Specialist Referral for Adult Circumcision
A 56-year-old male seeking circumcision should consult a urologist, as urologists are the surgical specialists trained in penile procedures and can properly evaluate for underlying medical conditions that may necessitate the procedure. 1, 2
Primary Specialist: Urology
Urologists are the appropriate specialists for adult male circumcision, as they have specific training in penile surgical techniques, management of complications, and evaluation of underlying genitourinary conditions. 1, 3
Urologists can assess for medical indications including phimosis, paraphimosis, recurrent balanitis, lichen sclerosus (balanitis xerotica obliterans), or concerns for penile malignancy that may warrant circumcision. 1, 2, 3
Critical Pre-Procedure Evaluation
Given the patient's age and potential comorbidities, the urologist must evaluate:
Diabetes status: Undiagnosed diabetes is present in 10.9% of men with candidal balanitis, and diabetic patients have compromised wound healing and higher infection risk. 2
Cardiovascular disease and hypertension: These conditions affect surgical risk and anesthetic considerations for the procedure. 1
Any lesions requiring biopsy: Pigmented, indurated, fixed, or ulcerated lesions must be biopsied before circumcision to exclude penile intraepithelial neoplasia or squamous cell carcinoma. 1, 2
Why Not Other Specialists
General practitioners or non-urological surgeons have higher complication rates when performing circumcisions compared to trained urologists, regardless of provider type. 4, 5, 6
While some general surgeons may perform circumcision, urologists have specific expertise in managing penile anatomy, potential complications (bleeding from subcutaneous veins, poor cosmetic results, sensation changes), and post-operative genitourinary function. 5, 3
Important Caveats
All removed tissue must be sent for histological examination to confirm diagnosis and exclude occult malignancy, particularly if there is any suspicion of lichen sclerosus. 1, 2
The procedure requires adequate anesthesia (dorsal penile nerve block with or without circumferential block), sterile technique, and proper training to minimize complications. 4, 3
Follow-up at 3 months post-circumcision is essential to assess wound healing, urinary function, sexual function, and examine for residual disease. 7, 8