penisdoctor.com

 am 29 years old and I would like to be circumcised. I want to know what is the average cost of a circumcision. Also, I am terribly afraid of needles. How many injections do I have to get for the anaesthetics? Is it one or three? In your experience in working with patients how painful do these injections appear to be?

Theo from Jamaica

Hi Theo,

Please don’t worry about needles.  We can apply some numbing cream to your skin so you will not feel them.   Cosmetic and painless circumcision is the specialty of the house.

Usually 3 needle sticks are involved, but we try to inject stick # 2 and # 3 in an area previously anesthetized.   Also we use the technique of the “advancing wheal” meaning the anesthetic fluid already inside the tissues precedes the needle, so when the needle gets that area it usually is not felt.  At any rate trust us to treat you very gently and compassionately.

This is our bread and butter.  My girlfriend is from Portland and remembers Bob Marley as a young man, playing down below in a canteen with his friends.

All the best,

Harold M. Reed, M.D.
305-865-2000

 

— In PROCIRCORG@yahoogroups.com, “jamb1234″ wrote:

I was wondering Dr. Reed if a patient would want to get recut and they wanted the cut done with the Tara Klamp, would you do it?. Seeing alot of pictures, the cut-line never comes-out as well as using a clamp. Sutures, can be fastidious and the best painter would not get be able to get that line as fine as with a clamp; and any thing else will never look neo. My friend got cut and freehand but it’s not as smooth as mine. I believe that using the Klamp would be great for him. He doesn’t want stitches; one can always tell the
difference.

If you can do it, I will let him know and we will be driving over for him to
get it done. If you want I can send you pictures of his peepee:-) Thanks, JAMB.

Jamb, we do not use the Kara Klamp. We believe we have more precision and neatness with a 15 blade, and of course a steady hand. We do show work in progress to patients with a hand held mirror and have been known to tighten a circumcision from as little as 1/8 to 1/4 of an inch if needed. This would not be feasible with a Klamp. We cannot possibly do every adult circumcision in the
world, and gladly say to those who wish to Klamp, look for a Klamp doctor.

Would certainly be interested in seeing some Klamp results. My E-mail address in infos@penisdoctor.com First, send me a simple letter to let me know it is on the way, as we receive over 250 E-mails a day.

Many thanks,

Harold M. Reed, M.D.

>

— In PROCIRCORG@yahoogroups.com, “Ms. VG” wrote:

I’m curious to know with local injections, to which part of the penis or pubic area is injected? Also how many injections are there?

if there is more than one, does the doctor wait at least until the first injection takes effect? How many injections total?

THanks.

VJ

Hi VJ,

The penis is innervated (supplied by nerves) which enter both from the top and underside. A ring of anesthesia could be placed around the base of the penis and ultimately the penis would become anesthetized for 3 to 4 hours if long acting agents are used (which is what we do). Please understand distal nerves are always in the center of the nerve bundle, so when injecting they are the last to become anesthetized. This could take up to 20 minutes as patients don’t want to feel anything.

Our injection technique uses the “advancing wheal” principle. A wheal is a swelling like you could get from an insect bite.

In that we are always pushing anesthetic in with our syringe in advance of the needle, ideally you should only feel one needle stick.

However, waiting for a ring of anesthesia at the base to take effect distally could take 20 minutes, if we inject anesthesia both at the base and more distally in the circumcision area, we achieve total anesthesia in about 10 minutes. Anesthesia costs virtually nothing, so this is what we do staying within the limits of safety.

For those who do not wish to feel even a needle stick, EMLA or Betacaine cream can be applied to the skin and after 20 minutes, the skin is numb.

Most of our patients are quite manly and tolerate a little needle stick or pinch without making a big to do over this.

When I see the dentist I say “no anesthesia” whatsoever unless he really insists.

I only wish you could talk to over 5000 patients we have done here and you would hear a resounding reassurance, “this is not at all painful.”

My assistant Anne and I once traveled 2500 miles to Nevada to hear a doctor lecture on ambulatory surgery and he said rule number one is never to hurt your patients. And we looked at each other and said, “do you mean we came 2500 miles to hear someone tell us this no brainer.” But you know, this was the best advice we could have ever received.

Harold M. Reed, M.D.

— In PROCIRCORG@yahoogroups.com, “Ms. VG” wrote:
>
> I’m curious to know with local injections, to which part of the penis or pubic
area is injected? Also how many injections are there?
>
> if there is more than one, does the doctor wait at least until the first
injection takes effect? How many injections total?
>
> THanks.
>
> VJ

Another paper presented at the AUA, April 2009 (Chicago) by Dr. Renea Strum and group from Houston, Tx. Two cohorts were examined, Peyronie’s patients versus all those receiving penile Doppler exams (erectile dysfunction) . The testosterone level of the Peyronie’s group was statistically lower, 306 versus, 372 ng/dl for the erectile dysfunction group.

Harold M. Reed, M.D.

Presented at the AUA April, 2009 (Chicago) by Drs. Sergio Moreno and Abraham Morganthaler.

121 patients seen for Peyronies were evaluated. 54% of the patients had testosterone deficiency compared with non Peyronies of 37%. Testosterone is helpful in wound repair and erectile function.
Further analysis will be done.

Harold M. Reed, M.D.

Circumcision is beneficial.  (courtesy of Joshua, unashamedly procirc)

What is important about the article below is that it comes from the South African Cochrane Center.

Their earlier document from 2003 concluded “We found insufficient evidence to support an interventional effect of male circumcision on HIV acquisition in heterosexual men. The results from existing observational studies show a strong epidemiological association between male circumcision and prevention of HIV, especially among high-risk groups. However, observational studies are inherently limited by confounding which is unlikely to be fully adjusted for. In the light of forthcoming results from RCTs, the value of IPD analysis of the included studies is doubtful. The results of these trials will need to be carefully considered before circumcision is implemented as a public health intervention for prevention of sexually transmitted HIV.”
http://tinyurl.com/cggdaq

This statement has been held up high by anti-circ activists as “proof” that there is not enough evidence to recommend male circ and an intervention in the battle against HIV/AIDS.

The new Cochrane review (see report below) changes all that.

Siegfried now states: “”Research on the effectiveness of male circumcision for preventing HIV in heterosexual men is conclusive,” adding, “No further trials are required to establish that HIV infection rates are reduced in heterosexual men for at least the first two years after circumcision.” ”

This must count as another small victory in the battle against the psychosexually motivated anti-circ lunatics.

See 2009 abstract here: http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003362/frame.html

=========================
Studies Provide Sufficient Evidence To Recommend Male Circumcision As HIV Intervention, South African Researchers Say

Main Category: HIV / AIDS
Also Included In: Men’s health; Sexual Health / STDs
Article Date: 17 Apr 2009 – 7:00 PDT

Researchers from the South African Cochrane Center concluded Wednesday that sufficient evidence exists that male circumcision reduces the risk of HIV transmission among heterosexual men and the procedure should be considered an appropriate HIV intervention strategy, the SAPA/Mail and Guardian reports. Located at the South African Medical Research Council, the Cochrane Center is part of the Cochrane Collaboration, an international network of researchers that reviews the effects of interventions to inform health care decisions and policy. Although the center in the past did not recommend male circumcision as an HIV prevention tool because of insufficient evidence, researchers “changed their previous conclusions” after reviewing data from three recent African trials, Nandi Siegfried, co-director of the center, said.

According to Siegfried, circumcision helps prevent against HIV by removing foreskin cells, which contain receptors that enable the virus to enter the cells. She said, “Research on the effectiveness of male circumcision for preventing HIV in heterosexual men is conclusive,” adding, “No further trials are required to establish that HIV infection rates are reduced in heterosexual men for at least the first two years after circumcision.” Although Siegfried recommended that policymakers include male circumcision as an additional intervention in HIV prevention programs, she also noted that officials should consider cultural and environmental factors when designing circumcision programs.

According to the SAPA/Mail and Guardian, researchers will need to conduct further studies to determine whether male circumcision provides protection against HIV to female sexual partners or to men who have sex with men (SAPA/Mail and Guardian, 4/15).

http://www.medicalnewstoday.com/articles/146480.php

hello i had to get a circumcision procedure from another doctor about 2  years ago. the problem is that too much skin was taken off, especially the outer skin. i never had a problem with the glans rubbing against  clothes, but the inner skin is very sensitive and even painful in my  everyday activities. i’d like to do some foreskin stretching to get  more of my outer foreskin to hopefully cover some of the inner  foreskin. i am new to all of this so i don’t what stretching  techniques there are for someone like me with not much skin left??

 anyone have experience in that area? also, i want to make sure that  only the outer skin grows, if possible. i don’t want to do foreskin restoration, just loosen everything up as it was done too tightly…   also, there was some scarring, i believe due to the tight nature of the  procedure. this has caused some curving in the direction of the scarring. is there any cream, etc. that can reduce scarring or is
the only way to correct that going to be surgery? i was planning on  probably going to dr. reed to get everything cleaned up once i grow a little more skin…

Dillon,

Hi Dillon,

How this could be avoided.

We make the first cut distally exactly in accordance with patient wishes, how much inner skin to leave behind. The second or upper cut is often done twice, the first is moderate and could be made tighter if when the two edges are temporarily brought together to see how much tension there is on the peno-pubic angle.

Ultimately the patient participates in making the decision for the final cut in the operating room with a hand held mirror. The urologist is an agent for the patient.

This is your circumcision, your calling card.

Harold M. Reed, M.D.

 In PROCIRCORG@yahoogroups.com, “sergio” wrote:

How much will this cost and is there some type of payment plan… i
really want to cut my foreskin off of my penis… this message is
mainly for the doctor

Sergio,  when considering adult circumcsion, think cosmetic adult circumcision.

Your penis is your calling card. I have done over 5000 circumcisions and still going strong. Whereas other doctors can do it in 10 to 15 minutes, we take close to an hour, and you have a hand held mirror to be sure it is being done exactly to your specifications. There are at least 4 considerations, high or low, obliquity of cut, remove or not the frenulum, loose or tight and all stages in between.

Our fee is 250 for consultation and 1500 for cosmetically performed adult circumsion. While we do not accept deferred payments, we have noted our credit worthy patients can get a cash advance on their credit card.

Harold M. Reed, M.D.
305-865-2000

Received a call last week from a patient who was unhappy with the contour of his penis post AlloDerm and also started to noted some hardness and some discomort, and wanted it removed.  Yesterday, call updated, leakage of fluid noted.  Patient will be seen ASAP this Monday and hopefully will have drainage of abscess and possible removal of an infected graft.  Every so often we see the occasional very affluent patient who says, “money is no object, put is as many AlloDerm pieces as you can.”

Please keep in mind overpacking the penis can lead to vascular compression and without blood flow, the patient is more likely to have an infection.   Moderation is always a good idea with elective surgery.

Avoid too much surgery on the penis at one time.  Can interfere with vascularization, so important for wound healing and lymphatic drainage.

Harold Reed, M.D.

Harold M. Reed, M.D.

Jill Stein
November 01, 2007
AMS 700 Series devices elicit high degree of patient satisfaction 

PARIS ?Early results suggest that patients like the newly modified AMS 700 series inflatable pump penis prosthesis. 

The findings are based on a six-month follow-up of 32 men diagnosed with organic erectile dysfunction who underwent implantation of an AMS 700 series penile prosthesis with the new Momentary Squeeze Pump. Findings were presented here at the Soci?t? Internationale d’Urologie 29^th Congress. 

Overall, there was a high degree of satisfaction with respect to ease of inflation and deflation of the device as documented by patient questionnaires, said principal investigator Ajay Nehra, MD, professor of urology at Mayo Clinic College of Medicine in Rochester, Minn. ?Developments in the field of biosynthetic materials have allowed physicians the use of artificial/mechanical devices to replace malfunctioning or damaged body parts and organs,? Dr. Nehra pointed out in a poster presentation. ?These devices, or prostheses, are not compatible with long-term error-free function and are limited to minimal local tissue reaction. They have replaced earlier attempts at using tissue from donor areas and even xenografts in substituting damaged organs.? 

Historically, penile prosthetic surgery did not become popular until the early ’70s with the introduction of the first inflatable penile prosthesis and paired semirigid intercorporeal sponge-filled silicone implants followed by the flexirod prosthesis.   

As for the hydraulic devices that are used today, modifications have resulted in significant improvements in overall mechanical failure rates. Recently, the FDA approved additional modifications in the AMS 700 series. Specifically, changes were made to the scrotal pump to ease deflation. In addition, angulation changes were made in the exit tubing of the penile cylinders to ease proximal and distal positioning. A new feature was added to the pump’s fluid to resist flow into the deflated cylinders caused by pressure on the fluid-filled reservoir with auto-inflation. 

Of the study participants, 29 had primary placement of the device, and three underwent explant of malfunctioning penile prosthesis and immediate re-implant of an AMS 700 MS prosthesis. There have been no cases of infection.      

Fifteen of 19 patients who completed the questionnaire six months after surgery said that they were very satisfied with the device, two re-ported being moderately satisfied, and two described themselves as somewhat dissatisfied. 

All 19 respondents agreed that it was easy to find the device for inflation of the cylinders. Eighteen patients agreed or tended to agree that it was easy to hold the pump while inflating, and 18 reported that there was a reasonable amount of force required to inflate the device. Sixteen reported that they could inflate the device with relative ease. 

Eighteen respondents felt that the force required to initiate deflation was reasonable. Nineteen reported that the amount of time required to hold the deflation button to deflate the device was reasonable, and all of them stated that the amount of time required to actually deflate the device was reasonable. Seventeen stated that the overall ease of deflating the prosthesis was either very easy or easy.