Circumcision
Newborn routine circumcision is considered by the American Academy of Pediatrics and us to be a surgical procedure whose medical benefits outweigh the medical risks. We consider this to be an elective surgery. You do not have to have your baby circumcised. Your non-medical reasons for not having a circumcision easily outweigh the medical benefit. It's really up to you!
Circumcision decreases the transmission of HIV, herpes, and human papilloma virus. It decreases the chance of penile cancer (an uncommon cancer). Circumcision decreases the chances of urinary tract infections. Circumcision is a surgical procedure with all the attendant risks-bleeding, infection, damage to the penis, etc. While we have never seen it, could you die from an allergic reaction to the local anesthetic or to the procedure itself? Anything could happen. There is a chance that after the procedure the foreskin will re-cover the head of the penis. That would necessitate another circumcision under general anesthesia if you still desire to have a penis which looks circumcised. There is a chance that the penis will appear sucked in/buried/hidden after the circumcision. This would necessitate a surgical procedure under general anesthesia if you want the penis to not look sucked in/buried/hidden. Having said all that, we are happy to circumcise your baby if you want us to do so and we do feel that it is a very safe surgical procedure.
Dr. Oshiro has been performing circumcisions since 1995. He first learned how to do circumcisions using the Gomco clamp method. When he moved to Las Vegas, he started performing circumcisions using the PlastiBell method. He is happy to let you watch the procedure. One family has even video taped it! You must remain seated while watching him perform the procedure.
Our favorite time to schedule a circumcision is at 10-16 days of age. If your religion requires that a circumcision be done at a certain age, let us know and we will attempt to accommodate you. We will perform circumcisions at any time from 0-30 days of age depending on our schedule. Feed your baby 30-60 minutes before your appointment time. We do not want the baby to have a full stomach before the procedure. The circumcision procedure itself takes about 10-15 minutes. If you include set up, cleaning, and the application of local anesthetic, the total procedure time is about 25 minutes.
HOW THE CIRCUMCISION IS PERFORMED AT OSHIRO PEDIATRICS:
Your baby is placed on a specially designed board so he will not move much during the procedure. The area is sterilized with betadine. Approximately one ml of 1% lidocaine is injected around the base of the penis. This is a local anesthetic method called the ring block. One of our staff (or the parent if he/she wishes) will comfort the baby. This often involves the baby sucking on a gauze dipped in water. Adhesions between the foreskin and the head of the penis are lysed. A clamp is tightly clipped to the foreskin and then removed. This area is cut with scissors. The PlastiBell (a small plastic device) is placed on the top of the penis with the foreskin around the PlastiBell. A string is tied around the foreskin. The foreskin is cut off with scissors. The top of the PlastiBell is removed. The bottom of the PlastiBell, which is a ring, is left at tip of the penis. We want you to feed your baby immediately after the procedure. We will keep you in the office for fifteen minutes after the circumcision for observation. The ring will fall off in 0-10 days. When you change the diaper, just briefly clean the ring with the diaper wipe. You can apply vaseline or neosporin to the ring during the first 24 hours if you would like. It is optional. If the ring slips down the shaft of the penis and you can not slip it back to the tip, you should have a health care provider see your son immediately. You can give your child a bath. Just do not submerge the penis underneath the water. If your child has pain, you may give acetaminophen (tylenol). If your child is 9-11 pounds, the dosage of acetaminophen (160mg/5ml) is 2ml. HOWEVER, IF YOUR CHILD HAS FEVER AT THIS AGE, YOU SHOULD GO TO THE EMERGENCY ROOM!
Almost all insurances cover newborn circumcision. If you have a high deductible insurance plan, circumcision will probably count towards your deductible. Straight medicaid (Magellan) now covers circumcision. If your insurance does not cover the circumcision, we charge $250. We will check with your insurance company before performing a circumcision, but we strongly recommend (as with anything we do), that you contact your insurance company to see what they cover. Sometimes insurance companies give us incorrect information. If your insurance company gives us incorrect information, you will have to pay the cost of the circumcision yourself.
This is what it will look like after we are done with the circumcision, but before the ring falls off: