At CHOC Urology Center, we are able to perform a number of procedures that are often associated with outpatient hospital visits. Procedures done in our center not only provide children with the comfort of our office atmosphere and friendly staff, but also alleviate the need to drive to more than one location to get a child’s care.
Many procedures can be completed on the same day as a child’s initial visit (if the patient’s insurance allows). In-office procedures also allow the entire urology team to be present and provide patients and their families with the most current education and post-operative instructions. All procedures done in the office are done with the use of topical anesthetic creams and not general anesthesia or needle sticks. There is little to no bleeding with these procedures, and we work hard to minimize the child’s pain.
We provide a number of in-office procedures, including:
Newborn circumcisions can be completed in healthy infants in our office with a fellowship-trained pediatric urologist. We use local anesthesia for infants to minimize their discomfort during and after the procedure. Our office uses the plastic bell circumcision method. The procedure generally is done within 30 minutes and the child comfortably goes home. The plastic bell remains on the penis for a set amount of days.
Lysis of Preputial Adhesions
Preputial adhesions are one of the most common complications following a circumcision. This occurs when the raw surfaces of a newly circumcised penis are allowed to rest next to each other and they subsequently will heal together. These adhesions often cause the penis to look uncircumcised and will cover the coronal groove that should be seen after a circumcision.
Local anesthetic cream is applied for the procedure. The anesthetic will take at least 40 minutes to take effect. After this, one of our licensed physicians or nurse practitioners will lyse (remove) these adhesions using simple gauze or a small probe.
After the procedure, the child may take over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil) for pain if needed. Additionally, patients are encouraged to take several baths per day for the first few days. It is also important to pull the shaft skin of your child’s penis back four to five times per day for the first week after the procedure is completed and apply an antibacterial ointment liberally under the coronal groove, this helps to prevent these adhesions from reforming.
Lysis of Labial Adhesions
Labial adhesions occur in female children when their labial minora have failed to separate completely and there is a fibrous membrane connecting them. A child may appear to have a thin membrane covering her vaginal and/or urethral openings. In some cases, these adhesions are treated with creams or time. If the child’s urology specialist determines that a lysis of adhesions is necessary, the procedure is commonly completed in the office.
Local anesthetic cream is applied for the procedure. The anesthetic takes at least 40 minutes to take effect. After this, one of our licensed physicians or nurse practitioners will lyse (remove) the adhesion with a small probe or clamp.
After the procedure, the patient may take over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil) for pain if needed. An antibacterial ointment should be applied between the labial four to five times per day for the first four to five days after the procedure to prevent the adhesions from reforming.
After a circumcision, a membrane may heal across the urethra of the penis. This is often found during a physical examination by the child’s doctor or discovered when a child “sprays” urine when he begins toilet training. This small membrane is called a meatal web.
We will ask your child to urinate for us to obtain an uroflow and post void residual prior to the procedure. This allows us to determine the speed of his urinary stream and how much urine he empties. The child should come to the appointment with a comfortably full bladder.
After completing the urination tests, a local anesthetic cream is applied into and around the urethra. It takes at least 40 minutes for the cream to take effect. After this, the web will be cut in the office. We will ask the child to urinate after the procedure, to see if there is a change to his urine flow.
After the procedure, the child may take over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil) for pain as needed. The child should be encouraged to urinate frequently throughout the first three days to help the opening heal. Antibacterial ointment should be applied into the urethral opening several times each day to help reduce the chances of this web reforming for one week.
Separation of Skin Bridge
A skin bridge is a piece of skin that has adhered itself to the glans of the penis after a circumcision. This looks similar to a preputial adhesion with the difference being that the physician or nurse practitioner can place a probe or other device underneath the bridge of extra skin. These bridges often do not cause pain, but as a child ages, depending on the significance of the bridge, it may cause his penis to appear tethered, or bent, when erect.
Local anesthetic cream is applied around, over and under the bridge. It takes approximately 40 minutes for the cream to take effect. This bridge will then be separated and taken down by either a physician or nurse practitioner in our office. After the procedure the child may take over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil) as needed for pain. Our specialists will provide specific instructions on how to apply an antibacterial ointment in order to prevent the skin bridges from re-adhering.
Not all children with the conditions listed above may be good candidates for in-office procedures. Some children may need to have these procedures done in an operating room as an outpatient surgery. Our specialists carefully evaluate the overall health needs of each child before determining the most appropriate setting for the patient’s treatment.