TEKNIK SIRKUMSISI

Berry Erida Hasbi

TIM BANTUAN MEDIS 110

ANGKATATAN XX
FAKULTAS KEDOKTERAN
UNIVERSITAS MUSLIM INDONESIA
MAKASSAR
2021
 TUJUAN PEMBELAJARAN
1. Definisi
2. anatomi
3. Indikasi dan kontraindikasi
4. Anestesi
5. Teknik dorsumsisi
6. Perdarahan intraoperatif
 SIRKUMSISI

Membuang preputium penis

sehingga glans penis menjadi
terbuka
• Lissauer T, Clayden G (October 2011). Illustrated Textbook of Paediatrics, Fourth edition. Elsevier. pp. 352–353. ISBN 978-0-7234-3565-5.
• Rudolph C, Rudolph A, Lister G, First L, Gershon A (18 March 2011). Rudolph's Pediatrics, 22nd Edition. McGraw-Hill Companies, Incorporated.
p. 188. ISBN 978-0-07-149723-7. Archived from the original on 18 January 2016.
• Sawyer S (November 2011). Pediatric Physical Examination & Health Assessment. Jones & Bartlett Publishers. pp. 555–556. ISBN 978-1-4496-7600-
1. Archived from the original on 2016-01-18.
 ANATOMI
PREPUTIUM

Urogenital system. Feneis, Pocket Atlas of Human Anatomy © 2000 Thieme, p. 165.
Male External Genital. Sobotta, Atlas of Human Anatomy. 14th edition. Urban dan Fischer. p.238
Male External Genital. Sobotta, Atlas of Human Anatomy. 14th edition. Urban dan Fischer. p.239
 INDIKASI
• Menjaga higiene penis dari smegma dan sisa-sisa urine .
• Mencegah terjadinya infeksi pada glans atau prepusium
penis.
• Mencegah timbulnya karsinoma penis
• Indikasi medis tindakan sirkumsisi
1. Fimosis atau parafimosis
2. Balanitis rekuren
3. Kondiloma akuminata, dan
4. Karsinoma skuamosa pada preputium
• Lissauer T, Clayden G (October 2011). Illustrated Textbook of Paediatrics, Fourth edition. Elsevier. pp. 352–353.
• Hay W, Levin M (25 June 2012). Current Diagnosis and Treatment Pediatrics 21/E. McGraw Hill Professional. pp. 18–19.
 KONTRAINDIKASI

• Hipospadia
• Epispadia
• Cordae
• Megalouretra
• Webbed penis (didapatkan jaringan diantara penis dan
raphe skrotum);
• Kelainan pembekuan darah (bleeding diarthesis) à
relatif
• "Manual for male circumcision under local anaesthesia". Geneva: World Health Organization. December 2009.
 TEKNIK DORSUMSISI
Kulit prepusium di sebelah kiri dan kanan ditegangkan ke lateral dengan klem kecil

Prepusium di sebelah dorsal dipotong memakai gunting pada garis midline, dari ujung distal ke arah proksimal
sampai sulkus koronarius

Pemotongan secara melingkar hingga kulit prepusium terlepas

Setelah kulit prepusium terlepas, dilakukan hemostasis untuk merawat perdarahan

Kulit proksimal dan distal dijahit dengan catgut

• Purnomo Basuki. Kateterisasi dan Sirkumsisi. Dasar-Dasar Urologi. Fakultas Kedokteran Universitas Brawijaya
Malang. 2003. hal 321.
• "Manual for male circumcision under local anaesthesia". Geneva: World Health Organization. December 2009.
• Shlamovitz, MD, FACEP. Dorsal Slit of the Foreskin. Online 2017 October 12. Available from URL:
http://emedicine.medscape.com/article/80697-overview#a7
REKOMENDASI à DORSUMSISI

Buku Pelatihan Sirkumsisi. TBM 110 FK UMI.

TIDAK DIREKOMENDASI

Buku Pelatihan Sirkumsisi. TBM 110 FK UMI.

portable
• Penggunaan kauter tidak direkomendasikan untuk
cutting karena efek panas ke penis
• Efek koagulasi dapat dipakai untuk kontrol perdarahan

monoplar
Disinfeksi lapangan operasi dengan providone iodine dari tengah keluar (sentrivugal)
 ANESTESI LOKAL
• Definisi à Obat yang memblokade konduksi atau channel natrium
pada dinding saraf yang bersifat sementara.
• Rekomendasi à lidokain (potensi sedang, mula kerja cepat, lama
kerja 60-120 menit.
• Teknik: Dorsal Penile Nerve block dan infiltrasi / ring block.
• Jangan lupa aspirasi.
• Analgesia tambahan: paracetamol tablet (dosis dewasa 500 mg) 1–2
jam sebelum pembedahan, dan 1 tablet selanjutnya 6 jam post
operasi.

• Latief, Suryadi, Dachlan, Anestesi Lokal. Petunjuk Praktis Anestesiologi. Fakultas Kedokteran. Universitas
Indonesia. 2010. hal. 97-104
Shlamovitz, MD. Dorsal Penile Nerve Block. Online 2017 october 12. available from URL:
http://emedicine.medscape.com/article/81077-overview#a4
• "Manual for male circumcision under local anaesthesia". Geneva: World Health Organization. December 2009.
 Local Infiltration

Insert the needle subcutaneously through the skin wheal and advance it distally while infiltrating
local anesthetic all the way to the tip of the foreskin (see image above).

Shlamovitz, MD. Dorsal Penile Nerve Block. Online 2017 october 12. available from URL:
http://emedicine.medscape.com/article/81077-overview#a4
 Circumferential Penile Block

This technique can be used for anesthesia of complex penile skin lacerations or before attempting to manually reduce
paraphimosis.
• Shlamovitz, MD. Dorsal Penile Nerve Block. Online 2017 october 12. available from URL:
http://emedicine.medscape.com/article/81077-overview#a4
 What about additional epinephrine?

• Only use anesthetic solutions without epinephrine when

administering injectable anesthesia to the penis.
• Injected anesthetic solutions that contain epinephrine have been
associated with penile ischemia and necrosis.

Emsen IM. Catastrophic complication of the circumcision that carried out with local
anesthesia contained adrenaline. J Trauma. 2006 May. 60(5):1150. (Medline)
 COMPLICATION
Failure to achieve adequate anesthesia à A different block should be
attempted as long as the toxic dosage of the anesthetic was not exceeded.

Skin sloughing à more common with distal shaft/glans injections and when
anesthetic that contains epinephrine is used.

Infectionà The injection site can become infected, but this is rare. A
prophylactic antibiotic is not recommended; rather, the patient should be
given detailed return precautions
• Emsen IM. Catastrophic complication of the circumcision that carried out with local anesthesia contained adrenaline. J
Trauma. 2006 May. 60(5):1150. [Medline].
• Kaplanian S, Chambers NA, Forsyth I. Caudal anaesthesia as a treatment for penile ischaemia following
circumcision. Anaesthesia. 2007 Jul. 62(7):741-3. [Medline].
Bebaskan dan desinfeksi glans penis
Pasang klem arah jam 6, 11, dan1
Gunting preputium arah jam 12 dan lakukan jahit kontrol
 PERDARAHAN?
• Mencari sumber perdarahan dengan menghapus daerah luka dengan
menggunakan kasa à jepit dengan klem/pean arteri kecil.
• Ligasi dengan mengikat jaringan sumber perdarahan dengan catgut.
• Potong simpul sependek mungkin.
• Cari seluruh sumber perdarahan lain dan lakukan hal yang serupa.
• Jika mempergunakan flashcutter, cukup menyentuh pendarahan
dengan probe, seketika langsung terhenti.
• "Manual for male circumcision under local anaesthesia". Geneva: World Health Organization. December 2009.
• Shlamovitz, MD, FACEP. Dorsal Slit of the Foreskin. Online 2017 October 12. Available from URL:
http://emedicine.medscape.com/article/80697-overview#a7
 Simple tie. A: the knot with two throws. B: the knot with three throws. C: the finished knot pulled tight.

• "Manual for male circumcision under local anaesthesia". Geneva: World Health Organization. December 2009.
 Haemostasis with artery forceps and tying off (suture ligation) of blood vessels

• "Manual for male circumcision under local anaesthesia". Geneva: World Health Organization. December 2009.
 PENYULIT

Hematoma

Oedema

Glands penis terpotong

Glands penis terbakar elektrocauter

THANK YOU