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Preoperative: The procedure and expected sensations are explained to the patient or his parents. Adult patients should be reassured that the procedure will not interfere with urinary, sexual, or reproductive function. Necessary equipment, including a restraining board for the newborn, and appropriate anesthetics are assembled. The newborn should not receive food within 1 hr before the procedure.
Postoperative: Vital signs are monitored, and the incision is inspected for bleeding every 15 min for the first hour, then hourly for 12 to 24 hr, as protocol directs. Bleeding is controlled by applying gentle pressure with sterile gauze sponges; any heavy or persistent bleeding should be reported, and preparations made for blood vessel ligation. A sterile petroleum gauze dressing is applied after circumcision, remains in place for 24 hr, and is replaced if it becomes dislodged during that time. The penis is gently washed at diaper change, and fresh sterile petroleum gauze is reapplied. The dressing, glans penis, and sutures, if present, are periodically examined for swelling, redness, or purulent exudate; any signs of infection are reported, and a specimen of the exudate is obtained. A plastic bell instead of petroleum gauze may be used to cover the glans and to prevent hemorrhage and contamination. The newborn is diapered loosely to avoid irritation and should not be positioned on the abdomen for the first few hours after the procedure.
For the adult patient, analgesics are provided, and a topical anesthetic ointment or spray is applied as needed. If prescribed, a sedative is given to help prevent nocturnal penile tumescence and resulting pressure on the suture line. The patient is encouraged to void within 6 hr after the procedure. Either the patient or his family is instructed how to keep the area clean and how to change and apply dressings. They are also instructed to watch for and report renewed bleeding or signs of infection. Adult patients can resume normal sexual activity as soon as healing is complete, usually within a week or so. Use of prescribed analgesics is recommended to relieve discomfort during intercourse.