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Introduction

The Circumcision Service was initially set up at Woodbank Surgery in Bury in 2009 to meet the cultural and religious needs of the local population. It is now provided at this Practice on Wednesday afternoons and Saturdays (Walmersley Road Medical Practice in Bury BL9 6DX). It is a Doctor-led service with a dedicated nurse. The doctor has been supervised and approved by a Consultant Urologist to undertake the procedure.

The service was introduced as a result of the request made by the Bury Council for Mosques. The service is welcomed by the local community and is of special benefit to the Muslim population as every male baby must be circumcised on religious grounds. Circumcision is provided under NHS only for medical but not for religious reasons. Therefore, a variable charge for the cost of the procedure is made depending upon the age of the child.

The service access is by ringing mobile number: 07811 125404 for appointments.

This service will be provided on every Wednesday / Saturday / Sunday to newborn babies between 2- weeks to 6-months of age. The babies out of this age range will be operated only in exceptional circumstances.

The babies are assessed initially using a questionnaire and parents are asked to sign an informed consent for their son’s procedure. The parents are also given Information leaflet about the procedure.

Plastibell procedure is carried out under local anaesthetic using lidocaine. Occasionally, we use EMLA cream for older babies. The procedure takes place in a dedicated minor surgery room. Parents may be allowed only on special permission.

We use an aseptic technique with sterile surgical packs for each individual child. The baby lies on a specially designed mattress for the purpose of circumcisions. Once the procedure is finished, the baby is then returned back to the parents who may stay up to ½ hour for review if they wish to do so.

Occasionally, I use silver nitrate stick to stop bleeding underneath the tip of penis. This is the same stuff which is used to stop nose bleed in A/E. It may look yellow in a few days time but it is not due to infection. It usually gets better by itself in a few days time after the ring fallen off.

Parents are given written information advice and leaflet. They receive a follow-up telephone call the next morning. No further follow up is arranged but all parents are encouraged to ring back if there is any concern at all until the ring falls off.

A dedicated 24-hours advice line is available for phone advice all the time but direct post op review will be limited for emergencies only. The appointment can be made by ringing the above mobile number only.

Aftercare

Your baby has had a circumcision. This is not a major procedure but care in the first few days can prevent any problems. You should remember that bleeding is a rare but possible problem following the procedure. You may find that the baby’s nappy may have a few small spots of blood on it where the penis touches the nappy. If spots are large, dark in colour and increasing in size, we advice you to contact Mr Hussain on 07811 125404. You may be asked to bring your baby to be seen.

A Few Things to Look For:

  • A bit of spotting of blood is acceptable but too much bright red blood need reporting.
  • Slight swelling / bruising / redness is acceptable but if baby start running temp with it, then it needs reporting.
  • Ring normally moves towards the tip of penis within a week. If it is still stuck at the same place after a week or seems to be moved back at any time, then it needs reporting to the doctor.

Any other concerns, give me a call during the day time, if possible.

  • Hygiene: You must keep the nappy area as clean as possible. Check and change the nappy regularly and cleanse the area with cotton wool and warm water. DO NOT use baby wipes or rub the end of the penis. Avoid bathing your baby on the day of circumcision. After this time bath baby once / twice a day, avoid using bubble bath. You are allowed to put some salt in his bath water. A smearing of petroleum jelly, such as Vaseline on the front of the nappy (as shown in clinic) will prevent his penis sticking on to it.
  • Care of The Wound: You should be able to see the bell at all times. The bell should drop off after 3-8 days. If it remains on, this is not a problem, however, if it is still attached at 14 days we will ask you to come for its removal. Expect to see some swelling and redness for a few days, this is normal and will settle down.
  • Infection: We aim to ensure a sterile procedure; a small number of babies may acquire infection. (Observe for the penis becoming tense and swollen or any discharge). In severe cases your baby may become unwell, off feeds and develop a temperature. If you are worried please contact the number supplied.
  • Feeding: Your baby has not had a general anaesthetic and therefore can feed normally. Although today’s procedure may have upset him and this could affect his feeding pattern during the first day or two.
  • Pain: Your baby had a local anaesthetic before the procedure. You may find your baby a little difficult to settle, do not be afraid of holding him. Rocking and cuddling him will help calm and reassure him.
  • Follow-Up: Parents are given written information advice and leaflet. They receive a follow-up telephone call the next morning. No further follow up is arranged but all parents are encouraged to ring back if there is any concern at all until the ring falls off.

Thank you for using our service. Do not hesitate to contact if you feel we could improve it in any way. If you require any further advice please contact Mr Hussain on 07811 125404.

Questions

1. What age group do you do circumcision?

This service is provided to new born babies preferably between 2- weeks to 6-months of age. The babies out of this age range will be operated only in exceptional circumstances.

2. Who will do the circumcision?

Dr Afzal Hussain does the procedure himself with the help of carefully selected nurse assistant. All members of our team are currently working in the NHS with appropriate certification and insurance cover. We regularly audit our results and actively seek feedback from the parents of our patients.

3. Where do I come?

Please report to the clinic reception at our address.

4. How long does the procedure take?

Be prepared to spend up to 2-hours in surgery

5. Why does it take so long?

Parents are encouraged to collect an information pack at booking appointment. Otherwise they are given this pack on arrival. The baby will be assessed by a doctor to ensure that he is well. The doctor will take some details about your baby and about his health since birth. Please allow a seven day period after his immunization. If the doctor thinks your child is not suitable a full explanation will be given as to why and alternative arrangements will be made. We would also wish to observe your baby for up to ½ hour after the circumcision, if required, to ensure that the baby is safe to be discharged.

6. What will happen at the clinic?

Both parents are encouraged to sign an informed consent agreeing to the procedure to be carried out on your son. Should you at any time not fully understand, the staff are there to answer your questions. The staff is fluent in English, Urdu, Hindi and Punjabi.

7. How much does it cost?

The rate is variable, depending upon age of the baby with no extra fee for pre-operative or post-operative follow up. Fee has to be paid by cash or by cheque. The receipt is provided on request.

8. Why not home circumcision?

I fully appreciate the logic, demand and the benefits of doing circumcision in their own trusted home environment but my current full time commitment as GP in Bury and travelling from Huddersfield does not allow me to spare enough time to do circumcisions at home visits.

 
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