Important COVID-19 Message:

Due to the current situation we have instituted important changes to our clinic to increase safety of our patients & staff:

  1. We have the option of selected few Private Visits which allows the patient to be alone in the whole clinic with the doctor & his assistant. No other patients would be scheduled at the same time.  (Please inquire specifically for this option)
  2. All of our regular visits are spaced out and we try our best to avoid having more than one customer in the same room or area at the same time.
  3. We offer telemedicine & virtual visits for consultations. We also offer same day consultation and procedure.

In addition we have implemented the following extra precautions beyond the CDC requirements for all visits:

  1. The staff and the doctor wear mask and protective equipment at all times.
  2. We ask our customers to wear a mask when in the clinic at all times.
  3.  We have implemented extra hand washing and room cleaning.
  4. We ask our customers that arrive early to call our office and wait in the car.
  5. Any patient with recent symptoms of fever or recent contact with someone with symptoms are not allowed in the room.
  6. The doctor wears a double mask, including a face shield & N-95 high filter mask during procedures in addition to additional body gown.

We understand that many of our adult patients may be experiencing discomfort, infection & pain that require procedures without delay.  Also, we understand that infant circumcision can lead to further pain, complications & possible need for stronger anesthesia if delayed even by few weeks.  A prompt procedure at the youngest age possible can avoid these issues.

Circumcision Los Angeles

AAP: Need to Re-Do Circumcision Rises, Reasons Unclear

Is circumcision revision becoming more common?

Could this be because doctors are more hesitant to take off enough skin compared to Mohels?

This issue comes up at times with circumcision or bris. How much foreskin to take off is tricky. Doctors actually usually tend to take off less. I have seen adults and children in clinic that you could not tell that they had a circumcision before. The parents are at times unhappy with this & also it could have serious halachic problems if it was not done correctly initially (it can invalidate the bris if it was like that initially) Orthodox Mohels are very careful with this; doctors care less. On the other hand If you take off a lot you are left with a lot of denuded skin which takes longer to heal and it doesn’t look very appealing to the parents while it’s healing.

What makes the situation more complicated is that the foreskin slides up & down & can heal in different positions. At times the skin can attach to the head of the penis that could be easily freed.  For this reason its important for the parents to retract the foreskin if it slides down during the first 2 weeks after the procedure.  Some of the skin is also not foreskin but it is the remnant of the membrane below the foreskin that can get thicker and darker and look like a regular skin.

This happens often with babies who have more fat in their pelvic region.   Some of this fat is absorbed when the baby gets older.  Some of it goes back to normal during puberty.  One test that can be done is to pull back on the pelvic fat and skin and see if the head of penis is till covered.  Ideally the skin should end before the corona (the rim), if not it could invalidate the bris if it was always that way. A competent mohel should be consulted in these cases.
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BOSTON MA — An unexplained increase in the amount of revision circumcisions has pediatric urologists wondering if these finding is real and, if so, what induced it.

Data contributed by pediatric nursing homes nationwide showed a 119% increase in the rate of revision circumcision processes from 2004 to 09.

In contrast, the fee of primary circumcision elevated by 19%, and procedures to get rid of penile adhesions rose by simply 37%.

Closer inspection with the data showed wide variation by hospital in the rate of revision circumcision throughout the study period, Paul L. Kokorowski, MD, reported here at the American Academy involving Pediatrics meeting.
“We found that you hospitals had dramatic soars in revision circumcision processes [approaching 1, 000% in most cases] while others had more modest increases, ” said Kokorowski, of Kids Hospital Boston.
“Only a few hospitals showed stable costs or slight decreases, ” he said.
Anecdotal evidence has suggested that an increased frequency of revision circumcision in recent years, despite historically low costs. Published data have consisted largely of small event series, some spanning a few years (Int Braz J Urol 2006; 32: 454-458, Pediatr Surg 2002; 37: 1343-1346, J Urol 1995; 153: 180-182).
Seeking to provide more informative data about them, Kokorowski and colleagues looked for the Pediatric Health Info Systems (PHIS) database, which usually comprises 28 hospitals that contribute data on outpatient pediatric surgery services.
They identified pediatric patients who underwent one of three types of distinct penile procedures during 2003 in order to 2009:
Revision circumcision
Major circumcision
Lysis of penile adhesions
The analysis integrated 34, 568 patients who underwent one of the targeted procedures. The total was comprised of 5, 632 revision circumcisions, 25, 768 primary circumcisions, and 3, 168 procedures pertaining to lysis of penile adhesions.
The 119% increase in the volume of revision circumcision on the participating hospitals stood out as significantly more than the increases in one other two procedures (P<0. 001).
The rate of revision procedures increased within a near-linear manner over the period reviewed, starting with a 17% climb from 2004 to 2005 and then to 47% for 2006, 71% pertaining to 2007, 91% for 2008, and 119% for 09.
In contrast, the fee of primary circumcisions peaked with 22% to 23% in the course of 2007 and 2008 previous to declining to 19% over the baseline level.
Your rate of adhesion-lysis processes declined by 11% coming from 2004 to 2005, peaked with 45% above baseline inside 2007, and then descended to 37% in 2009.
In an effort to discover factors contributing to the increased rate of revision circumcision, investigators performed an analysis limited to 13 hospitals that provided complete data on the three penile procedures for every year of the study period. They found simply no consistent patterns.
The findings left unanswered the question of what induced the large increase inside revision circumcision procedures over a five-year period.
“Revision circumcision does look like more common at specific PHIS hospitals and this also might represent a much more overall increase in updates, ” said Kokorowski. “Unfortunately, a result of the limitations of our dataset, we can’t speculate on the reasons for this transform. ”
Kokorowski and co-investigators had no relevant disclosures.
http: //www. medpagetoday. com/MeetingCoverage/AAP/29075
Examined by Robert Jasmer, MD Associate Clinical Professor involving Medicine, University of California, San Francisco and Dorothy Caputo, MUM, RN, BC-ADM, CDE, Health professional Planner
Primary Source
U . s . Academy of Pediatrics
Supplier Reference: Kokorowski PJ, et al “Is circumcision revision becoming more established? ” AAP 2011; Abstract 13760.

AAP: Need to Re-Do Circumcision Rises, Reasons Unclear – Circumcision Los Angeles

 

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