Correctly-performed circumcisions are least likely to require revisions.
All conventional newborn circumcision techniques can be done safely with the correct training and experience. No technique is superior for all children under all circumstances. Most common techniques include Plastibell, Gomco, and Mogen Clamp. These techniques all involve removing the foreskin that covers the glans (head) of the penis. Each has pros and cons and, if done correctly, should provide acceptable outcomes.
The goal is always to remove just the foreskin and NOT the normal skin covering the penile shaft. Removal of the shaft skin can cause a ‘tight’ penis or in extreme cases a penis with no shaft skin. If too little is removed then the remaining foreskin still will partially cover the penis and require more care and hygiene in the future. Care providers should always err on the side of too little foreskin removed than too much removed. With the correct experience, most newborn and infant circumcisions can be done with the correct amount of foreskin removed. See OUTCOMES section for more information.
Like the body, newborn penises come in many shapes and sizes. Even with their differences, penises are most commonly ‘normal,’ but the skin coverage is slightly different for each and requires special considerations as to when, by whom, and how the circumcision is performed. In some cases, circumcision should be deferred until a specialist such as a pediatric urologist can assess to determine if it can be safely done as an infant using conventional methods or should be performed later as a surgical procedure.
The following infant penis shapes may require special circumcision considerations or require that circumcision be performed by a pediatric urologist:
#1 Webbed Penis: This mild deformity is more of a “tepee” shape and the normal uncircumcised penis is more of a “rocket” shape. In other words, a circumcision, if not done very carefully, may result in too much external shaft skin being removed. This may require a circumcision done in the operating room that is done surgically and not by a clamp or plastic ring device. Also, regardless of the technique used, it will probably require the parents to ‘pop out’ the glans (head) often to make sure the shaft skin relaxes and allows easy exposure for future care and exposure.
#2 Concealed/Hidden Penis: This is a significant penile abnormality that should be addressed by a specialist (pediatric urologist), especially if circumcision is desired. An excellent outcome should be expected. The penis is normal, only the external skin is deficient. This also will probably require a formal circumcision in the operating room, and require the parents to regularly ‘pop out’ the penis until all the shaft skin relaxes.
#3 Mild Chordee: This deformity is usually caused by deficient foreskin development under the penis. Instead of having equal foreskin all around the penis, this chordee deformity has all the foreskin on the back side of the penis near the abdomen. Many of these children will have some curvature of the penis, especially with erection. This deformity is also usually mild and easily corrected in the operating room by a pediatric urologist, and an excellent outcome is usually obtained. If uncorrected, the penis will have an odd shape, since it will never have a normal uncircumcised appearance and may have curvature.
#4 Naturally Circumcised: Natural circumcision is a term used when a baby is born with less foreskin and appears slightly circumcised. This term is commonly used but not accurate in that foreskin is still present. In this case, the glans and meatus are visible but there is still circumferential and relatively normal foreskin present. Children with a “natural circumcision” can still be circumcised if desired by the parents and an experienced care provider can usually perform this as a newborn procedure—but with care not to remove too much foreskin.
#5 Hypospadias: Newborns and infants with significant bleeding, skin, or other disorders should only undergo circumcision with the correct medical preparation.
BABIES WITH A TOO SMALL, TOO LARGE, DEFORMED OR ABNORMALLY-SHAPED PENIS SHOULD ONLY BE CIRCUMCISED BY A SPECIALIST WITH COMPLETE KNOWLEDGE AND EXPERIENCE. In other words, many avoidable complications and suboptimal outcomes arise when boys with mild penile deformities are subjected to a routine newborn circumcision by a practitioner who does not have extensive experience with unusual or different penile anatomy.