Instructions for Procedures

Pediatric Urology Circumcision

Based on the initial exam and discussion, we may be able to proceed with a Plastibell circumcision the same day as your consultation. If there are anatomy or development concerns with the penis or foreskin, that a Plastibell circumcision is not advised, we will discuss additional options at the time of the consult. Please see information below regarding Plastibell circumcisions. Please contact our office with questions or concerns.

Plastibell Circumcision – Pre-Procedure Guidance

• Please bring a clean diaper for after the procedure, two swaddles or receiving blankets to help swaddle your child during the procedure and a pacifier, if he uses one.
• Parents and caregivers are not allowed in the procedure room for safety considerations; exceptions will not be made.
• The procedure is typically 20 to 30 minutes, we then show you the diaper area, which a small amount of blood is expected.
• You can then use the room to feed your child, or you may leave the office, there is not a set amount of time that he needs to stay after the procedure.

Plastibell Circumcision – Technique

• Under sterile conditions, the skin of the penis is numbed with injected medication. Bruising may occur at sites.
• The skin covering the penis is pulled-back gently to expose the entire head of the penis. The end of the penis will likely get red, then develop a yellow discharge, and finally scab over, "like a skinned knee". This is the normal healing process and will progress over the 7-14 days that the Plastibell Ring stays on.
• The correct size Plastibell Ring is secured with a string and the excess skin trimmed. The skin that overlaps the ring will turn dark "like the umbilical cord" before the ring falls off at 7-14 days, rarely as early as 3 days.
• Your child is returned to your arms after application of antibiotic ointment to the end of the penis, to protect this sensitive area from injury.

Plastibell Circumcision – Post-Procedure Care

• Application of Aquaphor or A&D Ointment will protect the area while it heals and is recommended with each diaper change for the first 2-3 months and then as needed until he is out of diapers.
• Keep area dry, with only "sponge baths" until the ring falls off. If your child's penis becomes soiled before ring separates, simply rinse the area off; pat it dry, and the resume care.
• Swelling of the shaft is expected following this procedure. Signs of infection are white/green drainage, and/or redness extending from the shaft of the penis onto the belly wall. Immediately bring these signs to the office's attention, if noticed.
• Please contact our office immediately if the Plastibell appears to be sliding down the shaft of the penis (the glans or "head" of the penis is through the ring).
• Tylenol (acetaminophen) may be given for discomfort every 4-6 hours.
• After the Plastibell falls off, if the fat pad at the base of the penis pushes the shaft skin forward, please compress the fat pad to expose and clean the glans ("head") and place A+D or Aquaphor ointment. This can prevent adhesions to the glans as well as abnormal scar tissue development.

Follow-up is with your pediatrician and incorporated into your routine visits in his/her office, unless specified otherwise.

Voiding Cystourethrograms (VCUG)

Before you come to have your X-ray pictures, you may want to practice some things at home that can help make this easier:

• Practice breathing like you will need to when the catheter is placed into your bladder: Lie down on your back with your knees bent, take a deep breath, and let it out long and slow. Or, for girls, lying with heels together, knees out, like a frog. This helps you to relax the muscles that need to let the catheter go into your bladder.
• You may also want to practice letting out the special water: Before you put water into your bathtub, and when you are ready, let yourself pee (if you do it there, it is easy to just rinse the tub and go on with your bath). Lying down in this position may make it easier to empty your bladder when you are asked to during your X-ray.

Information on Support Services

Ultrasound

Many patients have an ultrasound scheduled prior to the VCUG. This is done in the ultrasound area. This test is done with a machine that can also see inside you, but does not need any needles to be done. The camera is small, held in the hand of the person doing the ultrasound. Some special clear “jelly” will be put on your belly, so the ultrasound camera can slide around and see your kidneys and bladder.

Sedation

Occasionally young children (over two years) may need some medicine to relax them during this procedure. Your doctor will decide whether your child will need this ahead of time, since special arrangements need to be made. If needed, an oral medication is given in the X-ray department. This will usually relax the child and may make him/her slightly sleepy (but not asleep) during the procedure. Special monitoring and personnel are needed if this is done, but by individual arrangements.

Parents: We encourage you to ask questions and advocate for your child’s needs. You understand your child best. Once you have a clear understanding of what to expect, we think you will be better able to handle anxieties you may have, so you can focus on your child.