Structural reasons to postpone newborn circumcision

May 18, 2016 Beth Andersen, MD, FAAP

For parents who wish to circumcise their sons shortly after birth, there may occasionally be structural or anatomic reasons to defer the procedure.
Sometimes children are born with a genital anomaly that should be addressed before proceeding with circumcision. In these cases, parents often consult with a pediatric urologist, a surgeon who has specialized training to perform corrective surgery on infants and older children with genital problems. As a pediatric urologist, I often see these families to help them sort out their options.
The most common structural reason to avoid newborn circumcision is a lack of adequate skin length between the scrotum and the head of the penis. This may be related to buried penis anatomy, or scrotal tethering.  In these situations, the penis itself is normal, but the skin and scrotum are attached incorrectly. This increases the risk of removing too much skin during newborn circumcision and the chances for complications.
There also are conditions where the penile shaft itself may be curved or twisted, or where the urine opening is positioned below the head of the penis on the penile shaft. Surgery may be needed in these cases to improve penile function.
Deferring newborn circumcision in all of these cases is best to avoid complications and optimize later corrective surgery.

When is corrective surgery performed?

Corrective surgery can be combined with circumcision and is usually performed through the circumcision line itself. These techniques require pediatric general anesthesia and are performed as a brief day surgery when the child is between 6 and 18 months old.

The recommendation to wait at least 6 months comes from knowledge that pediatric anesthesia is safer when the child is no longer a newborn.  Another consideration is that children younger than 18 months tolerate corrective surgery very well and usually recover quickly.

Pediatric same-day surgery

 It’s a big decision to go forward with surgery for your child. The good news is that pediatric surgery can be performed very safely. Anesthesia performed by pediatric anesthesiologists who have specialized training to work with infants and young children minimizes risks.
For anesthetic safety, your caregiver will give you specific instructions for food and fluids the night before your son’s surgery.  These recommendations need to be strictly followed, but I have found that almost all babies and young children remain in good spirits before their operation.
On the day of surgery, you will meet with the pediatric anesthesiologist and the urologic surgeon. At Swedish, there is also a child-life specialist, who will work with your child to ease concerns and guide the family through the operative process. Here’s a complete guide to preparing for surgery.
At Swedish, parents are allowed to be with their child in the recovery room after the child awakens from anesthesia. They remain with their child until discharge later in the day.
At home, recovery varies depending on the surgery, but it usually involves applying ointment and using oral liquid pain medicines such as ibuprofen or Tylenol (or stronger pain medicine if the child is older, and if it is needed). 
A child’s recovery is usually uneventful. And when fully healed, the result looks the same as a newborn circumcision.

Pediatric Urology Consultation

If you face a decision about deferring circumcision, talk with your provider. When I meet with parents, we discuss options regarding the specifics of the child’s anatomy, the benefits and risks of proceeding with surgery, the appropriate timing of the procedure and the potential to avoid surgery or circumcision altogether.  
If you have questions or would like to schedule a consultation with a pediatric urologist, call 206-215-3137 or 206-215-2700, or visit Swedish Pediatric Urology online.

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