Circumcision performed in the first 28 days after birth is called ‘newborn circumcision’. Circumcisions performed after the first 28 days are not newborn circumcision, but are defined as circumcision performed only with local anesthesia. Making suggestions to families about newborn circumcision, Op. Dr. Tural Abdullayev stated that the ideal time for newborn circumcision is 7-15 days after waiting for the baby’s kidney and liver functions to mature and birth stress to decrease.
Any healthy baby over 3 kilos can be circumcised.
Noting that since colic attacks start after the 2nd week in babies, performing newborn circumcision before the 2nd week will be beneficial both for the recovery of the baby and for the surgeon to work more efficiently and more carefully. Dr. Tural Abdullayev said, “Due to the rapid motor development, the baby’s mobility is increasing day by day. Therefore, circumcision becomes more difficult after the first month. The fact that babies need to hold their hands and feet because they are very mobile during the procedure, and that many of them cry and protest this process because their hands and feet are held before the circumcision begins, make it difficult for the surgeon.
Pediatric Surgeon Op. Dr. Tural Abdullayev suggested that newborn circumcision should be performed within the specified time and time, stating that any healthy baby born over 3 kg and without any additional medical problems can be circumcised.
Circumcision should not be performed as soon as you leave the hospital.
Emphasizing that no matter what surgery is performed, it is necessary to always follow the basic surgical rules, Op. Dr. Tural Abdullayev made the following warnings;
“Some families demand circumcision before leaving the hospital, but I do not recommend this situation. The biggest obstacle we face here is that your baby is vaccinated the day he is born. As you know, the first dose of hepatitis B vaccine should be given as soon as babies are born. Normally, we surgeons wait at least 7-10 days after vaccination. Why should we do circumcision right away without getting vaccinated? Isn’t circumcision an operation too? Performing surgery in the days immediately after vaccination may cause us to encounter two different problems. The first is that the vaccine does not work, does not create sufficient immunity. Causes such as pain during and after the surgery, elevated blood sugar, cold in the operating room, and surgical tissue damage will suppress the immune system and prevent the formation of sufficient immune cells against the vaccine. Another problem is the risk of mixing the side effects of the vaccine with the side effects of the surgery and not being able to differentiate them.”
Bleeding and infection risk is low in newborn circumcision
Referring to the benefits of neonatal circumcision, which is becoming widespread today, Pediatric Surgery Specialist Op. Dr. Tural Abdullayev pointed out that one of the biggest advantages is that it can be done with local anesthesia without the need for general anesthesia and continued as follows;
“With circumcision performed in the newborn period, the psychological trauma caused by the procedure performed at later ages is prevented. Since wound healing is rapid in the newborn period, problems (such as swelling, edema, abnormalities in tissue union) are almost never seen during the healing period and the risk of infection is reduced. The risk of bleeding is very low due to the fact that newborns are generally immobile, their genital areas are less exposed to trauma and the diameter of the penile vessels is small. The need for post-procedure painkillers is almost non-existent or so low that they only need to be used on the first day.”
Mentioning the situations in which circumcision should and should not be done medically, Pediatric Surgery Specialist Op. Dr. Tural Abdullayev also warned families about circumcision issues.
Phimosis (Foreskin tip is narrow and closed to prevent urine flow)
•Recurrent foreskin inflammation (Balanitis) and inflammation of the foreskin with the head of the penis (balanoposthitis)
• “Epstein pearls” of the foreskin (smegma (white-cheese deposits) just in front of the preputial opening, preventing urine flow
Cysts of the foreskin (Epidermoid cysts)
• Hydronephrosis (Kidney enlargement) condition: Circumcision does not prevent kidney enlargement, but it has been scientifically proven to reduce urinary tract infections.
Recurrent urinary tract infections
Conditions that prevent circumcision
• Premature babies should not be circumcised. They are in a constant state of straining and the gas problem starts earlier because the intestinal development is not completed.
•Low birth weight babies
Babies with frequent vomiting due to gastroesophageal reflux, pylorospasm or metabolic causes cannot be circumcised. Stress caused by surgical intervention can trigger pain and vomiting. During the procedure, the baby may vomit, causing the vomit to escape into the lungs. If the vomiting intervals are not frequent, surgical procedure can be performed by taking precautions.
• Circumcision is not performed for infants with infantile colic. It is the main problem that hinders newborn circumcision. Colic babies are babies who are constantly experiencing gas distress, and it is more appropriate to circumcise such babies under anesthesia in the future, as they do not sit comfortably on the operating table and have crying fits for no reason before the circumcision starts.
Babies who are sensitive to local anesthetic
• Some blood diseases (Von Willebrand disease, hemophilia, etc.) progressing with non-stop bleeding or having a family history of diseases with bleeding
Non-physiological jaundice requiring radiation therapy
•Second and third degree webbed penis
Small penis size
• Penile axis anomalies (penile torsion) and penile curvature (curvature). If the urine flow is to the right or to the left while your baby is peeing, this may be a sign of curvature.
• Hypospadias is a disease that is known as ‘prophet circumcision’ among the people, and contrary to popular belief, it is not innocent. It is characterized by the absence of the urethra. One or more surgeries may be required to correct it.
• Presence of pathologies that will require surgery in the future (during surgery due to diseases such as undescended testis, inguinal hernia, water hernia, cord cyst, simultaneous circumcision will be comfortable for both the surgery and the baby.)
Correct care after circumcision is important
Underlining that circumcision should be performed by a pediatric surgeon or a pediatric urologist in competent hands, Pediatric Surgery Specialist Op. Dr. Tural Abdullayev mentioned that newborn circumcision should not be treated like an ordinary circumcision and should be polite to the tissues, and explained the things to be considered about the circumcision process and care as follows;
“Newborn circumcision is a one-day procedure. Babies can be discharged by checking the wound site 2 hours after the circumcision. For circumcision, you do not need to have a fasting or blood test beforehand. It will be enough just to be examined by your doctor before circumcision.
A doctor’s examination is very important in terms of detecting situations that may hinder circumcision. There is no dressing around the penis after circumcision. At each diaper change, cream is applied to and around the glans penis. This process ranges from 2 days to 7 days. Since the penis is anesthetized with local anesthetic drugs before the circumcision, there is no pain for about 6 to 8 hours after the procedure. A small amount of pain may develop only on the first day after the effect of the drug wears off. These pains can be controlled with pain relief syrups or anal pain relief suppositories. The wound site heals to a great extent in 2 days. Complete healing of the wound site takes 5 to 7 days. Often, babies can take a bath after 2 days, and families can return to normal care.”