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Aji Setia Utama

SIRKUMSISI

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Definition

Removal of penile preputium until exposing the glans penis

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Objective

1. Cultural / Ritual2. Medical

To keep penile hygiene from smegma and rest of urine

To prevent glans, preputium, and urinary tract infection

To prevent penile carcinoma

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Indication

Phimosis and paraphimosis Medis Ritual – Agama - Antropologi

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Contraindication

o Hypospadiao Epispadiao Chordeeo Small peniso Hematological disorder

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Basic principle

Asepsis Removal of preputial skin Hemostasis Cosmetic

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Circumcision kit

Gunting Klem arteri

(lurus/bengkok/panjang/kocher) Pinset (anatomis ,chirurgis) Needle holder Skalpel Jarum Spuit

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Operation technique

Disinfection Anesthesia Glans and preputial hygiene Removal of the foreskin Hemostasis Suture

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Local anesthesia

(dorsal penile nerve block and circumferentially infiltrating the superficial layers of the penile base with lidocaine 1%)

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Freeing and cleaning foreskin from smegma

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Preputium dissection technique

Dorsal slit Guillotine

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Dorsal slit technique

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Guillotine technique

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Haemostasis

Hemostasis Vena di dorsal

penis Arteri frenularis di

daerah frenulum

Ligasi atau Cauter

suturing

Jahit

Daerah arteri frenularis lebih utama

Figure of eight

suturing

Jahit dengan Catgut plain satu-satu ( Interrupted )

suturing

Jahit dengan catgut

interupted

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Complication

Bleeding Wound infection Injury to the glans, urethra, or

penile shaft Removal of too much or too little

skin Penile necrosis

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TERIMA KASIH