Overview Adult circumcision is completed for multiple reasons; it is best to do it for medical reasons rather than pure cosmetic reasons in the adult. The medical reasons are usually chronic irritation, infection, phimosis, paraphymosis, penile cancer, penile lesions, condyloma (venereal warts), and some other less common conditions. Our office will do an adult circumcision for pure cosmetic reasons, however, the patient must be aware that there is a significant recovery period in which the male is sore. Return to work is not immediate, usually after the pain has resolved in one week. You will be mildly sore for the next two weeks and the sutures will continue to bother you until they dissolve. The procedure involves a local anesthesia of the penis (Xylocaine and Marcaine) around the base of the shaft and possibly just over the midline pubic bone. One may require a separate injection of the frenulum, which is near the head of the penis. We perform a standard sleeve resection rather than the guillotine procedure. Multiple dissolvable sutures are used to close the incision site; a compressive dressing is placed for 24 hours. Narcotic pain medication is required. Pre-Operative Instructions Before your surgery, you will be seen by the physician and the anesthesiologist, and when applicable, there is a pre-admission appointment with the hospital. Click here to read more details about these appointments, referred to as the Pre-Operative Work-Up. Change In Health Status Notify your surgeon if you experience any significant change in your health status: develop a cold, influenza, a bladder infection, diarrhea, or other infection, before your surgery. Pre-Operative Medication Instructions Unless specifically instructed otherwise by your surgeon or anesthesiologist, please observe the following guidelines for taking your medicines before surgery: One Week Prior to Surgery STOP all aspirin and all aspirin-containing medicines (e.g., Anacin, Excedrin, Pepto-Bismol). Check any cold or pain medication bottles to make certain aspirin is not contained. See additional list at Blood Thinners. Two Days Prior to Surgery STOP all nonsteroidal anti-inflammatory medications (e.g., etodolac [Lodine], fenoprofen [Nalfon], ibuprofen [Advil, Motrin, Nuprin], ketorolac [Toradol], maproxen [Aleve], meclofenarnate [Meclomen], mefenamic acid [Ponstel], naproxen [Anaprox, Naprosyn]. Day Before Your Surgery Normally this is when you would start the pre-operative Bowel Preparation appropriate for this surgery. As this procedure is not close to the bowel and injury is extremely unlikely, there is no bowel prep required for the procedure. On the Morning of your Surgery DO NOT TAKE digitalis medicines (e.g., Crystodigin, Digoxin, Lanoxin).  DO NOT TAKE oral antidiabetes medicines (e.g., chlorpropamide [Diabinese], glyburide [DiaBeta, Glynase, Micronase], glypizide [Glucotrol], tolazamide [Tolinase], tolbutamide [Orinase].  DO TAKE one-half of your usual morning. INSULIN dose. DO NOT TAKE your morning INSULIN dose if you are driving a great distance the morning of surgery or if your surgery is scheduled for the afternoon.  DO TAKE, with a small sip of water, ALL of your other usual morning doses of regularly prescribed medicines. Use your asthma inhalers and bring them with you to the hospital. Pre-Operative Diet Instructions Unless specifically instructed otherwise by your surgeon or anesthesiologist, patients of all ages must observe the following diet restrictions before surgery: Eight hours before the Scheduled Start of your Surgery DO NOT EAT any solid foods, including juices with pulp (e.g., orange juice, nectars), lozenges, candy, chewing gum, and mints. DO NOT DRINK full liquid, such as milk, cream, and jello. You may continue to drink up to eight ounces of clear liquids until SIX hours before the scheduled start of your surgery. Clear liquids include Water, clear juices (e.g., apple, grape), black tea and black coffee. Six hours before the Scheduled Start of your Surgery DO NOT TAKE anything by mouth except for your usual medicines; follow the Preoperative medication instructions above. DO NOT TAKE anything by mouth for eight hours, except for your usual medicines, if you are pregnant, morbidly obese, or are diagnosed with diabetes, renal failure, or stomach acid reflux with heartburn. Patients undergoing operative or diagnostic procedures involving sedation are required to refrain from eating, drinking or taking anything by mouth for a stated period prior to their surgery or procedure. The reason for this is to prevent complications caused by nausea or vomiting while you are unconscious. Should you vomit while in the unconscious state, the risk exists that the vomit may enter into your lungs causing serious complications such as pneumonia. These complications may result in an extension of your hospitalization following your surgical procedure. It is for this reason patients are often instructed to have nothing by mouth after midnight the night prior to your operation unless otherwise instructed by an anesthetist. Pre-Operative Cleaning Instructions (bathing and showering instructions) Pre-operative showers are to be taken the night before and the morning of surgery just prior to your arrival. All adults are required to take a shower using either a Betadine or Hibiclens Surgical Scrub antibacterial soap. The reason is to remove as much bacteria from your skin as possible prior to your surgery. If you are allergic to these products please notify your physician or nurse. Perform your shower as follows: Generously lather your body, scrub well, and rinse. Give particular attention to the area were the incision will be made for your procedure. Following the morning shower, do not apply creams, body oils, lotions, perfumes, deodorants, makeup, lipstick, nail polish or any other cosmetic product to the skin or nails. Do not use Hibiclens on your face. You may use any other antibacterial soap for the face. Children under 5 years of age are to be given a bath using an over the counter antibacterial soap. On The Day Of Surgery Take your medicines as instructed above. You may brush your teeth; rinse your mouth, but do not swallow the water. Leave all jewelry (including wedding and all other rings) and valuables (including money and credit cards) at home. If you wear contact lenses, glasses or hearing aids, please bring a case or container, and solution for contacts, to protect them while you are in surgery. Wear a minimum amount of makeup, and no mascara. Please remove the nail polish from both index fingers. Please bring a copy of your current medical problem list from you primary care physician (family medicine/internist). Minors (anyone less than 18 years old) must be accompanied by a parent or legal guardian to sign the operative consent fount The anesthesiologist will discuss with you the anesthetic most appropriate for your medical condition and procedure prior to surgery. After your surgery you must be escorted/driven home by a responsible adult. You may take a taxi car or shuttle if accompanied by a responsible adult who can stay with you after the driver departs. Time To Arrive For Your Surgery During your Pre-Admission Interview, our Registered Nurse will provide you with the correct time to arrive for check-in prior to your surgery. Risks and Complications The risks and complications for this surgery are described in the "Counseling and Pre-Op Note" that you will need to sign before the surgery. The main content of that note is listed below. Indications Patient is a male patient with redundant prepuce/phimosis/ genital warts who desires circumcision. Alternatives To include watchful waiting and dorsal slit have been discussed. Risks/Complications These include but are not limited to: hemorrhage, pain, wound infection/ dehiscence, removal of to little skin, removal of to much skin, and meatal stenosis. In addition the seriousness of the patient's medical problems have been discussed in depth. The risks of myocardial infarction, heart failure, stroke, death and long-term stay in the Intensive Care Unit (ICU) have been raised with you. Additionally, mentioned were the possible serious complications of the anesthesia to include cracked teeth, airway damage, aspiration, pneumonia, spinal headache, nerve damage, spinal canal bleeding, infection and death. Your anesthesiologist will discuss the risks and complications in more depth separately. Additional procedures may be necessary. You understand the procedure as discussed, and agree to proceed with the procedure Family Waiting Instructions To the family and friends of patients undergoing surgery. You should plan to check in at the waiting area information desk as soon as your family member or friend has left for the Operating Room. This is the only way we can talk to you afterwards, or on occasion; reach you to give you updates on the operation's progress. If the surgery is scheduled for many hours, you can leave to eat or do other things, but you should let the information desk know that you are going to leave the area, where you are going, and how long you might be gone so that we might reach you if need be. You should be in the area before the elected time of the end of the operation. The information deck will overhead page you or the "family of" when they receive the recovery call to let you know that the surgery has been completed. The overhead page system works ONLY on the Surgical Waiting Area and not throughout the hospital or the cafeteria. We will plan to see you in the surgical waiting area after we have safely completed the early phases of the post-anesthesia recovery in the "Recovery Room" or PAR (Post Anesthesia Recovery). This may take up to an hour after the initial call. Sometimes, especially if another case is ready to start, we will call and talk to you. If for some reason, we have not come or called within 30 minutes, please ask the information desk to page us. Your family member will be in the Recovery Room for 1-2 hours. This is standard recovery time, although the times vary with each individual. For example, spinal anesthetics take longer to "wear off," local anesthetics are much shorter acting. Under no circumstances are family members or friends allowed in the recovery room. The information deck will inform you of the patient's return to the room as soon as they receive the information that the patient has left recovery. At that time, they will give you the room number and direct you to the correct wing and floor. Post-Operative Instructions Your operation was performed in an attempt to prevent recurrent infection, irritation of the foreskin, or urinary tract infections. GENERAL INSTRUCTIONS Your child may shower 48 hours after the surgery once the bandages have been removed. Your sutures will dissolve over time and do not need to be removed. Pat dry your area of incision, rather than rubbing it. You may swim or take a tub bath 1-week after surgery. Do not lift greater than 10 pounds for 2-weeks. Your child should be able to resume exercise and full un-restricted activity 2-weeks following the surgery. If discomfort returns then reduce activity, take it easy, and more gradually resume activities. Expect some spotting or bleeding from your incision for the next 1-week, if it progressively worsens then please call your physician. If your child experiences fever or chills, take a temperature during the episode with an oral thermometer, if it is greater than 100.8 F, then please call your physician. If you notice pus coming from any wound, please call your physician. In case of an emergency, please go to your nearest emergency room for evaluation. SPECIFIC INSTRUCTIONS Wear light fitting clothing (such as diapers, boxers, gym shorts, or sweat pants) for the next two weeks or until the suture material dissolves. This will decrease your discomfort with activity. It may soothe the pain if you use Bacitracin ointment (over the counter preparation found at any local pharmacy) on the incision 3-times per day. FOLLOW-UP INSTRUCTIONS Please call the office to schedule a wound check approximately 7-10 days after the surgery.