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http://www.ucdenver.edu/academics/colleges/pharmacy/Departments/ClinicalPharmacy/DOCPFaculty/Q-Z/Pages/Paul-Reynolds,-PharmD.aspx
Radical perineal prostatectomy In this open operation, the surgeon makes the cut (incision) in the skin between the anus and scrotum (the perineum), as shown in the picture above. This approach is used less often because it’s more likely to lead to erection problems and because the nearby lymph nodes can’t be removed. But it is often a shorter operation and might be an option if you aren’t concerned about erections and you don’t need lymph nodes removed. It also might be used if you have other medical conditions that make retropubic surgery difficult for you. The perineal operation may result in less pain and an easier recovery than the retropubic prostatectomy. After the surgery, while you are still under anesthesia, a catheter will be put in your penis to help drain your bladder. You will be able to urinate on your own after the catheter is 8 ____________________________________________________________________________________American Cancer Society cancer. You will probably stay in the hospital for a few days after the surgery, and your activities will be limited for several weeks. The most important factors are likely to be the skill and experience of your surgeon. If you decide that laparoscopic surgery is the right treatment for you, be sure to find a surgeon with a lot of experience. One of the instruments has a small video camera on the end, which lets the surgeon see inside the body. Laparoscopic prostatectomy has some advantages over open radical prostatectomy, including less blood loss and pain, shorter hospital stays (usually no more than a day), faster recovery times, and the catheter will need to remain in the bladder for less time. Robotic-assisted laparoscopic radical prostatectomy In this approach, also known as robotic prostatectomy, the laparoscopic surgery is done using a robotic system. The surgeon sits at a control panel in the operating room and moves robotic arms to operate through several small incisions in the patient’s abdomen. Robotic prostatectomy has advantages over the open approach in terms of less pain, blood loss, and recovery time. But in terms of the side effects men are most concerned 9 ____________________________________________________________________________________American Cancer Society cancer. Still, the most important factor in the success of either type of laparoscopic surgery is the surgeon’s experience and skill. But it is also sometimes used in men with advanced prostate cancer to help relieve symptoms, such as trouble urinating. An instrument called a resectoscope is passed through the tip of the penis into the urethra to the level of the prostate. Once it is in place, either electricity is passed through a wire to heat it or a laser is used to cut or vaporize the tissue. Spinal anesthesia (which numbs the lower half of your body) or general anesthesia (where you are asleep) is used. After surgery, a catheter (thin, flexible tube) is inserted through the penis and into the bladder. You can usually leave the hospital after 1 to 2 days and return to normal activities in 1 to 2 weeks. Risks of prostate surgery the risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include: q Reactions to anesthesia q Bleeding from the surgery q Blood clots in the legs or lungs 10 ____________________________________________________________________________________American Cancer Society cancer. Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach. If lymph nodes are removed, a collection of lymph fluid (called a lymphocele) can form and may need to be drained. In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team. Side effects of prostate surgery the major possible side effects of radical prostatectomy are urinary incontinence (being unable to control urine) and erectile dysfunction (impotence; problems getting or keeping erections). Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence: q Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Prostate cancer treatments can damage this valve or the nerves that keep the valve working. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue. This happens when the bladder becomes too sensitive to stretching as it fills with urine. Large cancer centers, where prostate surgery is done often and surgeons have a lot of experience, generally report fewer problems with incontinence. To learn about managing and living with incontinence, see Bladder 5 and Bowel Incontinence. Erectile dysfunction (impotence): This means you can’t get an erection sufficient for sexual penetration. Erections are controlled by 2 tiny bundles of nerves that run on either side of the prostate. If you can have erections before surgery, the surgeon will try not to injure these nerves during the prostatectomy. But if the cancer is growing into or very close to the nerves, the surgeon will need to remove them. If both nerves are removed, you won’t be able to have spontaneous erections, but you might still be able to have erections using some of the aids described below. If the nerves on only one side are removed, you might still have erections, but the chance is lower than if neither were removed. If neither nerve bundle is removed you might have normal erections at some point after surgery. Your ability to have an erection after surgery depends on your age, your ability to get an erection before the operation, and whether the nerves were cut. All men can expect some decrease in the ability to have an erection, but the younger you are, the more likely it is that you will keep this ability. Surgeons who do many radical prostatectomies tend to report lower impotence rates than doctors who do the surgery less often. A wide range of impotency rates have been reported in the medical literature, but each man’s situation is different, so the best way to get an idea of your chances for recovering erections is to ask your doctor about his or her success rates and what the outcome is likely to be in your case. If your ability to have erections does return after surgery, it often returns slowly. During the first few months, you will probably not be able to have a spontaneous erection, so you may need to use 12 ____________________________________________________________________________________American Cancer Society cancer. Most doctors feel that regaining potency is helped along by trying to get an erection as soon as possible once the body has had a chance to heal (usually several weeks after the operation). These drugs won’t work if both nerves that control erections have been damaged or removed. Common side effects of these drugs are headache, flushing (skin becomes red and feels warm), upset stomach, light sensitivity, and runny or stuffy nose. It can be injected almost painlessly into the base of the penis 5 to 10 minutes before intercourse or placed into the tip of the penis as a suppository. You might have side effects, such as pain, dizziness, and prolonged erection, but they are not usually serious. The air is sucked out of the pump, which draws blood into the penis to produce an erection.
Mount and intromission frequencies are known as useful indices of = Rat receiving testosterone (10mg / kg) by subcutaneous injection erectile dysfunction quitting smoking buy silagra cheap. Group V = Rat receiving 400 mg / kg of the methanolic extract intromission frequency of is an indicator of the efficacy of erection impotence pumps purchase generic silagra canada, of A erectile dysfunction caused by ssri buy generic silagra 50mg line. The decrease recorded in mount and intromission latency can perceived in terms of performance (potency) [31] erectile dysfunction medicine reviews cheap silagra 100 mg amex. We have also be explained by stimulation of sexual motivation and arousal, and noticed in this study that, the methanolic extract of Alchornea may also be an indication of improved sexual behavior in treated male cordifolia leaves has supported an increase in the average interval of animals, which further supports the effect of the administered extract copulation (indicator of sexual vigor) which increased from the 1st to on sexual enhancement [23]. This would have been the consequence of a lasting administration of the low dose (200 mg / kg) of extract to sexually erection due to the presence in the extract of the metabolites that unexperienced rats leads to good performance at both mount and maintain the erection and increase the sexual motivation. Moreover, intromission level (increases frequencies and reduces latencies) when this increase in overtime could also be explained by the fact that the compared with effect observed after treatment at high dose (400 mg / animals would have acquired a sexual experience. This could be due to the extract of Alchornea cordifolia leaves could be used as a stimulator of action of the alkaloids present in the extract that have estrogenic sexual behavior of aging and unexperienced male rats. It is well known that, estrogens can induce vasodilatation could be attributed to the secondary metabolites present in the extract. In addition, saponins present in the extract have erogenous problems of the third age people. Nevertheless, further investigations properties in the vasodilatation of blood vessels and consequently can are needed to characterize the bioactive agents of these components of initiate erection [23]. Helicobacter pylori Infection and by allowing or supporting erection [22], possibly by facilitating the Reproductive Disorders. In the other hand, several lines screened aphrodisiac plant-A review of current scientific literature. Then, flavonoids and sterols of Aqueous Extract of Phoenix Dactylifera Pollen Grain on Sexual present in the extract could act by inducing changes in the level of Behavior of Male Rats. Effect of aqueous extract of Massularia modulate the action of these neurotransmitters at their target cells or acuminata stem on sexual behaviour of male Wistar rats. The evolution of sexual levels by inhibiting the cytochrome P450, enzyme aromatase dysfunction in young men aged 18-25 years. Untersuchen Zur Vegleichiendun Physiologies der [29] mannlichen geschleetsorgane insbesondere der accessorischeur vigor and endurance. Pharmacological treated at doses of 200 and 400 mg / kg when compared to negative management of erectile dysfunction. Effects of the lyophilized aqueous extract form the root 14 days when compared to negative controls. The prolongation of bark of Perianthus Longifolia miers (menispermaceae) on sexual ejaculatory latency after administration of the extract may be behaviors of normal male wistar rats and its acute toxicity. World J considered as a strong indication that the sexual function of male rats Pharm Pharmaceut Sc. Aphrodisiac studies of diherbal has been improved by prolonged coitus and suggesting aphrodisiac [12] mixture of Zanthoxylum leprieurii Guill. Global J Res Med Plants [30], substances that act on male sexual reflexes such as ejaculation are Indigen Med 2012; 1(9):381-390. Acta Pol aqueous extract of pollen grains of Phoenix dactylifera on the sexual Pharm. Combining natural reaction analogues and first derivative spectrophotometric method to enhance the visible spectra of a non-polar crude leaf extract. Wound healing and anti-infective properties of Myrianthus arboreus and Alchornea cordifolia. Isolation and identification of anti-cancer compounds from Alchornea species and their encapsulation in nanostructure drug delivery system. Aphrodisiac Effect of Ethanol’Extract of Piliostigma thonningii Leaf on Male Albino Wistar Rats. Effect ofaqueous extract of allanblackia floribunda (oliver) stem bark on sexual behaviour in adult male rats. Androgens regulate phosphodiesterase type 5 expression and functional activity in corpora cavernosa. Flavonoids-potent and’versatile biologically active compounds interacting with cytochromes P450. Chrysin, a natural flavonoid enhances steroidogenesis and steroidogenic acute regulatory protein gene expression in mouse Leydig cells. Aphrodisiac activity of the aqueous crude extract of Purple Corn (Zea mays) in Male Rats. Aphrodisiac properties of Tribulus Terrestris extract (Protodioscin) in normal and castrated rats. Effect of methanolic extract of Alchornea cordifolia leaves on the sexual behavior of senescent and sexually inexperienced rats. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior permisss sion of the publisher. Accurate indications, adverse reactions, and dosage schedules for drugs are provided in this book, but it is possible that they may change. The reader is urged to review the package information data of the manufacturers of the medications mentioned. The Publishers have made every effort to trace the copyright holders for borrowed material. If they have inadverss tently overlooked any, they will be pleased to make the necessary arrangements at the irst opportunity. The great tragedy of science : The slaying of a beautiful hypothesis by an ugly fact Thomas Huxley ( 8 5s 895) First pages. After having watched and listened to each and every one of the presentations given during the four day meeting, we are pleased to afirm that the ield of Sexual Medicine for both Men and Women is making enormous progress. This well deserved success is due to the dedication, perseverance and hard work done by the renowned experts in the ield who sellessly devote their time, intellect and energy to promoting the results and indings obtained by their studies. To successfully carry out a meeting and publication as important as this, careful preparation was necessary. Much thought and consideration went in to deciding what topics should be considered as chapters and how the meeting and eventual publication would be organized. Choosing the Chairpersons, Members and Consultants was not an easy task as the experts in these ields are many and each very distinguished. The identiication of the members of all the committees started from a very rigorous as-- sessment of the chairpersons and members of the 2003 Consultation as we clearly wanted to have on board again all those who had given a substantial contribution to that meeting and were still available to actively participate this further endeavour. In addition, a very extensive PubMed search and a thorough evaluation of the scientiic programmes of the most impor-- tant international scientiic meetings devoted to sexual medicine served to identify the names of the top experts from the ive continents. The topics that were discussed in the 2003 Consultation served as the basis to build the programme of the 2009 meeting. We considered the advances done in the ield during the last six years and we identiied all the areas which deserved to be speciically investigated by the experts of the new Consultation. In the end, we were able to produce a table of contents composed of 25 Chapters covering a vast spectrum of the critical topics concerning aspects of sexual medicine for both men and women. Although a few of those on each of our “wish lists” could not be included due to economic restraints, we were able to guarantee the participation of 186 experts to the inal program. These meetings allowed everyone to inally meet face-to-face under the same roof to streamline ideas and inal recommendations of their respective chapters. We were impressed to see the close collabo-- ration the committees had with one another to make sure that ideas were shared without overlap. The work of the various committees was indeed very hard and was witnessed by the exchange of a huge number of emails aimed at discussing the contents of the various chapters. We are very pleased to inform you that we were always able to touch with our hands the enthusiasm and passion for science shown by the chairs and members of the com-- mittees. Sometimes there were strong views which would be contrasting but at the end it was always possible to ind a general consensus and the inal editing of the chapters text was overall very smooth. In Paris, the presentations of the committees were really top quality and it was clear to the audience that a huge amount of work was behind the slides that were shown. The discussion sessions were always very lively and many ideas that came out of these were used to improve the inal text of the chapters.
The 121,163, 219,221,222,225,226,233 remaining eight trials failed to report the proportion of hypertensive 103,118,214,215,224,229,241 patients. The authors of 13 163,216,222-224,226,230,233,235-237,239,240 trials did not report the proportion of smokers. In seven 118,121,223,228,229,234,236 trials, this proportion was from 20 to 30 percent. Interventions Patients across the 30 trials that were reviewed received oral tadalafil monotherapy in either 215,221,226 experimental or active control arms. In most of the trials, tadalafil was given in 10 mg 230,237,238 118,121,163,214-220,222-230,232,234,236-240 221 and 20 mg doses. One trial included three additional 238 randomized arms in which patients received 2 mg, 5 mg or 25 mg of tadalafil. In another trial, one additional arm of randomly assigned patients received 5 mg of tadalafil. In one placebo- 235 controlled trial, patients were randomly assigned to receive either 2. In addition to these three trials, a 118,121,163,217-220,225,235 fixed dose of tadalafil was used in nine others. The duration of tadalafil treatment across the trials ranged from about 4–6 214,215,218,230,232,233,239 216 weeks to 24–26 weeks. In half of the trials, tadalafil was administered for 103,118,217,219,220,222-224,226-229,234,236-238 about 12 weeks. Outcomes In total, all 30 trials reported some information on the absence and/or occurrence of either total or serious adverse events. In four trials, the incidence of any adverse events was not 121,217,221,224,232 reported. Authors of 14 trials failed to report the absence or occurrence of serious 118,121,163,216,218,219,221,225-227,229,230,232,237 adverse events. The number of patients who withdrew as a 221,232 result of adverse events was reported in all but two trials. Study Quality and Reporting the mean Jadad total score for the 30 included trials was 3. The individual Jadad total 163 216,222,225 103,163,214, 219,228, 232 score for 30 trials ranged from 1 to 5. Three trials could not have been double blinded because patients received either 214,228,232 on-demand or fixed dosing regimens of tadalafil. Of the 24 double-blind trials, only nine 118,216,218,221,222,224,225,227,239 trials reported some description of the blinding method(s) used. Only 219,238,239 three trials reported some information on the allocation concealment, which was deemed to be adequate. The adequacy of allocation concealment for the remaining 27 trials could not be ascertained (i. The length of washout period 118 121,228,232 for the seven remaining crossover trials ranged from 4 days to 14 days. The occurrence of total and serious adverse events across the 23 placebo-controlled 215-227,229,230,233-240 trials was reported poorly. For example, in one trial, the proportion of patients who experienced at least one adverse 222 event in the tadalafil and placebo arms were 51. Even though the proportion of patients in one trial was numerically greater in the tadalafil arms (39. Most common adverse events reported across all trials were headache, back pain, dyspepsia, dizziness, nasal congestion, flushing, and myalgia. In general, the occurrence of these events tended to be numerically more frequent in tadalafil arms than in placebo arms. Moreover, a statistically significant higher incidence of these 215,220,222,223,225,226,239 events was reported across several trials in tadalafil versus placebo arms. The majority of the trials reported that tadalafil was well tolerated and that patients had had adverse events mostly of mild or moderate severity. Eleven of the 23 trials did not report whether there had been any occurrence of serious 216,218,219,221,225-227,229,230,237,239 adverse events. Of the 12 trials that reported any occurrence of 215,220,222 serious adverse events, three trials did not specify what these events were. The proportion of patients who withdrew due to adverse events across trials was five–six 217,222,224 215-220,222-227, 229,230,233-240 percent or less and similar across the tadalafil and placebo arms. In general, the results of the 23 placebo-controlled trials showed that patients who received tadalafil (10 or 20 mg) experienced greater improvement in erectile functioning (e. The corresponding mean treatment 216 237 response change in placebo arms ranged from 0. Furthermore, results of two trials indicated that patients receiving even lower doses of tadalafil (2. In several trials, there was a statistically significant greater mean per-patient percentage of successful intercourse attempts measured at different intervals after dosing in tadalafil arms 217,219,220,224,225,230 compared with placebo arms. The effects of both 215,226-230,237,238 tadalafil doses 20 mg and 10 mg were evaluated in eight trials. In one of these 238 trials, there was an additional randomized arm in which patients received 5 mg tadalafil. In three trials, the incidence of headache was slightly higher in patients receiving 20 mg tadalafil as compared with those receiving 10 mg (or 5 mg) of tadalafil. In the second trial, numerically more patients who received 20 mg tadalafil had headache compared with those who received a 10 mg dose (8. In one 227 trial, compared with those who received 10 mg of tadalafil, patients receiving a 20 mg dose experienced numerically higher rates of dyspepsia (22. The incidence of back pain was numerically slightly higher in patients receiving 20 mg versus those receiving 10 mg of 237 215 tadalafil in one trial (4. Of the eight trials comparing the efficacy/safety profiles of 20 mg and 10 mg tadalafil, the absence or presence of 221,226,227,229,230,237 serious adverse events could not be ascertained for six trials. In the same trial, patients on 20 mg tadalafil had a faster erectogenic response (starting 16 minutes post-dose) than those on 10 mg of tadalafil (starting 26 230 minutes post-dose). For example, there was a statistically significant higher mean per- patient proportion of successful intercourse attempts (i. Two 214,232 trials compared the efficacy/safety of two dosing regimens of 20 mg tadalafil (on demand therapy versus scheduled therapy). In the first trial, the rate of any adverse events (percentage of patients with at least one adverse event) did not differ between groups who were given tadalafil either on demand or 3 times per week (21. The proportion of patients who withdrew from the on-demand and the 3 times per week dosing regimens were 4. In the second trial, the most frequent adverse events were dyspepsia, headache, back pain and myalgia, observed in two of the 20 patients. The other trial evaluated whether 20 mg tadalafil dosing regimens (on demand versus scheduled on alternate days) differed in improving endothelium-dependent vasodilation of cavernous arteries (e. There was also a statistically significant improvement in regard to morning erections observed in patients treated with the 61 scheduled dosing regimen (90 percent of the patients; p <0. One of these additionally evaluated the efficacy/safety profile of vardenafil (20 mg). In general, in these trials, all three therapies were well tolerated and had similar safety profiles. There were no statistically significant differences in the incidence of any adverse events between tadalafil- and sildenafil-treated groups of patients. In the tadalafil arms the proportion of patients with at least one adverse event across the four trials ranged from 27. Three remaining trials did not report the occurrence or absence of serious adverse events. The total number of withdrawals due to adverse events across the four trials ranged from 121 103,163 two to 12 patients. The proportion of patients who withdrew from tadalafil groups ranged 121 103,241 from one to seven. The respective proportion of patients who withdrew from the 121 103,163 sildenafil arms ranged from one to five.
Syndromes
- Hypothyroidism - primary
- Vomiting
- Sclerosing cholangitis
- You should get plenty of rest and eat a well-balanced diet during the course of your radiation therapy.
- Work
- Meat
- Loss of muscle function or feeling
- Personality changes
The parents should be told to come back to the clinic if: • the child appears to be distressed or in pain; • the child has fever; • the child does not wake for feeding as per his usual pattern; • there is any separation of the skin edges; • there is any unusual swelling or bleeding; • the child has any difficulties with urination; • the plastic ring slips onto the shaft of the penis; • the tip of the penis becomes swollen or changes colour • one part of the foreskin remains pink or has not shrivelled after 48 hours; • the plastic ring has not fallen off within 8 days; • the parents have any other worry about healing. Infant and paediatric circumcision Chapter 6 - 16 Male circumcision under local anaesthesia Version 3. There have been several studies comparing it with the Gomco clamp, another widely used device. The Mogen (“shield”) clamp compares favourably, because it is easy to use and has no parts to assemble. The fewest complications with this method have been reported in the context of circumcision of 8-day-old babies. Since the Mogen clamp is reusable, careful precautions have to be taken to ensure the device is properly cleaned and sterilized between procedures. Also there is a risk that the glans can be pulled i into the slit and crushed or partially severed. After cleaning, draping, anaesthesia and marking the line of the circumcision over the corona, retract the foreskin and separate the adhesions to expose the corona, as described above. It is important to separate all adhesions in order to prevent the glans from getting accidentally pulled into the Mogen clamp and injured. Put traction on the foreskin, and introduce it into the slit in the device, with the concavity facing the glans (Fig 6. If there is any doubt, remove the clamp, inspect the glans for any sign of crushing injury and reapply the clamp. Pediatrics 97: 134-136, 1995 Infant and paediatric circumcision Chapter 6 - 17 Male circumcision under local anaesthesia Version 3. If the device is left too long it may be difficult to separate the foreskin to reveal the glans after the device is removed. Manipulate the penis, using gentle pressure from the side, to allow the glans to emerge from under the crushed foreskin (Fig 6. This is an important step to ensure the foreskin heals below the level of the corona. In older infants (>60 days) it may be necessary to place some 5-0 simple sutures to approximate the edges. Infant and paediatric circumcision Chapter 6 - 18 Male circumcision under local anaesthesia Version 3. Information for parents the parents of an infant or child who has had a circumcision using the Mogen clamp technique should be told that it is not necessary to use a dressing and the child can be looked after in the normal way, including normal washing and the use of nappies. The parents should be told to come back to the clinic if: • the child appears to be distressed or in pain; • the child has fever; • the child does not wake for feeding as per his usual pattern; • there is any separation of the skin edges; • there is any unusual swelling or bleeding; • the child has any difficulties with urination; • the parents have any other worry about healing. Infant and paediatric circumcision Chapter 6 - 19 Male circumcision under local anaesthesia Version 3. In addition, the crushing of the foreskin is circular (unlike with the Mogen clamp, which is linear).. A disadvantage of the Gomco clamp is that, unlike the Mogen clamp, it consists of four parts – base plate, rocker arm or top plate, nut and bell. There is a risk that parts of the clamp may be mislaid or lost during cleaning and sterilization. Before the start of the procedure and before any anaesthetic is given the surgeon must check that likely sizes of Gomco clamps are available. Once the procedure has started and the correct size has been selected the clamp should be assembled to ensure parts are complete and fit correctly. If a small bell is used with a larger base plate the device will not crush the foreskin or protect the glans, possibly resulting in haemorrhage and penile laceration. Component parts from different clamps or manufacturers are not interchangeable and care must be taken to ensure that the clamp is assembled only from its original parts. The Gomco clamp should also be thoroughly checked and not used if it has stripped threads, a warped or bent base plate, a bent arm, twisted forks on the rocker arm, or a scored or nicked bell. Infant and paediatric circumcision Chapter 6 - 20 Male circumcision under local anaesthesia Version 3. After cleaning, draping anaesthesia, and marking the line of the circumcision over the corona, retract the foreskin and separate the adhesions to expose the corona, as described above. It is usually necessary to make a small dorsal slit to allow the clamp to be placed on the glans (Fig 6. Otherwise, it will extend beyond the ring of crushed tissue produced by the Gomco clamp and may produce an untidy result with increased risk of bleeding. The dorsal slit should be long enough to allow all adhesions to be divided and the bell of the Gomco clamp to be placed over the glans. Place the base plate of the Gomco clamp over the bell, keeping the foreskin pulled over the bell (Figs 6. Put the rocker arm of the clamp in position, taking care to place the crossbar at the top of the bell correctly in the yoke. Before tightening the clamp, make sure that the foreskin is symmetrical over the bell. Finally, the crossbar at the top of the bell should sit Infant and paediatric circumcision Chapter 6 - 21 Male circumcision under local anaesthesia Version 3. Once you are sure that the clamp is in the optimal position, tighten the nut until the foreskin is crushed (Fig 6. Using a scalpel, excise the foreskin circumferentially against the bell, distal to the clamp (Fig 6. American Journal of Obstetrics and Gynecology 1935, 30:146-147 Infant and paediatric circumcision Chapter 6 - 22 Male circumcision under local anaesthesia Version 3. To obtain a good result with the Gomco clamp, the surgeon must ensure: (a) the dorsal slit is not made too long, the apex must be above the crushed skin edge. Information for parents the parents of an infant or child who has had a Gomco clamp circumcision should be told that it is not necessary to use a dressing, and the baby can be looked after in the normal way, including normal washing and the use of nappies. Bleeding is rare Infant and paediatric circumcision Chapter 6 - 23 Male circumcision under local anaesthesia Version 3. Parents should be told to bring the child back to the clinic if: • the child appears to be distressed or in pain; • the child has fever; • the child does not wake for feeding as per his usual pattern; • there is any separation of the skin edges; • there is any unusual swelling or bleeding; • the child has any difficulties with urination; • the parents have any other concern about healing. Infant and paediatric circumcision Chapter 6 - 24 Male circumcision under local anaesthesia Version 3. The information should be given verbally in the local language using non-technical terms. In addition, the clinic should have printed information sheets that the parents can take home. Information given needs to be specific to the clinic, and should include the following topics. It does not affect the ability to pass urine normally and does not affect the ability to father children in adult life. It should be explained that complications from male circumcision are extremely rare but can include poor cosmetic outcome, bleeding, infection, or injury to surrounding structures. If the child becomes ill before the planned operation date, the parents should contact the clinic to postpone the procedure until after the child recovers. The instructions will depend on the procedure that has been used (see descriptions of techniques in Chapter 6). This will usually be for the family to bring the baby back to the clinic, but if distance makes a return visit difficult then an alternative health facility should be identified. Infant and paediatric circumcision Chapter 6 - 25 Male circumcision under local anaesthesia Version 3. I am asking you to do a circumcision operation (removal of the foreskin) on my son/ward and I give you permission to do this operation. I have given information about: • what circumcision is; • the benefits of circumcision; • how circumcision is done; • the risks of circumcision; • what to do before circumcision; • what to do after circumcision; • what to do if there are any complications or problems after circumcision; • an emergency contact number and information about where to go in an emergency. I have asked the parent or guardian some questions to make sure that he or she understands the information I have given. To the best of my belief the client is capable of giving consent and has enough information to make a proper decision about whether to proceed with the operation of circumcision. Signed ……………………………………………………… (Circumcision clinic counsellor or surgeon) Infant and paediatric circumcision Chapter 6 - 26 Male circumcision under local anaesthesia Version 3. Nurses or other staff members can carry out the tasks related to postoperative recovery and discharge, but the surgeon is ultimately responsible for the quality of post-circumcision care. The summary below assumes that the circumcision has been performed in a clinic under local anaesthetic.
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