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Plastibell technique

Here's all you need to know about this technique of neonatal circumcision.

Approximate duration of the procedure: 45 minutes

The cost associated to the procedure for infants from 0-3 months* is 400$ for the Plastibell technique and 500$ for the Gomco technique**.

The procedure for babies between 3-6 months will be offered soon. 

*This service is offered to children between 10 days to 3 months. Please note that parental consent is necessary to carry out this procedure.

**A $75 deposit is required, and it will not be refunded if the patient reschedules or cancels their appointment more than once.

Technique and benefits

Here's some information about the circumcision technique used at Circoncision Mieux-Être and the potential benefits for your child. This information is essential for parents seeking a better understanding of the procedure.

  • At Circoncision Mieux-Être, we use the techniques: Plastibell™ and Gomco.

    The Plastibell™ technique is used for infant circumcision due to its simplicity and speed. This method, performed under local anesthesia, is particularly suitable for more anxious or less cooperative children as it is easier and faster, and no bandaging is required. The Plastibell™ involves the use of a transparent plastic ring with a handle that detaches at the end of the procedure. This safe technique minimizes bleeding and does not require any stitches, as the glans is protected by the ring throughout the circumcision. The ring gradually detaches within 10 days following the procedure.

  • The Plastibell™ method is preferred for babies who are restless, as it is safer than using a surgical instrument.

    It minimizes bleeding and does not require any stitches, as the gland is protected by the ring during the procedure. The ring gradually detaches within 10 to 21 days following.

    Furthermore, no bandage is necessary, allowing for easy monitoring of healing and signs of infection.

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Process

We are here to guide you through each step and ensure your child receives top-notch care. Your trust is invaluable, and we are dedicated to earning it at every moment.

  • BEFORE YOUR CLINIC VISIT, FOLLOW THESE STEPS:

    • Plan for a 2-hour visit to the clinic.

    • Arrive at the clinic 15 minutes before your appointment time and bring two baby blankets. If you are late, your appointment may be rescheduled.

    • Plan to feed your baby before your clinic visit to prevent hunger during the visit.

    • Do not give any drinks 1 hour before the appointment.

    • Administer the recommended dose of Tylenol or Tempra for babies 30 minutes before the appointment time. DO NOT use Motrin or Advil for babies to avoid excessive bleeding.

    AT THE CLINIC:

    • Using a fine needle, they inject an anesthetic into the area already numbed by a topical anesthetic.

    • Approximately 7 to 10 minutes later, the penis is completely numb, and the team will proceed with the circumcision.

    • Placing the Plastibell: Once the genital area is clean and dry, the doctor places the Plastibell around the penis head. The Plastibell is a small plastic ring with an attached string.

    • Tying the string: After placing the Plastibell, the doctor gently ties the string around the base of the penis head. This creates pressure on the tissue and helps cut off blood flow to the foreskin.

    • Cutting the foreskin: Once the Plastibell is in place and the string is tied, the doctor carefully cuts off the excess foreskin above the Plastibell.

    • Scab Formation: The Plastibell remains in place for a few days. During this time, the cut foreskin forms a small scab around the Plastibell.

    • It's normal for your baby to be a bit irritable during the first 24 hours.

    • We advise keeping your baby's genital area protected for optimal healing by carefully wrapping their legs in a blanket over the diaper to ensure comfort. Avoid sudden movements.

    • During sleep, position your baby on their side for added comfort. Avoid placing them on their stomach. Most babies sleep well after circumcision.

    • Do not bathe your baby in the first 24 hours, then bathe them once a day.

    • Regularly check if your baby's diaper shows signs of active bleeding. If your baby is asleep, simply check the front of the diaper. Each diaper change should show blood spots about the size of a coin, and the gauze may be slightly reddened due to bleeding, which is normal.

    • It is NOT normal for drops of blood to drip from the penis. Refer to the "What to watch for" section in case of active bleeding.

    • It is normal for the penis to show discoloration, drops of blood, and bits of skin at its tip. The yellowish membrane that may appear at the tip or around the foreskin is a normal part of the healing process and is not a symptom of infection.

    • For the 10 days following the circumcision, gently apply Polysporin (adult tube) to the incision area and the tip of the penis at each diaper change.

    • This application should be done for at least two weeks.

    • Scab Formation: The Plastibell remains in place for a few days. The circumcised foreskin forms a small scab around the Plastibell.

    • Plastibell Fall-off: After about a week, the scab completely forms, and the Plastibell naturally falls off, taking the excess foreskin with it. - Note: The Plastibell should NOT slide down the shaft but rather into the child's diaper.

    • Apply a small amount of petroleum jelly around the tip of the penis during diaper changes.

    • Around days 4 to 9, the plastic ring around the tip of the penis will fall off into the diaper on its own. With this ring, comes the small white string and the irregular skin left at the tip of the penis.

    • Once the ring has fallen off, you can continue applying vaseline or Polysporin for a week.

    • Discontinue applying Polysporin to the penis.

    • In preparation for the follow-up telephone appointment, which will take place approximately 15 days after the procedure, please email us clear photos to assist the doctor in evaluating the healing progress (see the following section "Patient Identification").

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Identification of the patient

Circoncision Mieux-Être handles a large volume of follow-up emails daily. When sending photos of their son, parents should include minimal information to ensure our team can accurately identify the patient, convey relevant details to the doctor, and record the information in the appropriate medical file.

    • Child's name

    • Child's RAMQ number

    • Your phone number

    • 4 photos (top, each side (left/right), and underside of the penis)

    IMPORTANT: Avoid sending repetitive or similar-angle photos. Blurry or distant images can lead to incorrect conclusions and increase health risks. For an accurate diagnosis from the doctor, ensure clear visibility of details in the sensitive area (skin, mucous membrane, etc.).

  • Emails not meeting identification requirements or containing an excessive number of photos may be returned without a doctor's diagnosis. Limit your submissions to four clear photos taken from different angles, as this will streamline the process.

    IMPORTANT: Our team typically responds within 24 hours. If you do not receive a response, please wait at least 48 hours before reaching out to us via email or phone at (514) 360-3975.

The healing in steps

After circumcision, it's common for parents to be concerned about the appearance of their son's penis. It's important to note that penises can vary considerably in shape and size.
While most may appear "normal" a few days after circumcision, some may only look completely "normal" after the child grows. Additionally, it may appear smaller after circumcision due to the loosening of the skin surrounding the penis. Before circumcision, this skin keeps the penis more taut.

    • 24 hours: The genital area may be swollen, red, and tender, with slight swelling around the Plastibell.

    • 1-2 days: A small scab forms around the Plastibell in the first few days, providing protection to the wound.

    • 4-10 days: The Plastibell and scab typically fall off after a week to ten days.

    • 1-2 weeks: The wound begins to heal and gradually close after the Plastibell falls off.

    • Up to 2 weeks: The operated area may show green and yellow hues. This is not pus but rather part of the normal healing process. The color returns to normal within 14 days.

    • Approximately 1 month: The glans may show shades of bright red or purple. This is due to the keratinization of the mucous membrane (which covers the glans of an uncircumcised penis). This transformation takes about 30 days for the penis to return to a normal appearance, indicating healing.

Details of the service
  • This service is currently available for babies aged 0 to 3 months*. To be eligible for neonatal circumcision, the child must be between 10 days and 3 months old and must not weigh more than 6 kg**.

     

    The rates for children aged 0-3 months are:

    • 400$ for the Plastibell technique

    • $650 for the Gomco technique

    Please fill out the form to request an appointment, and a member of our team will contact you to schedule it.

    *The service is available for children between 10 days and 6 months (The service for babies aged 3 to 6 months will be available soon). Please note that parental consent is required to perform this procedure.

    **A deposit of $75 is required, which will not be refunded if the patient changes or postpones their appointment more than once.

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FAQ

Here are the answers to frequently asked questions:

  • It is common for a baby to sleep for 6 to 8 hours after circumcision, possibly missing a feeding. Some babies may be slightly irritable, but most settle down within 48 hours of the procedure.

  • Your baby may feel slight tingling when urinating in the first 24 hours, but this sensation should quickly fade away.

  • In case of feces, try to clean the area as thoroughly as possible using a cotton ball soaked in soap or a soft cloth, and rinse gently.

  • It is recommended not to give your son a bath in the first 24 hours after the procedure. After this period, one bath per day, with regular soap and water, is generally acceptable.

  • Please apply Polysporin at each diaper change for at least two weeks.

  • It is important to note that complications are rare, but may include:

    • Excessive postoperative bleeding

    • Slippage of the Plastibell

    • Phimosis or narrowing of the opening of the skin covering the tip of the penis

    • Buried or trapped penis in the abdomen

    • Urethral injuries

    • Infection requiring antibiotics

    • Stenosis of the urethral meatus or narrowing of the urethra

    • Suboptimal aesthetic result

    • Trauma to the tip of the penis

    • More serious complications, including death

    • Maintain the treated area clean and dry. Use disposable diapers during the first week as they tend to be less irritating and help keep the area drier and cleaner.

    • Gently clean the area around the penis with warm water, a cotton ball, or a soft cloth. Avoid the use of wet wipes, alcohol, powders, or lotions, as these may irritate the wound.

    • Limit car rides that could irritate the newly circumcised penis. If necessary, place a folded diaper between your baby and the seatbelt to avoid pressure on the penis.

    • We recommend using Tylenol as needed to facilitate quick healing and manage pain.

  • Active bleeding - Stopping active bleeding

    • A few drops of blood may appear, which is normal. Take your child's penis between your fingers and apply sustained pressure for at least 2 to 3 minutes, as you would to stop bleeding from a cut on your finger.

    • Check if the area continues to bleed. Repeat the pressure application if needed. Then cover with a dressing to prevent any risk of re-bleeding.

    • After two or three attempts, if the bleeding persists, contact us at (514) 360-3975 (during business hours) or go to the emergency room outside business hours.

    • If you have concerns, feel free to call us at (514) 360-3975; a member of our team will be happy to assist you.

     

    Infection

    Infections are rare but possible. Common symptoms include:

    • Purulent discharge

    • Bad odor

    • Excessive sweating or redness

    • Local warmth

    • Fever

    • Itching around the penis

     

    IMPORTANT: If your son experiences these symptoms or hasn't urinated for more than 12 hours, call immediately at (514) 360-3975 (during business hours) or go to the emergency room outside business hours. If your baby has a fever, we recommend going directly to the emergency room.

Other resources

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