Advantages of NES
Nerve Sparing Esthetic Circumcision
Preserving neural conduction integrity and sensitivity:
Prepucium provides sensation and lubrication for the penis and contains numerous (between 20.000 and 70.000) super-specialized nerve endings and nerve corpuscules. These tiny structures are related to the perception of fine-touching, erogenous stimulus followed by orgasm and ejaculation. Thus, prepucium is one of the most sensitive part of penis.
In the standard circumcision techniques, the full thickness of the foreskin is removed. Namely the skin (epidermis) and the underlying dermis and adventitial tissue which are rich with superficial nerves-nerve corpuscles, blood vessels and lymphatic vessels all removed. As a result, sensitivity of glans penis is reduced dramatically in comparison to uncircumcised one. 1,2,3
In The Nerve Sparing Esthetic Technique of Circumcision (NES), superficial sensorial nerve-rich tissue containing nerves, nerve corpuscles and blood all is saved maximally. The nerve count in the removed skin was significantly less. So, sensitivitiy of glans preserved maximally.
Appropriate circumcision technique for the children with bleeding disorders:
The children who have bleeding diathesis must not be circumcised unless treatment is done.
As the bleeding is only at capillary level in Nerve Sparing Esthetic Technique of Circumcision (NES), the baby or child can be circumcised without the need of clotting tests.
Less pain after post-operative period and less analgesic need.
Pain is caused by some substances released from tips of nerves which is cut. As the superficial sensorial nerves are not cut in Nerve Sparing Esthetic Technique of Circumcision (NES), pain, analgesic usage and the possible side effect of them in the postoperative period is quite less. 5,6
Frenulum, a skin band below the glans penis is the most sexually sensitive area of penis so that he most important function of the frenulum is pleasure. Unfortunately, It is frequently cut off partially or totally by traditional circumcision techniques, especially in newborn circumcision performed in United States5.
In Nerve Sparing Esthetic Technique of Circumcision (NES), frenulum is preserved and only prepucium is removed by fine-marking in an esthetic surgical way.
The appearance of penis after healing period will be cosmetically perfect.
- Depth, Distributioin and Probably Identification in the Prepuce of Sensory End-Organs Concerned in Sensations of Temperature and Touch; Thermometric Conductivity,” (H.C. Bazett, et. Al., Archives of Neurology and Psychiatry 27 (1932), pp. 489-517)
- Fine-touch pressure thresholds in the adult penis, Sorrells ML1, Snyder JL, Reiss MD, Eden C, Milos MF, Wilcox N, Van Howe RS., BJU Int. 2007 Apr;99(4):864-9.)
- A paper written by Paul Turek, MD · Art of Circumcision, Feb. 2015, San Francisco
- Hemostaz mekanizması Tanju Atamer İstanbul Üniversitesi, İstanbul Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, İstanbul; www.thd.org.tr/thdData/userfiles/file/2007thtk_01.pdf
- A nerve sparing circumcision with minimal foreskin mucosa (NSCMFM; C. Mmeje, J.L. Marmar Urology, Robert Wood Johnson Medical School at Camden, Camden, NJ.
- Male and Female Circumcision, Denniston et. Al, Kluwer Academic I Plenum Publishers, New York, 1999. pp. 9-18
Hakan ERDOGAN, M.D
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