Post-Laser Circumcision Care: Common Concerns and Solutions

Q: Post-Laser Circumcision Care: Common Concerns and Solutions

Hello： <br>1. <br>The wound condition is generally okay, but there are still some residual gauze fragments adhering. <br>It cannot be torn off with slight force, and I am afraid that pulling hard may cause the wound to tear. <br>Should this be addressed? --> If it has not fallen

Fifth day after laser circumcision?

Dear Dr.
Du,
I underwent a laser circumcision on May 8 due to phimosis (only a small part of the glans is visible during erection, and I cannot manually retract the foreskin).
During the procedure, tissue adhesive was used, and according to the doctor's instructions, I do not need to change the dressing.
I started to remove the gauze and elastic bandage four days post-operation and took my first shower.
I have a few questions:
1.
The wound seems to be generally okay, but there are still some remnants of gauze fragments adhering to it.
They do not come off with slight pulling, and I am afraid to pull too hard and cause a tear.
Should I address this issue?
2.
Due to nocturnal erections, I can still see a slight red spot of blood at one of the sutures.
It does not ooze blood, but I can absorb a small amount of reddish blood with tissue paper when I touch it.
Should I clean this area or change the dressing?
3.
While I can completely suppress any inappropriate thoughts to prevent erections while awake, I experience involuntary erections during REM sleep, which often wakes me up in pain, occurring quite frequently (e.g., four times in 2.5 hours last night).
This severely affects my sleep quality, and I am concerned about the impact on the sutures (as mentioned in point 2, which may cause the visible red blood at one suture).
Is there any way to avoid or alleviate this issue?
4.
After removing the gauze and elastic bandage, I am unsure if the persistent urge to urinate is due to edema pressure.
5.
Due to my previous phimosis condition, my glans is very sensitive post-surgery, and friction with my underwear feels like an electric shock, which is unbearable.
Therefore, I usually stay in my room without wearing pants.
However, I have read that it is advisable to increase exposure to shorten the adaptation period.
Should I force myself to wear underwear to train for adaptation?
6.
Regarding the sensitivity of the glans, I purchased a small bottle of "Lidocaine Spray" at the clinic, but its effectiveness seems inconsistent.
How long does the effect of this spray typically last?
7.
As mentioned in point 6, since the spray costs 650 NTD for a small bottle (10 mL), I find it somewhat expensive.
I am concerned that if the sensitivity issue persists, are there any other topical anesthetics (sprays/creams, etc.) that could be alternatives?
Thank you for your guidance.

Josh Hart, 30~39 year old female. Ask Date: 2024/05/13

Dr. Du Shixi reply Urology

Hello:
1.
The wound condition is generally okay, but there are still some residual gauze fragments adhering.
It cannot be torn off with slight force, and I am afraid that pulling hard may cause the wound to tear.
Should this be addressed? --> If it has not fallen off after seven days post-surgery, you can use saline solution to soften it and gently remove it.
2.
There is a slight red blood visible at one of the sutures, possibly due to nocturnal erections.
It does not ooze blood, but a tissue can absorb a small amount of red blood when touched.
Should I clean this wound or change the dressing? --> Follow the doctor's instructions; you can use a sterile cotton swab to gently absorb it.
3.
When I am awake, I can completely suppress any inappropriate thoughts to prevent erections, but during sleep, I involuntarily experience erections during REM cycles, which often wakes me up in pain (e.g., four times in 2.5 hours last night).
This severely affects my sleep quality, and I am concerned about the impact on the sutures (as mentioned in point 2, which may cause visible red blood at one suture).
This is quite distressing; is there any way to avoid or alleviate this? --> There is no way to prevent it.
4.
After removing the gauze and applying the bandage, I am unsure if the persistent urge to urinate is due to edema pressure.
--> Drink more water; it should help.
5.
Due to a past condition of phimosis, my glans is very sensitive post-surgery.
Rubbing against my underwear feels like an electric shock, which is unbearable, so I usually stay in my room without wearing pants.
However, I read that it is recommended to increase contact to shorten the adaptation period.
Should I force myself to wear underwear to train for adaptation? --> If the wound is healing normally, you should wear underwear.
6.
Regarding the sensitivity of the glans, I purchased a small bottle of "Lijiuin spray" at the clinic, but its effectiveness seems inconsistent.
How long does the effect of this spray typically last? --> Ask the prescribing doctor; it should not last too long.
7.
As mentioned in point 6, the spray costs 650 TWD for a small bottle (10mL), which seems expensive.
I am concerned that if the sensitivity issue persists, are there any other local anesthetics (sprays/ointments, etc.) that can be used as alternatives? --> None available.
Wishing you good health.

Reply Date: 2024/05/13

More Info

Post-laser circumcision care is crucial for ensuring proper healing and minimizing complications. Here are responses to your concerns based on medical knowledge and common practices following such procedures:
1. Residual Gauze Fragments: If you notice remnants of gauze stuck to the wound, it's important to avoid forcibly removing them, as this could cause tearing or further injury. Instead, you can gently clean the area with saline solution or warm water to help loosen the gauze. If it does not come off easily, it’s best to consult your doctor for professional removal to avoid complications.

2. Red Discharge from Sutures: A small amount of red discharge can be normal, especially if there is minor irritation or if the area is still healing. However, if you notice persistent bleeding or significant discharge, it’s advisable to clean the area gently with saline and apply a sterile dressing if necessary. If the bleeding continues or worsens, you should contact your healthcare provider.

3. Nocturnal Erections: Experiencing erections during sleep (especially during REM cycles) is a normal physiological response. However, if they are causing pain or discomfort, you might consider discussing this with your doctor. They may suggest strategies such as wearing supportive underwear at night or using a cold compress to alleviate discomfort. Relaxation techniques before bed may also help reduce the frequency of these occurrences.

4. Persistent Urge to Urinate: After surgery, swelling can occur, which may lead to increased sensitivity and a feeling of urgency. If this sensation persists or is accompanied by pain, it’s important to consult your doctor. They may recommend measures to reduce swelling or assess for any underlying issues.

5. Sensitivity of the Glans: It’s common for the glans to be sensitive after circumcision. Gradually increasing exposure to clothing can help desensitize the area over time. However, you should do this at a pace that feels comfortable for you. If the sensitivity is too uncomfortable, you might want to continue avoiding tight clothing until the sensitivity decreases.

6. Duration of Topical Spray Effect: The duration of effect for topical anesthetics like the "立久因噴劑" can vary based on the formulation and individual response. Typically, the numbing effect lasts from 30 minutes to a few hours. If you find it inconsistent, it may be worth discussing with your doctor to ensure it’s the right product for your needs.

7. Alternative Local Anesthetics: If you find the current spray too expensive or ineffective, there are other options available. Topical anesthetics like lidocaine gel or cream can be effective alternatives. These are often available over-the-counter or by prescription and can provide relief from sensitivity. Discussing this with your healthcare provider can help you find a suitable and cost-effective option.

In summary, post-operative care following laser circumcision involves careful monitoring of the surgical site, managing discomfort, and addressing any complications promptly. Always follow your healthcare provider's instructions and reach out to them with any concerns or unusual symptoms. Your recovery is important, and they can provide tailored advice based on your specific situation.

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