Prepuce Transillumination: A Safety Tool in Forceps-guided Circumcision

Background: Injury or even amputation of the glans or the penile shaft occurs rarely but can be a tragic circumcision-related complication. The forceps-guided technique can cause this complication due to an inability to visualize the glans before incising. This study was designed to solve this problem by transilluminating the prepuce before the incision, thus exploring whether it contains any tissue between its layers and visualizing what is being done rather than performing the procedure blindly. Methods: Forceps-guided circumcision was done on 432 males, from August 2018 to July 2019.The mean age of patients was 15.57 (1–348) days. The pulled prepuce was transilluminated, showing the prepuce and verifying that no glanular or penile tissue was involved in the forceps lock before incising. Results: The mean follow-up period was 12.45 (2–35) days. Twenty-one patients had postoperative bleeding, and six patients had a hematoma. Fourteen of the 21 patients were managed using a tight bandage; the remaining 7 patients needed surgical exploration. None of the patients had glanular or penile injury. Conclusion: Transilluminating the prepuce as a modification of forceps-guided circumcision is a protective safety step before cutting the prepuce, to eliminate the incidence of glanular or penile injuries.