ELECTROSURGERYFORPENILEPROCEDURES 1455

5. Belman, A. B.: Electmutery Circumcision. urology, lS: 506,1981.

EDITORIAL COMMENT

The authors present an interesting and successful study of elec- trical current in both commonly used modes for minor penile proce- dures. In our experience major penile injuries have been treated mainly in the newborn period when circumcisions were performed by nonurological surgeons with and without the Gomco clamp. The difference between the 2 injuries is that with the Gomco clamp the glans and shaR typically sloughed within 1 or 2 days, while when the clamp was not used the injury took several days to weeks to evolve. Nevertheless, this study clearly shows that these procedures can be safely performed by a urological surgeon. Whether the risk of penile injury, albeit slight, is outweighed by the lack of hematoma and other minor complications is up to the judgment of the surgeon.

John P. Gearhurt Department of Pediatric Urology Johns Hopkins Hospital Baltimore, Maryland

REPLY BY AUTHORS

We agree that most penile injuries associated with circum- cision occur in the newborn period. Anecdotal cased of penile injury secondary to electrosurgery and theoretical concerns regarding why one should not use electrical current on the penis are often stated. We believe that electrosurgery is not the cause of penile injuries but rather it is the inappropriate application of electrical current to a metal object, such as a Gomco clamp, that produces tissue necrosis. To our knowl- edge there is no well documented case in the literature dem- onstrating that the appropriate use of electrocautery on the penis causes injury unless it is brought into contact with a Gomco clamp or similar device. We believe that electrosur- gery can be used safely and effectively on the penis when applied appropriately, using the minimun current needed to achieve the desired effect. Our confidence in electrosurgery is such that we now use this operative modality routinely for most penile surgery, including hypospadias repair.