The following information is taken from Family Practice, September 7th, 1998.


[MALE CIRCUMCISION]
Quick and painless approach
has 10x lower complication rate

New protocol eliminates
'barbaric' nature of technique


By Monica Matys

NEW WESTMINSTER, B.C. - Using the combination of a modified circumcision technique and a new pain control protocol, Dr. Neil Pollock's quick, bloodless and painless approach is changing the standard of practice in British Columbia.

Dr. Pollock is a mohel, an individual recognized by the Jewish community as someone allowed to perform circumcisions. After performing thousands of procedures, he spent years researching and consulting with experts to find a better method. Dr. Pollock used this knowledge to modify the mogen clamp method - a technique that has existed since the 1950s - and recently added a new pain control protocol to his technique.

"The technique has evolved to now being almost consistently a painless, bloodless procedure that's done in 50 seconds," said Dr. Pollock. "It's also safe; the complication rate has been 10 times lower than what's quoted in the literature for circumcision."

With the mogen clamp technique, two forceps are attached to either side of the foreskin and another forceps is inserted between the glans and the foreskin. The dilated foreskin allows for clear visualization of the glans. The forceps with the foreskin are then pulled through the clamp opening. Finally, the clamp is closed over the foreskin, which is then cut off.

Pain control protocol

Dr. Pollock combines this with a five-step pain control protocol. First, he administers 40-80 mg of acetaminophen (depending on the baby's weight), followed by 3 g of Emla cream, which is applied 45 minutes prior to the procedure. The infant is then given several sucrose solution soothers to suck on, made up of granulated brown sugar in gauze dipped in grape juice. Next, the dorsal penile ring block is injected - a new type of block combining elements of the ring block with the dorsal penile nerve block-consisting of 2.25 cc of 0.5% Xylocaine (no epinephrine). A few seconds before injection, the syringe is warmed, and 0.1 cc to 0.2 cc of sodium bicarbonate are added to buffer the sting of injection. Dr. Pollock waits 7-10 minutes, and then performs the procedure in about 50 seconds.

"The important thing about the dorsal penile ring block is that I've found the effectiveness was related more to the volume of solution injected than the absolute milligrams of Xylocaine," said Dr. Pollock. "All of the texts describe using 1 cc of 1.0%, whereas I use 2.25 cc of 0.5% xylocaine."

Widely used circumcision methods include the Gomco and the Plastibell techniques, which can take up to 15 minutes to complete. "A lot of the objection to circumcision is in the pain and barbarism in the technique, and now that's been eliminated." Dr. Pollock added that the cost of his technique is lower in hospital, and that babies up to four months old can undergo the procedure.

Dr. Pollock is hoping to get the word out about his new combination method to CME courses and conferences. He advised that family physicians should familiarize themselves with new methods for circumcision.

"Before physicians do circumcisions, or refer to people who do circumcisions, they should be very aware of what pain control protocol that doctor is using and what circumcision technique that physician is using to make sure the patient undergoes the safest, quickest and least painful technique."

Dr. Krista Nickel, an anesthesiologist at the Royal Columbia Hospital in New Westminster, saw her son undergo Dr. Pollocks procedure. "I wasn't prepared to have him circumcised unless it was done totally painlessly. When I saw Dr. Pollock's video at the hospital where I gave birth, I thought it was great that he was striving to do it totally painlessly."

Dr. Nickel indicated that her son was fine during the swift procedure and she was happy with the results. There are a several medical reasons for circumcision. The foreskin can trap bacteria, which can lead to urinary tract infections. Other problems can occur later in life, such as foreskin infections. There is also evidence that circumcision reduces the risk of penile cancer, certain STDs and AIDS, as well as sexual dysfunction later in life.