Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.
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The diagnostic phase for circumcision at Liv Hospital is a rigorous process designed to ensure patient safety, identify the specific anatomical indication, and rule out any contraindications that would render the surgery unsafe. Unlike internal organ surgeries that require complex imaging, the diagnosis for circumcision is primarily clinical, relying on visual inspection and physical palpation. However, the simplicity of the examination belies the importance of the decision-making process. The urologist must differentiate between physiological conditions that will resolve on their own and pathological conditions that require surgical intervention. Furthermore, systemic health parameters must be evaluated to prevent peri-operative complications such as bleeding or infection.
The assessment begins with a detailed medical history. The clinician investigates the duration of symptoms, the frequency of infections, the presence of comorbidities like diabetes, and any history of bleeding disorders in the family. This holistic approach ensures that the procedure is tailored to the patient’s specific physiological profile.
The cornerstone of diagnosis is the physical examination. The urologist assesses the penis in both flaccid and, if possible or necessary via patient history, simulated erect states to understand the elasticity of the skin.
While imaging is rarely needed, laboratory tests are essential for pre-operative safety, particularly in adults or children with a medical history.
In cases where the appearance of the foreskin is atypical—such as ulcerative lesions, vegetative growths, or persistent red patches (Erythroplasia of Queyrat)—a diagnostic biopsy may be performed prior to or during the circumcision. This is to rule out penile carcinoma or carcinoma in situ. The removed foreskin is almost always sent for histopathological examination as a standard of care to confirm the benign nature of the tissue and document specific pathologies like BXO.
For children or adults requiring general anesthesia, an assessment by an anesthesiologist is part of the diagnostic workflow. This involves evaluating airway patency, lung function, and cardiovascular health to assign an ASA (American Society of Anesthesiologists) physical status classification. This ensures that the risk of anesthesia does not outweigh the benefit of the procedure.
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The most critical condition to rule out is hypospadias. This is a congenital defect where the urinary opening is not at the tip of the penis. In these cases, the foreskin is essential medical tissue used to surgically reconstruct the urinary channel (urethra) later in life. Removing the foreskin in a child with hypospadias can compromise future reconstructive options.
The penis has a very robust blood supply. Even though circumcision is a surface procedure, unexpected bleeding can lead to hematomas (blood clots) or excessive blood loss. Screening for clotting disorders like hemophilia ensures that the medical team can take necessary precautions or administer clotting factors to prevent complications, especially in infants where blood volume is low.
Doctors look for the presence of a “phimotic ring.” In pathological phimosis, the tip of the foreskin often has a white, scarred, fibrous appearance that feels rigid and does not stretch. In physiological (normal) tightness, the skin is soft, healthy, and pink, but simply adhered to the glans due to natural developmental stages.
Generally, no. If there is an active bacterial infection (cellulitis) or severe infected balanitis with pus, the surgery is typically postponed. Operating on infected tissue can spread the bacteria into the bloodstream or deeper tissues, causing wound breakdown. The infection is usually treated with antibiotics or antifungals first to sterilize the field before surgery.
A buried penis occurs when the penile shaft is hidden below the surface of the pubic fat, making it look very small. It is crucial to diagnose this pre-operatively because standard circumcision techniques can be dangerous in these cases. If cut normally, the penis can retract inside the healing skin, becoming trapped. Specialized surgical techniques are required to safely circumcise a buried penis.
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