When circ's go bad...

Specialties Ob/Gyn

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Gompers, BSN, RN

2,691 Posts

Specializes in NICU.
One of the obstetricians also uses gelfoam around the circ. As this material 'melts' it really looks like sloughing skin.

That gelfoam is good stuff. I much prefer it to silver nitrate, hands down. We've never used it on a circ - usually wrap in vaseline gauze and hold a little pressure if bleeding, but since we use lidocaine they usually don't bleed much - but we've used gelfoam on kids with stomas. Usually those kids have bad livers because of the short-gut and TPN dependence, and their stomas bleed sometimes and I've even had some with vericies that just start pumping! Gelfoam worked every time.

Ross1

112 Posts

Referring to the original posting, I'm sure that this baby boy is going to grow up to be an adult male with a dysfunctional member. I cannot believe that in this day and age, especially with all the concerns about medical liability, routine infant cirucmision is still being performed here in the USA.

While it is true that in this country, a parent as the legal right to consent to this procedure for his/her infant son, in my opinion, that parent does not have the ethical or legal right to do so. And any MD who performs this unnessessary and permant procedure (or RNs who assist) in my opinion are violating basic medical ethics.

I am not some radical anti-circumcision activist, an adult male. I am just stating to me what seems so obvious. The only person who has the right to consent to part of his body being surgically removed is the owner of that body....plain and simple. It is not the doctor's member, the nurse's member, or the parent's member.

When are people going to recognize this.

I

Nursewise

9 Posts

During my OB rotation, I watched a few circs and one was done by a second-year resident. She had circed a few kids before with supervision so they let her do this one herself. I was comforting the baby while she did the procedure. So she goes ahead and makes the cut, then goes..."Hmmmm.." She tells me she'll be right back. She comes back into the nursery with another resident who agrees, "Hmmmm...that doesn't look right." I might add that each time they look, they're moving the cut foreskin up and down, all around, and the baby is screaming around his pacifier. Finally they get an attending to come in...takes one look...turns out the resident didn't examine baby and he had a hypospadius! The attending sighed and commented that the baby would need extensive surgery later, and because the resident had circed the baby, it would be that much harder to repair the hypospadius.

I might add that this particular hospital had a policy of putting EMLA cream on the babies an hour before the procedure...if they had insurance. If they didn't, NO ANALGESIA was used. NONE. :angryfire

In the NICU where I work, about 80% of the boys are circed before discharge. If they have an upcoming surgery (about 50% of the preemie boys end up with hernias) they'll do the circ in the OR while the baby is under anesthesia. If it's done up on the unit, urology does the procedure. We give Tylenol an hour before, then q6h after for at least 24 hours. They also use lidocaine for a local block, thankfully.

Maybe someday little boys will acquire the same legal status of little girls, where in the U.S.A., in the absence of any pathology, this kind of procedure is a felony.

Ross1

112 Posts

Maybe someday little boys will acquire the same legal status of little girls, where in the U.S.A., in the absence of any pathology, this kind of procedure is a felony.

Well said! Thank you.

All surgery has risks and clearly a percentage of circumcisions do go awry and it is the unfortunate boys/males who pay the price, not the doctors, not the nurses, and not the parents. There is no medical reason to be perform routine infant circumcision. In fact, I recently read a quote somewhere (can't remember the source though) that said that more male babies die each year from complications associated with circumcision then adult males who are diagnosed with penile cancer (a very rare cancer for both circumcised and uncirumcised males, but often toted as one of the reasons to perform circumcision....to prevent penile cancer).

jwk

1,102 Posts

Well said! Thank you.

All surgery has risks and clearly a percentage of circumcisions do go awry and it is the unfortunate boys/males who pay the price, not the doctors, not the nurses, and not the parents. There is no medical reason to be perform routine infant circumcision. In fact, I recently read a quote somewhere (can't remember the source though) that said that more male babies die each year from complications associated with circumcision then adult males who are diagnosed with penile cancer (a very rare cancer for both circumcised and uncirumcised males, but often toted as one of the reasons to perform circumcision....to prevent penile cancer).

You're a medical professional (to be) - quote your sources, otherwise it's called hearsay. You say you're not a "radical anti-circumcision activist", but that kind of statistic is straight out of their playbook.

Ross1

112 Posts

You're a medical professional (to be) - quote your sources, otherwise it's called hearsay. You say you're not a "radical anti-circumcision activist", but that kind of statistic is straight out of their playbook.

Excerpts From the American Association of Pediatrics 1999 Policy statement:

CHICAGO - After analysis of almost 40 years of available medical research on circumcision, the American Academy of Pediatrics (AAP) issued new recommendations today stating that the benefits are not significant enough for the AAP to recommend circumcision as a routine procedure. The new policy statement was published in this month's issue of Pediatrics, the journal of the AAP..........................

Studies conclude that the risk of an uncircumcised man developing penile cancer is more than three-fold that of a circumcised man. However, the AAP policy notes that in the United States only 9 to 10 cases of this rare disease are diagnosed per year per 1 million men, indicating that while the risk is higher for uncircumcised men, their overall risk is extremely low.

I don't need to quote statistics or citations to form my opinion. Circumcision is a surgery and ALL surgery has risks. Clearly a certain percentage of circumcisions do go wrong as evidenced by the postings on this list. Why would anyone impose a surgical procedure on a healthy patient for which there is no medical reason for that surgery? .....especially on something as sensitive and important as a male's sexual organs?

If anything is radical, it is circumcision. All a male requires is basic hygiene and he will have no problems with his foreskin. I know this firsthand experience.......not from what others tell me...and not from anti-circumicsion web sites....but from my own actual experience as a male (with a foreskin.....which is probably more then most of the posters in this discussion can say!)

It is true that circumcision does promote penile hygiene, but so does soap and water. I'm sure that the men out there who have had botched circumcisions, and there are many, would much rather have a life of soap and water then their botched circumcision. Even if the complication rate of circumcision is only 1%, that is still a lot of people given the numbers of male babies born each year in the USA.

jwk

1,102 Posts

Studies conclude that the risk of an uncircumcised man developing penile cancer is more than three-fold that of a circumcised man. However, the AAP policy notes that in the United States only 9 to 10 cases of this rare disease are diagnosed per year per 1 million men, indicating that while the risk is higher for uncircumcised men, their overall risk is extremely low.

Close but no cigar - your original stat was regarding the mortality rate from infant circs compared to penile cancer. This statement from the AAP doesn't address that.

Why would anyone impose a surgical procedure on a healthy patient for which there is no medical reason for that surgery?

That would leave out about 98% of the work that plastic surgeons do every day.

I think the main point is that it's up to the parents to decide what is or is not appropriate in this situation - not you, not the RN in the nursery, not me. Whether you agree with it or not, it's a perfectly legal procedure nationwide, and I'd guess you'd have a hard time restricting it.

I might add that this particular hospital had a policy of putting EMLA cream on the babies an hour before the procedure...if they had insurance. If they didn't, NO ANALGESIA was used. NONE. :angryfire

And this is amazingly unethical. The standard of care is the same, insurance or no insurance. Did you (if you worked here) or anyone else at that hospital have the cojones to report this? It's called advocating for your patient. By being silent, you're complicit in the act.

allnurses Guide

Spidey's mom, ADN, BSN, RN

11,304 Posts

Interesting perspectives from the guys - thanks.

I do remember arguing with my husband at the time regarding the cleanliness issue . .. "you know, it is very difficult to keep little kids ears clean and they get those darn ear infections all the time so why don't we just lop off our son's ears while we are at it?". He didn't think that was very funny. He still insisted that our boys be circumcised.

I still say that the majority of the time it is the man who advocates for circumcision, not the women.

I still feel awful that I had to sign the consent since I was the one who gave birth. I really wanted it to be my husband but it had to be me. And I didn't want it done.

steph

Ross1

112 Posts

I guess this discussion may be somewhat futile because minds are made up. But let's not forget what originally started the discussion. A new graduates observation of a severely botched circumcision. And it is that little boy and future man who is going to have to live with the physical, psychological, and sexual implications of having a deformed member. Not you, not I, not the RN, and not the MD. This trauma was completely preventable.

I do agree with you on one point though. You comment about cosmetic surgery is correct, however, most cosmetic procedures are performed on patients who can consent to the operation, or as is sometimes the case, on minors who may be disfigured and the surgery is "reconstructive" as well as cosmetic. I believe in such cases, the pros far outweigh the risks and the parent does have the legal and moral right to make that decision on behalf of the child. Circumcision just doesn't meet that standard. Having a natural intact member is not a disease or a deformity that requires surgical intervention so I disagree that it is the parent's right to make this decision.

What if the parent decided to cut the child's ear lobe off? Would that be okay?

Close but no cigar - your original stat was regarding the mortality rate from infant circs compared to penile cancer. This statement from the AAP doesn't address that.

That would leave out about 98% of the work that plastic surgeons do every day.

I think the main point is that it's up to the parents to decide what is or is not appropriate in this situation - not you, not the RN in the nursery, not me. Whether you agree with it or not, it's a perfectly legal procedure nationwide, and I'd guess you'd have a hard time restricting it.

And this is amazingly unethical. The standard of care is the same, insurance or no insurance. Did you (if you worked here) or anyone else at that hospital have the cojones to report this? It's called advocating for your patient. By being silent, you're complicit in the act.

Fiona59

8,343 Posts

OK, Ross, we get it you are attached to your foreskin. So are my husband and sons. But it is not my place as a nurse to try and get a family to change their ways.

It's a personal choice that a family makes for religious or cultural ideals. We as nurses are not there to judge their practices only make sure the child is adequately cared for. I often wonder how many "accidents" that the religious practioners have or is it just a problem for doctors.

I mean, when I gave birth, I had male doctors who decided that a forceps delivery was "best" for me. I didn't get a lot of input into that. End results, torn cerevix, and within five years corrective surgery. Trust me it wasn't pretty. I was kind of attached to my original parts to..

Mimi2RN, ASN, RN

1,142 Posts

Specializes in NICU.

We only have one ped does circs in the hospital, and most parents don't ask about it. As we have at least 50% hispanic population, I don't think even 40% of the babies are circed.

Anyone remember the story from at least 30 or 40 years ago about twins being circed, the doc was using something new to cauterize, and bungled the job on one baby. I think the doc severed the end of his member. To make matter worse, the parents were talked into castrating the baby and raising him as a girl.

As an adult, the boy decided he was really male, and later wrote a book.

Ross1

112 Posts

We only have one ped does circs in the hospital, and most parents don't ask about it. As we have at least 50% hispanic population, I don't think even 40% of the babies are circed.

Anyone remember the story from at least 30 or 40 years ago about twins being circed, the doc was using something new to cauterize, and bungled the job on one baby. I think the doc severed the end of his member. To make matter worse, the parents were talked into castrating the baby and raising him as a girl.

As an adult, the boy decided he was really male, and later wrote a book.

That was just in the news last year. Sadly, the victim committed suicide last year. Source:

http://www.cbc.ca/news/background/reimer/

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