Circumcision Surgery - Laser & Stapler Treatment

What is Circumcision?

Circumcision surgery is the removal of the penile foreskin. It is a very common practice and is performed for a variety of medical and non-medical reasons. It is commonly performed in babies as a religious practice. In addition to that, it is performed in adult men for aesthetic reasons, to prevent or treat penile infections, etc.

When is Circumcision Required?

The penile foreskin is a small piece of skin that covers the tip of the penis (glans penis). The foreskin is completely attached to the penis at birth, but as the child (and his penis) grows, it separates and can be retracted easily. However, it also provides a convenient location for bacteria to breed, leading to penile infection and inflammation. 

Different penile issues that circumcision can be performed for are:

• Aesthetic and sexual concerns: Some men do not like the shape, look, color, size, or texture of the foreskin and want to get it removed. Sometimes, the foreskin can also result in decreased pleasure during sex and masturbation, so men get circumcised for better orgasmic pleasure.
• Phimosis: Phimosis is a common condition in uncircumcised men and is defined as the inability of a person to retract their foreskin. It can occur naturally or due to scarring from forcible retraction of the foreskin.
• Paraphimosis: Paraphimosis is a medical emergency in which the foreskin gets trapped in a retracted position behind the head of the penis and can’t be pulled back without considerable pain and discomfort.
• Posthitis: Posthitis is the inflammation of the foreskin itself due to bacterial or fungal infections, poor hygiene, allergies, skin conditions, dermatitis, etc.
• Balanitis: Balanitis is the pain, swelling, and irritation of the penis glans caused due to a fungal or bacterial infection. It is often associated with discharge from the penis.

Circumcision is also performed in some cases even when it is not strictly necessary due to a myriad of benefits like:

• Better hygiene: It is easier to clean a circumcised penis as the foreskin can trap dirt, bacteria, and other substances under it, making it harder to clean.
• Decreased risk of UTIs and STIs: It is easier to wear a condom with a circumcised penis, which makes it easier to avoid sexually transmitted infections. Similarly, better penile hygiene also makes it easier to avoid urinary tract infections.
• Prevention of penile problems: With better hygiene and a low risk of infections, the person can prevent penile issues like phimosis, balanitis, etc., that are caused due to issues with foreskin retraction. 
• Decreased risk of uterine infections in sexual partners: Many research studies have noted that sexual partners of circumcised men have better uterine hygiene and decreased risk of uterine infections and cervical cancers.
• Decreased risk of penile cancer: In various research studies, circumcised men have been proven to have a lower risk of getting penile cancer.

Preoperative Preparation

Before circumcision surgery, you will have to undergo a physical examination and certain diagnostic tests to ensure you are completely healthy. Your urologist will retract your foreskin to examine your penis glans for any signs of infection, injury, or inflammation and its extent, etc. Additionally, you may require diagnostic tests like: 

• Urinalysis for UTI detection by checking the appearance, concentration, and content of the urine
• Tissue culture/swab tests to examine the foreskin for bacterial/fungal infection 
• Random blood sugar and glucose urine tests to find the glucose levels (for diabetic patients)

Once the urologist has examined the results of the diagnostic tests, they will draft a treatment plan and schedule the surgery, if needed. Before getting the surgery, the patient should ensure their surgeon is fully aware of their medical history. If they are taking any blood thinners or clotters, they should get consent for the surgery from their general physician and stop taking them at least 2-3 days before the surgery.

Day Before Surgery

Circumcision is performed as a daycare surgery, so the patient is hospitalized and discharged on the same day. On the day before the surgery, the patient will have to make preoperative preparations. For example, arranging for someone to drive them after the surgery as they will be unable to drive for at least 24-48 hours afterward due to the effects of the anesthesia. If the surgery is to be performed under anesthesia, they should not eat anything after midnight on the day before the surgery. They should also arrange for some time off after work to ensure healing. For office workers, 1-2 days rest is sufficient, but for people who perform manual labor, about a week’s rest before returning to work is necessary. 

Procedure Day

On the day of the surgery, you will be admitted to the hospital, and a nurse will check your pre-surgery vitals to ensure you are in optimum health for the surgery. After this, you will be anesthetized and moved to the operation theatre. Your surgery will be performed according to your preference, and once the surgery has concluded, you will be moved to a recovery room for observation. Most patients are in the recovery room for a few hours and are free to go home on the same day as the surgery. You may not be able to drive yourself due to the after-effects of anesthesia, so you should arrange for someone to drive you home.

Types of male circumcision surgery

There are three main types of circumcision surgeries, as detailed below:

• Open circumcision: It is the oldest and most conventional way to circumcise someone. During the procedure, the foreskin is cut off using a surgical blade. The surgery is bloody and painful and hence is not preferred by most medical professionals now. Moreover, the surgery may also result in an aesthetically displeasing scar on the patient’s penis.
• Stapler circumcision: Stapler surgery is performed using a special stapler device known as an Anastomat. The stapler fits snugly around the penis and pulls out the entire foreskin in one quick motion while simultaneously replacing it with a silicone ring. The silicone ring covers the circumcision site and falls off on its own within 7-10 days when the penis has healed.
• Laser circumcision: Laser circumcision surgery is the most advanced type of circumcision procedure. It involves the removal of the foreskin using a laser beam. Since a laser is used, there is no bleeding or scarring, and the patient heals much faster.

Post Procedure Tips and Recovery Rate

Recovery after circumcision is often faster in the case of stapler and laser surgeries and involves fewer complications/side effects as compared to conventional circumcision. After laser and stapler surgeries, the patients are discharged on the same day and have minimal pain or discomfort. The patients may also need to take NSAID painkillers and antibiotics to prevent pain and infection. 

The patient may have penile swelling and discomfort for about 3-4 days, and most patients are able to return to regular life and office routine in 1-3 days (6-7 days for people performing manual labor). For stapler circumcision, the silicone ring falls off within 7-10 days, while complete healing typically takes about 2 weeks.

You should follow the given tips to improve your recovery after surgery:

• You should clean and shave your pubes to maintain hygiene. Wear tight-fitting underwear or compression undergarments immediately after the surgery to keep the surgical gauze in place.
• Avoid sex and masturbation for about 6 weeks after the surgery to allow your penis to heal completely.
• While recovering, apply petroleum jelly to the tip of the penis to avoid it sticking to your underwear.
• Wear light, loose-fitting clothing to avoid irritation to your penis while healing. Do not pull or scratch your penis while healing.
• Avoid heavy lifting and physically strenuous work during recovery. Wait about 3-4 days to return to work if you have a desk job and about 7-10 days if your work is physically taxing.
• Take good care of your wound and clean it at least twice every day. Do not scrub your wound and 
• If you have any pain, take over-the-counter pain medications. If your pain is not manageable through those, consult your urologist.

Risks and Complications

While extremely advantageous, there are certain disadvantages of circumcision surgery as well. Some people have described increased penile sensitivity after circumcision, which has reduced their sexual pleasure. Some people also do not like the look of their circumcised penis and find it aesthetically unappealing. 

Other risks of circumcision are:

• Hemorrhage
• Infection
• Anesthesia-related complications
• Pain
• Foreskin is cut too short or long
• Irritation of the glans penis
• Meatitis, i.e., inflammation of the glans
• Penile adhesion, i.e., leftover attachment of foreskin to the penis tip
• Foreskin tearing, etc.

These complications are very common in conventional circumcision procedures, especially if they are being performed by a non-medical professional. However, they can be easily avoided through advanced circumcision procedures like stapler or laser surgeries.