CIRCUMCISION - HOW DO UROLOGISTS DO IT

Objective To determine the range of surgical techniques, analgesic pra ctice, post-operative care and follow-up procedures used in the circum cision of children by urologists in the United Kingdom, and to suggest changes which would improve patient care and medical training in the relatively simple procedure of circumcision. Materials and methods In 1994, all consultant urologists in the United Kingdom were sent detail ed questionnaires asking about their practices in the circumcision of children. Results of 308 urologists, 61% replied; of these, 55% use th e sleeve-resection technique and 39% the free-hand method, and 57% use diathermy, half of which is bipolar. There is wide variation in the t ype of post-operative analgesia; 95% use an initial dressing but few r ecommend any subsequent dressing, 70% perform all circumcisions as day cases and 48% review patients in the clinic. There is significant con cern that circumcision is not taught adequately to junior surgeons. Co nclusion The sleeve technique of resection should be more widely used. Analgesic practice could be improved with greater use of regional ana esthetics. Most urologists promote no specific care after discharge. T here is probably a place for increasing the use of alternative procedu res to circumcision.