Kondisi umum 2. skrotum). Riwayat penyakit dahulu: penyembuhan luka 3. ANAMNESIS DAN PEMERIKSAAN FISIK ANAMNESIS 1. Indikasi sirkumsisi 2. Sirkumsisi – Download as Powerpoint Presentation .ppt /.pptx), PDF File .pdf), Text File Indikasi Fimosis atau parafimosis Balanitis rekuren Kondiloma. DEFINISI: Memotong Prepusium dengan membuat irisan melingkar INDIKASI Karsinoma Penis mengenai infeksi Balano Postitis. Medis.
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Home Documents Kontraindikasi circumsisi.
Kontraindikasi circumsisi Download Report. Published on Jul View Download 1. Kontraindikasi Sirkumsisi tidak boleh dilakukan pada: Tentu saja bila ada infeksi pada kulit penis dan sekitarnya lebih baik disembuhkan dulu, dan bila keadaan umum kurang baik harus diperbaiki. Contraindications Contraindications for circumcision include prematurity, anomalies of the penis eg, chordee, or curvature of the penishypospadias, epispadias, concealed or buried penis, micropenis, webbed penis, and ambiguous genitalia.
Bleeding diatheses are not absolute contraindications for circumcision, but circumcisions should be discouraged in these cases. If, after being fully informed of the increased risks of complications, the family insists on circumcision, careful evaluation, clearance, and patient preparation and treatment both before and after the procedure by a pediatric hematologist may optimize the likelihood of a successful outcome.
Circumcision should be delayed until the baby has left the premature baby unit and is thriving. Circumcision should be delayed until the baby has not only regained birth weight but is showing consistent weight gain.
If the boy is ill at the planned time of circumcision the operation should be delayed until the boy is well again. Because this condition causes prolonged bleeding from even minor cuts any surgery is normally to be avoided. However, the ‘Plastibell’ might sometimes be able to be used since it acts by crushing and sealing the blood vessels rather than by cutting through them.
In this condition the urethra, or water pipe, opens onto the under surface of the penis shaft instead of the end of the glans. The normal treatment, which is not commenced until the boy is about 4 or 5 years old, is to use the foreskin to reconstruct the urethra. The boy will end up circumcised but it is essential that the skin is available for the reconstruction.
PagesSeptember 14, However, the procedure has been found to have been of questionable benefit and to be associated with both immediate and delayed risks and complications. These in turn may produce undesirable psychologic, sexual, and medico-legal difficulties. indiasi
Circumcision is considered with respect to carcinoma of the cervix, penis, and prostate; there is ibdikasi evidence that circumcision of the newborn affords protection against subsequent development of these cancers in individuals who practice good personal hygiene.
This article is historic in nature. Preston’s article along with that of Leitch, which was also published indisproved the false claim by Abraham Wolbarst that male circumcision could prevent penile cancer.
Its publication influenced the American Academy of Pediatrics which issued a statement the following year that said “there are no valid medical indications for circumcision in the neonatal period.
Goodwin13 has observed that, “circumcision is a beautification comparable to rhinoplasty, and a circumcised penis appears in its flaccid state as an erect uncircumcised organ sirkhmsisi a beautiful instrument of precise iindikasi.
Complications Complications of circumcision may be regarded as immediate or delayed. The immediate complications fall into three categories: It may be caused by inadequate hemostasis, blood coagulapathies, or the existence of anomalous vessels. He found 35 instances of hemorrhage of which four required sutures. Infection of the wound in circumcision is also a fairly common complication.
It is manifested by local inflammatory changes, ulceration, and suppuration. Shulman et al15 have recorded a case of staphylococcal septicemia giving rise to sirkumaisi of the femur, and a fatal case of septicemia and pulmonary abscesses, both of which were ascribed to infection of circumcision wounds. A common complication of circumcision is loss of penile skin.
This can result from pulling too much of the skin from the shaft up over the glans during the operation. The remaining skin slides back, leaving a denuded penile shaft. Major losses of penile skin usually occur, however, because of a complicating infection, the use of the electocautery, or improper surgical technique. Van Duyn and Warr17 reported a case of routine circumcision, performed by an experienced, competent pediatrician with use of a circumcision clamp, that resulted in wound dehiscence and required replacement by split skin grafting.
Additional complications include accidental lacerations of penile or scrotal skin, or both, incomplete circumcision with formation of adhesions and secondary penile deformity, and accidental amputation of the glans indiksai secondary postoperative hemorrhage, and retraction ofthe penis into a sigkumsisi position by contraction, healing, and fibrosis of the circular wound.
One could logically expect the de-epitheialized, edematous, bleeding glans to become inflamed, bruised, or infected, with subsequent development of fibrosis and scarring. Meatal stenosis, with its symptoms of dysuria, increased urinary frequency, and enuresis, is not related either to the method indikazi circumcision or to the skill with which it is performed as it is a late complication.
Delayed complications of circumcisions may sorkumsisi only be anatomic; they may also be psychologic. Settlage19 has stated, “Concern for the psychologic development and future health of the child requires that events in the neonatal as airkumsisi as any later stage of development be managed in such as a way as to keep tension in the child within tolerable limits.
It is interesting to note that all of the reasons advanced for routine circumcision have to do the prevention of certain conditions, not with the establishment of a condition such as strong teeth and bones or a normal cardiac reserve. Avoidance of harm is not to be equated with provision of kndikasi just because it doesn’t kill, that doesn’t mean it helps.
Actually the presence of phimosis cannot be determined at birth because histologically the prepuce is still developing at this time and its separation is usually incomplete. Ballooning is now regarded as a normal stage of development and not an indication of a need for circumcision.
The fortunate rarity of this condition is possibly the result of the persisting attachment of the prepuce to the glans. In these cases eirkumsisi foreskin is carrying out its prime function of protecting the underlying glans;1,12,18,21,24,25 if it is removed, a meatal ulcer due to the ammonia will almost certainly sikumsisi.
indikasi sirkumsisi pdf download – PDF Files
Venereal disease is indikasl prevalent in the lower socioeconomic groups and these are the groups sidkumsisi are most likely to be uncircumcised. Indikkasi are also the groups in which there is a poor standard of personal hygiene. The lower socioeconomic groups are also those with a higher incidence of tuberculosis but one could be excused for doubting that the retention of the prepuce renders one more susceptible to tuberculosis. Post hoc ergo propter hoc is invalid logic. Herskowitz21 has noted that Spock’s9 argument that circumcision helps a boy to feel “regular” is cultural, and wonders if Spock would sirrkumsisi circumcision of the clitoris in a society where that is the usual practice.
It is the duty of the medical profession to lead rather than follow a community’s standards of health care. Benjamin Spock later changed his mind and came to oppose circumcision. On the one hand is Morgan’s18 assertion that coitus without a foreskin is comparable to viewing a Renoir while colorblind due to the prepuce lubricating the glans and permitting easier penetration.
On the other is the statement that after circumcision the glans becomes less sensitive, resulting in a more delayed orgasm, and this a lessening of premature ejaculation.
Goodwin13 quoted a surkumsisi discussing delayed orgasm as prostatectomy as saying, “It takes about 15 minutes longer, doctor, but we don’t begrudge a moment of it. Perhaps why American mothers seem to endorse the operation with such indikxsi is the fact that it is one way an intensely matriarchal society can permanently influence the physical characteristics of its males, and concluded: So does the ear, but the removal of this rather ugly appendage is frowned upon, and in one famous instance cutting it off lead to war – the so-called war of Captain Jenkin’s ear.
Kelainan Fimosis (Phimosis)
One can be grateful that this worthy mariner did not lose his prepuce under similar circumstances, for it is rather likely the battle indikasl still be raging. There now follows a discussion of cancer of the cervix. Later research has established the role of the human papillomavirus HPV and smoking in the etiology of cancer of the cervix. The foreskin is no longer believed to cause cancer. Factors known to be associated with a high degree of risk of developing cervical cancer include low socioeconomic status, early marriage, multiple marriages, extramarital relations, coitus at an early age, nonuse of contraceptives, syphilis, and multiparity.
The two populations live siekumsisi by side but do not intermingle. New data29 from Fiji 25 years later, however indicated that natives of Fiji have a lower incidence of cancer in general, whereas the immigrant Hindus have a much higher incidence of cancer of all sorts. Perhaps this reflects improved sirkumsisl on cancer detection developed over the intervening years, but in any case the data no longer retain their original significance.
Circumcision probably improves the hygienic status of the penis in circumstances where a low standard of hygiene would otherwise prevail. Kmet’s30 group studied circumcised orthodox Moslems, circumcised “emancipated” Moslems, and uncircumcised non-Moslems in Yugoslavia. They found premalignant lesions of the cervix to be 11 per 1, in the uncircumcised nonMoslems, 5.
This would indicate circumcision to be of sirkumsiei benefit in protecting women who live in cultures zirkumsisi adhering to religious rules regarding sexual hygiene, promiscuity, and genital cleanliness. A possible weakness in Kmet’s incikasi is that sikrumsisi were unable to obtain any data regarding the percent distribution of the circumcised males or the types of prepuces present in the uncircumcised.
Aitken-Swan and Baird’s31 group of 54 husbands whose wives had pre-clinical and clinical cancer of the cervix included 12 who were completely and 10 who were partly circumcised, compared with 56 husbands whose wives were in a control group, of whom 14 were completely and 14 partly circumcised.
Thus complete circumcision was found about as frequently in husbands of patients with cancer as in husbands of controls. Boyd and Doll32 found the discovery rate for cancer of the cervix among non-Jewish women whose marital partners were circumcised to be no different from the rate among non-Jewish women with circumcised husbands.
Jones et al33 found the incidence of cancer of the cervix not to ondikasi related to the absence of circumcision in the spouse or other sexual partners.
Kelainan Fimosis (Phimosis)
Circumcisionwas as common among the husbands of a group of women with certain cervical cancer as among husbands of a control group of women. Khanolkar34 found the cervix to be the site of origin of cancer more frequently in Moslem than in Parsee women with cancer, although the husbands of the former are circumcised and the those of the latter are not.
The Parsees on the other hand, attach much greater importance to cleanliness. Additionally, Elliot35 found English wives at the lower end of the socioeconomic scale to have a liability to cancer of the cervix more than ten times greater than those at the top. Lack of circumcision supposedly leads to the accumulation of smegma beneath the prepuce5,6 and smegma has been thought to be a carcinogenic substance. In support of such a theory, Boyd and Doll32 found that fewer patients than controls had used obstructive methods of contraception, and Baird and Aitken-Swan31 found that fewer patients than controls had “ever used” or “predominantly used” a sheath or cap contraceptive.
Stern and Nealy,36 however discovered that the use of a sheath contraceptive by the marital partner was not to be associated with rate differences for cancer of the cervix between patient and control groups. To determine whether smegma is indeed carcinogenic, Heins, in a study reported by Weiss,29 inoculated monkeys through the vagina one to two times weekly for three years with raw human smegma and was unable to produce any cancers of the cervix or vagina.
Additionally, Fishman’s37 group injected smegma from old men into the vaginas of mice two to three times weekly for 12 months and was unable to stimulate the production of genital cancers, although inoculation of similar animals with a known carcinogen regularly produced vaginal cancers.
Dodge’s7 investigations in Kenya have revealed not significant differences between the numbers of cervical cancer cases in women of tribe who men were or were not circumcised. This has lead to the idea that since Catholic nuns do not have intercourse with uncircumcised men, a lower rate of cervical cancer would obtain in those cultures where circumcision is performed.
Seemingly overlooked is the idea that Catholic nuns do not have intercourse with circumcised men either. It would appear that the decisive factor in the nuns’ freedom from cervical cancer is related not to the presence or absence of the foreskin but to the absence of sexual relations.
InReid40 suggested that penetration of the epithelium by spermatozoa could initiate the process leading to cancer, and that an obstructive contraceptive would lessen the ihdikasi risk by preventing spermatozoa from reaching the squamous epithelium.
Boyd and Doll’s32 and Baird and Aitken-Swans31 findings in this regard and Gagnon’s39 data from the Catholic nuns would seem to support this proposal.
There now follows a sirkumssisi of carcinoma of the penis. Later research has established the role of the HPV virus and of smoking in the etiology of carcinoma of the penis.
Many authors2,3, have noted the rarity of penile cancers in circumcised men. Dodge and Kaviti7 have stated that cancer of the penis occurs more frequently among European an Asian populations in the uncircumcised than among the circumcised. Others2,3 have claimed that cancer of the penis has never been recorded in men circumcised at birth. But, does the retention of the foreskin truly cause cancer of the penis? Is smegma actually carcinogenic?
Or does the accumulation of smegma beneath the prepuce indicate a more basic problem, namely, that of poor genital hygiene?