DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Phimosis.
POSTOPERATIVE DIAGNOSIS:
1. Phimosis.
2. Probable balanitis xerotica obliterans.
PROCEDURE PERFORMED:
Circumcision.
SURGEON: John Doe, MD
ANESTHESIA:
General anesthesia via LMA.
COMPLICATIONS:
None.
DRAINS:
None.
ESTIMATED BLOOD LOSS:
Minimal.
INDICATIONS FOR PROCEDURE:
The patient presented with a history of being unable to retract the foreskin. Examination showed clear-cut phimosis. The opening into the foreskin was extremely tight and it could not be retracted over the glans. The foreskin itself appeared pale, scarred and thickened consistent with balanitis xerotica obliterans. We discussed treatment options, but the patient has little choice but to go with circumcision. Explained to the patient that circumcision in adult males is quite painful and has a very prolonged recovery. He understood and provided informed consent.
DESCRIPTION OF PROCEDURE:
The patient was placed on the operating room table in the supine position. General anesthesia was administered via LMA. The genitalia were prepped and draped in the usual sterile fashion. The foreskin was white and scarred, creating a tight phimosis. Two straight clamps were placed at the 12 and 6 o’clock positions, approximately 1 cm in depth along the foreskin. The tissue between the jaws of the clamps was crushed for hemostasis. The clamps were then removed and heavy scissors used to cut the foreskin at the 6 and 12 o’clock positions. At that point, the foreskin had been liberated enough to retract over the glans. The internal foreskin attached to the glans is also greatly diseased with a scar-type process. A close margin was cut around the glans portion of the penis to excise the foreskin. Another close margin was cut on the penile shaft skin to excise the foreskin. Hemostasis was obtained in the dartos layer with electrocautery. The shaft skin was then reapproximated to the glandular foreskin using an interrupted 3-0 chromic suture. This resulted in a very nice cosmetic effect. No other penile lesions or abnormalities were noted. Sponge and needle counts were correct x2. Polysporin ointment was applied to the incision area. The patient was returned to the recovery room in satisfactory condition.
Circumcision Sample Report #2
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Phimosis.
POSTOPERATIVE DIAGNOSIS:
Phimosis.
PROCEDURE PERFORMED:
Circumcision.
SURGEON: John Doe, MD
ANESTHESIA:
General anesthesia via LMA.
COMPLICATIONS:
None.
DRAINS:
None.
ESTIMATED BLOOD LOSS:
Minimal.
INDICATION FOR PROCEDURE:
This patient has developed a tight phimosis. Examination in the office shows that the foreskin can no longer be retracted over the glans due to a tight rim of scar tissue at the tip of the foreskin. The patient would like to have a circumcision performed and informed consent was obtained.
DESCRIPTION OF PROCEDURE:
The patient was placed on the operating room table in the supine position. General anesthesia was administered via LMA. He was placed in the dorsal lithotomy position. The genitalia were sterilely prepped and draped in the usual fashion. Examination shows a very tight phimosis with a small opening into the area of the foreskin. A straight clamp was placed on the dorsal midline and crushed. The clamp was then removed and scissors were used to incise the dorsal midline of the foreskin, which then spread laterally to expose the glans penis. The ventral foreskin at the frenulum was then crushed with a clamp and cut with scissors. The two lateral flaps of foreskin were then removed with sharp excision. The underlying dartos was then examined and hemostasis was obtained where needed with electrocautery. The skin of the penis was then reapproximated to the small rim of inner foreskin at the glans with interrupted 3-0 chromic sutures. This resulted in a good cosmetic appearance and good hemostasis. Polysporin was then applied and the patient was returned to the recovery room in satisfactory condition.
Circumcision Sample Report #3
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Phimosis.
POSTOPERATIVE DIAGNOSIS:
Phimosis.
PROCEDURE PERFORMED:
Circumcision.
SURGEON: John Doe, MD
ANESTHESIA:
General.
COMPLICATIONS:
None.
TUBES:
None.
DRAINS:
None.
POSTOPERATIVE CONDITION:
Stable to the PACU.
OPERATIVE FINDINGS:
The patient did have a phimosis of his foreskin and tolerated the procedure without complications.
INDICATION FOR PROCEDURE:
The patient is a (XX)-year-old male with a history of phimosis who elected operative management.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room by the OR and anesthesia staff. He was placed on the operating room table and anesthesia was administered without complications. The patient was intubated and his genitalia prepped and draped in a sterile fashion. A 15 blade was used to make a circumferential incision approximately 5 to 7 mm from the coronal sulcus around the glans on the shaft of the penis. The foreskin was then replaced over the glans and another circumferential incision was made through the epidermis approximately midway between the coronal sulcus and the tip of the penis as seen through the foreskin. At this point, the foreskin was retracted again and Metzenbaum scissors was used to dissect subcutaneously connecting both circumferential incisions. At this point, electrocautery using the Bovie was used to deglove the penis between these 2 incisions. Hemostasis was then achieved with electrocautery. At this point, a 3-0 interrupted chromic stitch was used to approximate the skin of the shaft at the 12 o’clock position and also a horizontal mattress interrupted chromic suture was used at the 6 o’clock position. Now that the skin of the shaft was approximated, interrupted 3-0 chromic sutures were placed approximately 5 to 10 mm apart circumferentially around the shaft just proximal to the glans. The wound was hemostatic and the incision was wrapped with Vaseline gauze, Kling wrap and loosely fitting Coban. The patient was awoken from anesthesia, extubated without difficulty and transitioned to the PACU for postoperative resuscitation.
Circumcision Sample Report #4
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Phimosis.
POSTOPERATIVE DIAGNOSIS:
Phimosis.
PROCEDURE PERFORMED:
Circumcision.
SURGEON: John Doe, MD
ANESTHESIA:
General, penile block.
ESTIMATED BLOOD LOSS:
Less than 5 mL.
SPECIMEN:
Foreskin.
DESCRIPTION OF PROCEDURE:
Following the induction of an adequate level of general anesthesia, the patient was placed in supine position. The penis and surrounding areas were prepared with Betadine and the patient was draped in a sterile manner. Dorsal slit was created by using a straight hemostat crushing the dorsal foreskin in the midline down to the level of the preputial tissue. The foreskin was incised and an eventual slit was created in a similar manner. The lateral flaps of redundant foreskin were then excised sharply. The edges were then retracted and hemostasis was obtained. The edges were reapproximated using 3-0 chromic suture. A penile block was performed by using 8 mL of 0.25 plain Marcaine. Infiltration occurred in 4 quadrants at the 2, 4, 8 and 10 o’clock positions. This was done while withdrawing to ensure that there was no vascular injury. Tegaderm was then applied. The patient went to the recovery room in satisfactory condition.
