Child Circumcision

There are several reasons why a child may need to be circumcised. Among other things, it can be due to medical reasons, such as a phimosis (where the foreskin is sealed to the penis glans which prevents it from retracting properly). A foreskin that is not dilated is not necessarily a reason to resort to circumcision since this problem usually corrects itself over time. There are other non-medical reasons such as cultural, religious and personal beliefs.

At Les Cliniques Marois, a child circumcision is preceded by an initial consultation and evaluation. During this consultation, a short questionnaire is administered, a physical examination is performed and all the different techniques are explained to the parents. The circumcision process is mostly difficult in children from ages two to five, as they are often agitated for the surgery. If it is difficult to control or medically required, it is possible to have it done in a hospital under general anesthesia. If it is not medically required, then it is best to wait at least a year to re-evaluate the child to determine if he has reached the level of maturity required for circumcision under local anesthesia.

Afterwards, the circumcision is performed either during the same appointment or a second one. So, it is often possible to have the evaluation and circumcision done in one single appointment; however, the examination must be normal and the child has to be mature enough to collaborate and listen to the instructions. Also, the child must not have blood clotting disorders.

What are the possible techniques for a child circumcision?

There are two possible techniques, both using a local anesthetic: the standard technique with sutures and the Plastibell™ technique.

The Plastibell™ technique has been used for several years in Europe and especially in several circumcision clinics in the UK. This procedure is not well known in Quebec. It is currently used for newborns and infants. Plastibell™ consists of a clear plastic ring with a handle that detaches at the end of the circumcision. This very safe technique causes less bleeding and there is no need for stitches, since the glans is protected by the ring during the procedure. The ring loosens progressively 7 to 10 days after. The risk of the ring (which doesn't loosen spontaneously) getting stuck is very low, but it is higher among infants since they may experience more swelling. The patient will be required to return to the clinic for the cord to be cut and for the ring to be removed manually. This technique is especially performed on children who are more anxious and more difficult to collaborate with, since it is a quicker procedure. We use rings with larger Plastibell™ diameters in children whose penises are not yet developed. Quick and easy, this method is performed under local anesthetic. No bandage is required.

The standard technique requiring stitches takes longer and is essentially the same as for adults. There is also a bandage to be changed every day for the first week. The risk of bleeding is low, but occurs more frequently than with the Plastibell™ technique.

What Is the procedure?

First, one of the two parents may be present during the intervention, if he or she desires. To facilitate the child’s collaboration, a narcotic syrup and a low-dose Ativan can be administered an hour before the surgery.

There are several steps to this procedure. First, we apply an anesthetic cream on the penis for about 10 minutes. We then proceed to the penile bloc 10 minutes before the circumcision by infiltrating a local anesthetic adapted to the weight of the child at the base of the penis.

The child is placed on his back.

For a Plastibell™ circumcision, the appropriate sized ring is introduced and placed on the head of the penis using the detachable handle after the incision of the foreskin and its retraction. Then, we proceed to the circumferential ligation of the foreskin with a ligature around the groove of the ring. After this, we trim the excess skin protruding beyond the ring. The ring should fall off on its own 10 to 14 days after the procedure. The residual foreskin will be white or sometimes black like the umbilical cord after birth. Schedule an appointment if the ring has not yet fallen off after 10 days.

For a standard circumcision, the skin is excised using a scalpel. Bleeding is controlled using electrocautery. The excess mucosa is also incised using a scalpel and excised using electrocautery. Finally, there is an aesthetic wound closure. It can be performed with continuous absorbable sutures. This technique leaves less scar marking than with the use of separated sutures which are often used.

A compression bandage is applied around the circumference of the penis.

We schedule an appointment for two (2) months later.

What are the possible risks and complications?

The risk of infection is very low.
The risk of bleeding is low with the Plastibell ring, but a little higher after circumcision with a clamp. It is usually easily controlled by a compression bandage.
The risk of imprisonment of the ring (which would not come off spontaneously) is low, but higher than in children since it may have more swelling. You must then return to the clinic to cut the cord and remove the ring manually.

Preparation for a child circumcision

Recommendations after a child circumcision

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Dr. Marois is a urologist who is not a member of the Régie d’Assurance Maladie du Québec (RAMQ). As such, the clinic can not claim the RAMQ for the payment of his services. If you consult Dr Marois, you must pay for the services rendered.

Cancellation of appointment:

To ensure the smooth running of the clinic and a minimum of courtesy towards other patients and our staff, we ask you to notify us 48 hours in advance for the cancellation of a consultation, 5 working days in advance for a surgery at the office and 21 working days in advance for a major surgery. If these deadlines are not respected, a cancellation fee of 50% of the service will be charged.

Change of appointment:

We understand that events occur, so we ask you to provide us with at least a 24-hour notice for any change in their appointment; we will be happy to accommodate you, the best we can. However, if you fail to inform us within this timeframe or do not show up, we will charge a $ 100 fee.

Thank you for your understanding.

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Dr. Marois is a urologist who is not a member of the Régie de l’Assurance Maladie du Québec (RAMQ). As such, if you require his professional services, you will have to pay directly the Cliniques Marois for the services rendered.

Cancellation Policy:

To ensure the smooth running of the clinics aa well as a minimum of courtesy towards other patients and staff members, we ask you to notify us 48 hours in advance for cancelling an appointment, 5 working days for cancelling a minor surgery in the office and 21 working days for major surgery at the CMC. If these deadlines are not respected, a cancellation fee of 50% of the service will be charged.

Change of appointment:

We understand that events occur and schedules change, so we ask patients to give us at least a 24-hour notice for any changes of appointment. We will be happy to reschedule another one for you. Failure to provide such notice within this timeframe will result in a $ 100 fee.

Thank you for your understanding.

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