Targeted temperature management, warm alkaline hydrogen peroxide solutions, and dilute solutions of local anesthetics as safety factors for circumcision

Foreskin circumcision is the oldest surgical procedure that has become part of Muslim and Jewish cultures and has been performed on healthy boys and men since ancient times. In addition, circumcision is a surgical method of treating phimosis, balanitis and balanoposthitis, which is used regardless of religion. A review of the literature showed that surgical and medical factors of foreskin circumcision sometimes lead to local complications such as penile ischemia and amputation, wound infection, bleeding, meatal stenosis, cutaneous urethral fistula, urethral erosion, iatrogenic hypospadias, bruising after injection, inflammation, necrosis and abscess. These complications worsen the aesthetic outcome of circumcision, the mood of patients and their relatives, and increase the costs of the healthcare system associated with the treatment of complications. In this regard, the current priority is to improve the safety of surgical procedures and medicinal solutions of the following pharmacological groups: anesthetics (drugs for intravenous anesthesia), local anesthetics, detergents (disinfectants), antiseptic and anti-inflammatory drugs. The fact is that it is these medicinal solutions that are most often used in circumcision. In recent years, targeted changes in local temperature have become very relevant, since hypothermia inhibits the intensity of local complications, increases the viability of damaged, ischemic and excised tissues and hyperthermia potentiates the disinfecting effect of antiseptics and helps stop bleeding. It has been shown that the risk of local complications during circumcision can be reduced by infrared monitoring of the local temperature of the penis and skin at the injection sites, as this ensures early detection of local hyperthermia in inflammation and local hypothermia in ischemia. It has been shown that the risk of ischemic soft tissue injury and amputation can be reduced by therapeutic hypothermia, as cooling increases tissue resistance to ischemia. It has been reported that the risk of wound infection in phimosis, paraphimosis, balanitis and balanoposthitis can be reduced by the use of antiseptic pyolytics, which are warm alkaline hydrogen peroxide solutions, and the risk of post-injection necrosis and abscesses can be reduced by pre-diluting drug solutions with water for injection by 2 or more times.