circumcision in an infant whose mother has human immunodeficiency virus. This article reviews the technique of circumcision using the Gomco clamp and answers some of the more common questions.
Adult Circumcision - Article
ABSTRACT: Adult circumcision can be performed under local or regional anesthesia. Medical indications for this procedure include phimosis, paraphimosis, recurrent balanitis and posthitis (inflammation of the prepuce). Nonmedical reasons may be social, cultural, personal or religious. The procedure is commonly performed using either the dorsal slit or the sleeve technique. The dorsal slit is especially useful in patients who have phimosis. The sleeve technique may provide better control of bleeding in patients with large subcutaneous veins. A dorsal penile nerve block, with or without a circumferential penile block, provides adequate anesthesia. Informed consent must be obtained. Possible complications of adult circumcision include infection, bleeding, poor cosmetic results and a change in sensation during intercourse.
ABSTRACT: Urinary tract infections in children are sometimes associated with vesicoureteral reflux, which can lead to renal scarring if it remains unrecognized. Since the risk of renal scarring is greatest in infants, any child who presents with a urinary tract infection prior to toilet training should be evaluated for the presence of reflux. Children who may be lost to follow-up and those who have recurrent urinary tract infections should also be evaluated. The preferred method for evaluation of urinary reflux is a voiding cystourethrogram. Documented reflux is initially treated with prophylactic antibiotics. Patients who have breakthrough infections on prophylaxis, develop new renal scarring, have high-grade reflux or cannot comply with long-term antibiotic prophylaxis should be considered for surgical correction. The preferred method of surgery is ureteral reimplantation. A newer method involves injection of the bladder trigone with collagen.
AAP Updates Its Recommendations on Circumcision - Special Medical Reports