From the Guidelines
No, routine neonatal circumcision should not include frenulotomy, meatotomy, skin bridge excision, or reduction of paraphimosis. Standard neonatal circumcision involves only the removal of the foreskin. A typical neonatal circumcision procedure includes:
- Cleansing the penis
- Administering local anesthesia
- Separating the foreskin from the glans
- Removing the foreskin
- Applying dressing The additional procedures mentioned are typically only performed when specific medical indications are present, which is rare in newborns. Frenulotomy may be done for a short frenulum, meatotomy for meatal stenosis, skin bridge excision for adhesions, and paraphimosis reduction for a trapped foreskin - all of which are uncommon in neonates. Performing these additional procedures routinely would be unnecessary and could increase the risk of complications, as suggested by the British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018 1. The goal of neonatal circumcision is simply to remove the foreskin while preserving normal penile anatomy and function. More extensive interventions should be reserved for cases where they are medically indicated, such as in the management of lichen sclerosus, where circumcision may have an important role, as noted in a review of the literature and current recommendations for management 1. However, the most recent and highest quality study, the British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018 1, does not support the routine inclusion of these additional procedures in neonatal circumcision. Therefore, routine neonatal circumcision should only include the removal of the foreskin, and any additional procedures should be performed only when medically indicated, based on the latest evidence from 1.
From the Research
Neonatal Penile Circumcision Procedures
The question of whether neonatal penile circumcision should include additional procedures such as frenulotomy, meatotomy, skin bridge excision, and reduction of paraphimosis is not directly addressed in the provided studies. However, the studies do discuss the benefits and risks of neonatal circumcision and the various techniques used.
Benefits and Risks of Neonatal Circumcision
- The benefits of neonatal circumcision include a lower risk of urinary tract infections, penile cancer, and several sexually transmitted infections 2, 3, 4.
- The risks of neonatal circumcision include bleeding, injury to the penis, adhesions, excessive skin removal, phimosis, and meatal stenosis 2, 3, 4.
- The American Academy of Pediatrics and the American Academy of Family Physicians recommend continued access to circumcision on an elective basis and conclude that the benefits outweigh the risks 2, 3.
Techniques and Considerations
- There are several techniques used for neonatal circumcision, including the Gomco clamp, the Mogen clamp, and the Plastibell device 5, 3.
- The choice of technique should be guided by operator training and comfort 5.
- Physicians should present information about potential benefits and risks rather than withholding or recommending circumcision 3.
- Parents should weigh the health benefits and risks and consider their own religious, cultural, and personal preferences when making the decision 3, 4, 6.
Additional Procedures
There are no research papers provided that directly address the inclusion of frenulotomy, meatotomy, skin bridge excision, and reduction of paraphimosis in neonatal penile circumcision. Therefore, it is not possible to provide evidence-based information on these specific procedures.