Perioperative generally refers to the three phases of surgery: preoperative, intraoperative, and

postoperative.

Preoperative details

 Obtaining proper informed consent before the procedure is critical. In particular, inform
patients of potential risks, which include bleeding, hematoma formation, infection, suture
disruption, inadvertent injury to the urethra or glans, removal of too much or too little skin,
and a change of sensation during intercourse.

 Patients undergoing circumcision for recurrent balanitis should be free from infection
before the procedure.

 Circumcision may be performed in the office under a local anesthetic or in the operating
room under a regional or general anesthetic.

Intraoperative
Surgical repair for phimosis

 With the patient in a supine position, the genital area is prepared with povidone-
iodine solution. Shaving or clipping of the pubic hair is usually unnecessary.
 A general anesthetic is recommended in children. A local anesthetic may be used in
adults. Local anesthesia is accomplished by administering a dorsal penile nerve block
followed by a ring block.
 A mixture of equal volumes of 0.5% bupivacaine (Marcaine) and 1-
2% lidocaine (Xylocaine) without epinephrine is common.
 A potential complication of epinephrine use is local tissue ischemia. The maximum
recommended dose of lidocaine without epinephrine is 4.5 mg/kg, or 315 mg in a 70-kg
male.
Postoperative circumcision
Adult circumcision

 Following adult circumcision, many urologists choose not to use a dressing. However,
either petroleum jelly and sterile gauze or Xeroform petrolatum gauze may be wrapped
around the penis circumferentially, followed by application of sterile gauze and a
nonadhesive elastic wrap.
 Discharge medications should include oral narcotics.
 The dressing is removed 24-48 hours after surgery.
 The patient should wear loose-fitting briefs after surgery, and he may shower but should
wash gently around the incision site.
 Full recovery may require 4-6 weeks of complete sexual abstinence.