Babies from 1 week to 12 months: Plastibell (Ring) technique
We use the Plastibell ring for circumcision in infants. The Plastibell technique is one of the commonest methods used in babies all over the world. It was invented in 1950 and has continued to have a major role in children circumcision whilst many other techniques have come and gone.
The Plastibell is one of the methods for paediatric circumcision described by the World Health Organisation (WHO) in its Manual for Male Circumcision under Local Anaesthesia.
Steps involved in the Plastibell circumcision
1. After thorough consultation, we apply local anaesthesia by means of injection at the base of the penis. For chubby babies (see below), we may decide not to proceed after consultation and in this case a consultation fee of £30 will be charged.
2. We wait for some few minutes and confirm the anaesthesia has taken effect, that is the foreskin is numb.
3. An incision is made along the length of the foreskin just enough to allow the ring to be placed on the head (glans) of the penis.
4. (Optional) Part of the frenulum (the band that attaches the inner foreskin to the underside of the penis) may need to be removed to allow the proper placement of the ring.
5. The Plastibell ring is placed on the head of the penis.
6. A ligature (string) is tied over the ring, the foreskin is removed and dressing applied.
7. Within 10 days the string, ring and the foreskin separate and the circumcision is complete. In about 1 in 25 babies the ring may need to be removed in the clinic.
IMPORTANT INFORMATION – PLEASE READ CAREFULLY
CHUBBY BABY & CIRCUMCISION
High standards of living in our part of the world has meant many babies are chubby. This also means these babies have a lot of ’puppy’ fat in their groin area which often projects forward to cover their penis.
This ‘puppy’ fat makes the penis look like it is ‘buried’ and circumcision in this condition can be quite tasking.
Why is it important for us to talk about this?
As a clinic, our aim is to provide a honest, professional opinion and because we receive clients from all over the UK and Republic of Ireland (by recommendation we have had clients from Holland and Germany!) it is important that parents/guardians have adequate information so they can decide the best time for their chubby baby to have circumcision.
As professionals we have had situations where we ask parents to postpone the circumcision because we do not think it is the right time for this. Whilst the parents/guardians do appreciate our professional advice, explanation and putting the interest of their babies first, we have always felt there is more we can do so families can avoid making an initial journey (for example, from Scotland) to the clinic and now be told to defer the procedure for a while.
What are the risks in circumcising a chubby baby?
With most chubby babies circumcision will be uneventful. However, with very chubby babies there are some possible risks.
Firstly, it may be difficult to properly assess the amount of foreskin to remove and this may lead to excessive or inadequate foreskin removal.
Secondly, because the groin fat is covering (‘hiding ‘) the penis the healed circumcision may form a scar in front of the penis and lead to a ‘trapped’ penis.
Thirdly, our experience is that cleaning and maintaining hygiene during healing can be tasking in chubby babies.
Lastly, we have observed that ‘bridging’ (where a part of the circumcision scar becomes adherent to the head of the penis) may have a higher incidence in these babies.
Does this mean a chubby baby can not be circumcised?
No. Chubby babies can be circumcised but timing is the important factor. With mild ‘chubbiness’ circumcision may be possible at any time but for quite chubby babies we advise that circumcision be delayed until when the puppy fat goes down. This usually happens when your child becomes a toddler, that is starts to walk.
Although it is true that the earlier the circumcision is done the better, we also take the view is that since circumcision is not an emergency operation, it should therefore be done at an optimal time with regards to each baby’s circumstance.
What should I do as a parent – how can I know if my chubby baby is fit for circumcision?
This is a question a lot of parents ask us. Also, some parents have come from faraway (and spent money on tickets, fuel, hotel, etc) and then be advised to defer circumcision. This is the reason why, as a clinic, we feel it is very important that parents are aware and not incur unnecessary travel costs.
Below are suggestions on what you may do to determine if your chubby baby can have circumcision now or later:
1. See your GP. Your GP will be able to tell you if your baby’s groin fat is burying the penis at the moment. If this is the case, then it is best to postpone circumcising your baby.
2. Examine your baby. This should be done at rest, that is when your baby is not passing urine or you are not stretching the skin of the penis. As a rule of thumb, if the outline of the head of the penis (glans) cannot be separately identified away from the groin fat then it is very likely that the groin fat is burying the penis and we would advise postponing circumcision.
3. Have a remote consultation with us. Having considered the cost incurred by parents to come to the clinic we have come to the conclusion that offering a remote consultation in the first instance would be beneficial by saving time and money. We are able to offer consultation on Skype™ and the fee is £30. Please note that this consultation is optional and does not go towards the cost of the procedure itself. It is a fee for the time the doctor has spent in providing advice.
Please note that the advice above on chubby babies is the personal opinion of Dr Boye based on his experience and observation after doing over 1500 circumcisions. It reflects the policy of the clinic although we are aware that other practitioners may differ in their practice.