Adult Circumcision

SAN ANTONIO ADULT 
CIRCUMCISION

Our Board-Certified Urologists perform in-office Circumcisions and make them as painless as possible

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Circumcisions can be done for medical reasons or personal reasons

No referral needed for patients electing a cosmetic circumcision

Relatively painless procedure with local anesthetic. Nitrous gas is included with every procedure at no cost to you

Out of town patients welcome! We have telemedicine for initial consultations and follow ups

Why should I consider a Circumcision?
The world’s first planned surgical procedure was a circumcision. Over 1/3 of men worldwide are circumcised. This procedure is very common in the United States. Circumcisions are associated with a lower risk of penile cancer, urine infections, and HIV.
Whether for medical or personal reasons, a circumcision could be the right choice for you. No matter what reason you choose to undergo this procedure, The Urology Place strives to ensure your procedure is as quick and painless as possible. 
Dr. Naveen Kella

Dr. Naveen Kella

Founder and Experienced Circumcision Doctor

Dr. Naveen Kella is board certified in urology, with a fellowship in Urologic Oncology and robotic surgery. He is known for his experience in treating prostate cancer. As a urologist, he has done hundreds of circumcisions. Many patients desiring circumcision appreciate the lower cost of getting a circumcision done in the office. Dr Kella has trained on doing in-office circumcision. The office procedure is safe and painless as possible and we have the necessary equipment to perform the procedure in the office. 

Choosing an Experienced Urologist Matters

Experience is very important, even for a circumcision. We are board-certified urologists. Dr Kella started performing in-office circumcision many years ago. Our urologists have performed hundreds of pediatric and adult circumcisions through residency and practice. Urologists are routinely called for trauma and unexpected issues for the penis.

Call our office at (210) 617-3670 to schedule your appointment

If you are planning to be self-pay we can complete your consultation and procedure within the same day. However, if your procedure is deemed as medically necessary and can be covered by insurance, we will need two appointments. One appointment will be your consultation with Dr. Kella and the other appointment will be your procedure. Through insurance, the procedure will need to be booked at a surgical facility where you will also be looking at the costs of using the facility as well as anesthesia. Our in-office option typically works out cheaper if you are not using insurance. 

Safety, Comfort and Quality are Our Priorities

Here at The Urology Place, we practice the sleeve resection technique. The sleeve resection technique is ideal as it removes the foreskin in a single ring of tissue. Through this method, we are able to complete the circumcision with as smooth and refined scar line as possible. We work with our patients and their requests of how much of the inner foreskin they wish to preserve. This is sometimes referred to as a “high” or “low” circumcision. When a majority of the shaft’s skin is removed and the scar line is closer to the center of the penile shaft, it is described as a “high” circumcision. However, a “low” circumcision is when the majority of the foreskin is removed and less of the shaft skin which results in the scar line being closer to the head of the penis. 

When the procedure is done in our office, we use a local numbing medication. We offer nitrous gas, also known as laughing gas, to our patients to reduce any anxiety and pain. This gas is safe to use and does not restrict your ability to drive home after the procedure. 

Before the procedure begins, I mark the incision lines with a marker and take measurements to ensure the correct modifications are made to meet the patients aesthetic preferences with the functionality of comfortable erections in mind. The purpose of marking the penis before making incisions is to visualize and match the incision lines together without causing uncomfortable tension when erect. When the incision lines have been determined with a marker, I begin the procedure by making the outer incision first, then retract the foreskin and make the inner incision and remove the foreskin in a single ring. I then cauterize any bleeding points with an electrocautery to stop the bleeding. In terms of customization, the distance between the inner and outer incisions from the tip of the foreskin can be modified. However, this is not to be confused with altering the tightness of the skin. The issue of tightness is correlated with the length of foreskin that is removed. 

If the patient desires a frenulectomy, the removal of the frenulum, we do this after the circumcision has been done. To close the wound, I use dissolvable sutures that typically disappear within three weeks. The needle I use is specifically made for closing skin, resulting in minimal scarring and bleeding.

Before and After Photographs

Click the button below to view before and after photos of adult circumcisions performed at The Urology Place in San Antonio by Dr. Naveen Kella. 
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Coming in from out of town?

Many of our patients come from out of town to have their procedure performed with us. Patients can have a telemedicine conference with the doctor prior to the visit. Pictures of the penis are necessary to give us an idea of your condition. The photographs and video conference can help make your visit and procedure go as smoothly as possibly. If everything works out, we can schedule a procedure at our office.

You can drive or fly yourself to our office on the same day of the procedure. Pain medications are not usually needed, but we can prescribe some medication and send it to a pharmacy close to our office. Plan on wearing comfortable clothes but bring an extra pair of of snug or elastic underwear. You should use clippers to cut away any pubic hair (not razors- they can cause skin infections!). If we are doing the procedure in the office, you can eat as you normally would, but do not eat heavy or right before the procedure. You should be OFF any blood thinners or supplements (Vitamin E, for example) for a week. Feel free to bring your phone to watch videos or listen to music. 

After the procedure is done, we will have you use antibiotic ointment to minimize irritation from the suture. You will have some gauze wrapped around the penis for some expected, minimal oozing. A shower is okay after 24 hours. However, no baths until the sutures are gone. You can drive yourself home after about 3 hours from the procedure. This is to make sure there is no bleeding. (If you decided to take any medication prior to the procedure (xanax), then you should have someone who can drive you home.)

We will have a follow up virtually or in person at 1 and 3 weeks. 

We advise no sexual activity until the sutures are gone, which is usually within 2-3 weeks.

Your urination should not be affected.

You can get back to desk work right away, but physical activity should be curtailed if it is not comfortable.

With proper planning, you can have a relatively painless, in-office procedure with an experienced urologist and return home the same day.

Learn More Here

Patient Testimonial

If you or a loved one are looking into getting an adult circumcision, check out this video from one of our patients explaining his personal experience at our clinic.

Call our office at (210) 617-3670 to get scheduled for your same day consultation and procedure.

Frequently Asked Questions about Circumcision

  • Why Might You Consider a Circumcision?

    There are many reasons why you might consider getting a circumcision. This includes but is not limited to: 

    • Phimosis-inability to retract the foreskin
    • Paraphimosis-when the foreskin gets stuck behind the glans
    • Blantitis, balanoposthitis or lichen sclerosis-infection and inflammation of the foreskin and glans
    • Frenulum breve-a short frenulum that restricts movement
    • Diseases of the foreskin-such as cancer
    • Aesthetic appearance

  • What is the cost of a Circumcision at The Urology Place?

    The procedure can typically be done comfortably and safely in our office for $1875. This includes the in-person consult, all supplies, and a post-operative visit. Because we perform the Circumcision procedure in our office rather than in an OR and without facility fee's or anesthesia fee's we are able to offer our patient a much cheaper circumcision procedure including nitrous gas. 

  • Does Insurance Cover a Circumcision?

    If you have a medical problem with your foreskin, insurance may cover the cost of circumcision surgery. Call today for a consultation. Our doctors will work with you to help determine if you have a medical condition that may qualify for insurance-covered circumcision surgery. Our team of experts can help you determine your insurance benefit for this procedure. If the procedure is deemed as medically necessary, we will need to do the procedure in a surgical facility.

  • What Can I Expect During The Procedure?

    The circumcision procedure can take 30 minutes to an hour depending on the patient. If the procedure is performed in the operating room, the patient can be asleep. An operating room procedure is more expensive than an office procedure and is done when insurance covers the procedure. Either way, the procedure is typically done using the same sleeve removal technique. A scalpel is used on the outer and mucosal foreskin to create the sleeve. The frenulum can be removed if needed as well. 

    When the frenulum, the band of tissue under the glans that connects to the foreskin, is removed, it is called a frenulectomy. 

     

    We offer a cost effective in-office circumcision procedure to patients without an insurance-covered benefit. Our facility in San Antonio is designed to accommodate adult circumcision surgeries. Instead of general anesthesia we use a lidocaine block, which makes the procedure essentially painless. Patients usually listen to music during the procedure. We can prescribe nitrous gas for patients who are anxious or nervous as well. Nitrous is safe and reduces pain and anxiety. You can still drive home after nitrous gas.

     

     

    Patients have questions about whether the circumcision will be "high and tight" or how we handle other issues.  We can discuss these issues during your consultation.

     

    Closing Your Incision

    Fine suture is used to close the circumcision. As a result, the sutures are absorbable and usually disappear within 3 weeks. The needle is specially made for closing skin, leaving less chance of bleeding and scar.

     

    Afterwards, you will leave the clinic and possibly return later in the day if the doctor decides. Patients experience minimal pain after their circumcision, and typically only take Tylenol and an anti-inflammatory during recovery. The doctor is available after hours for any concerns.

     

    Risks

    Any surgical procedure has risks. Circumcision’s major risks are penis injury, infection, and significant bleeding. These risks are very rare in our experience. Scarring along the suture line is possible. We use advanced plastic surgery fine suture techniques during skin closure to avoid tension along the suture line, minimizing the appearance of any scars.

  • Post Procedure Activity and Care

    FIRST 72 HOURS

     

    The penis will normally have swelling after the procedure. You should have no problem urinating. Tylenol or Advil is usually all that is needed for discomfort. We recommend ice packs and compressive shorts to minimize jostling. Keep the penis upright. Use the ice pack for 10 to 15 minutes on and off  for the first day. Try to do this 2-3 times. You can return to desk work in 24-48 hours.

     

    You can eat whatever you normally eat.

    You can resume blood thinners in 48 hours unless you are noting any spotting or bleeding.

    You can shower after 24 hours.

    Remove any dressing after 24 hours. If there is any spotting, you can replace the dressing.

     

    EXERCISE AFTER CIRCUMCISION

    You should be able to walk and take stairs slowly after the procedure. However, you should avoid exercise for a week.

     

    SEX AFTER CIRCUMCISION

    Usually 3 weeks. Wait for the sutures to dissolve. Do not stimulate the penis because the stretching can potentially disrupt the suture line.

  • What is Nitrous Gas?

    Nitrous gas relieves any discomfort or anxiety that the patient may experience during the procedure. It is the laughing gas you find in the dentist office. We invested in a system that is safe.

    • Patient administered
    • Safe to drive home afterwards
    • Cannot overdose
    • Well tolerated

  • How do you handle the frenulum?

    Everyone has a slightly different anatomy, so we typically discuss the frenulum option that may be best for you during your initial consultation. The frenulum is the elastic band of tissue that connects your glans to your foreskin. Sometimes this tissue is kept intact during circumcision surgery, and at other times it is removed.

  • Why does my Foreskin hurt after sex?

    The foreskin can hurt after sexual activity. Usually, this happens in men who may have had an infection known as balanitis, prior trauma, or diabetes. The foreskin has a tongue of tissue at the bottom known as the frenulum. The frenulum can hurt after sex as well. 


    Men may complain about this after rough sex or a prolonged period of sex. The foreskin is pulled back automatically during intercourse. This can cause swelling because the folding over of the foreskin causes self constriction. Blood flows in, but cannot flow out. After a while, the patient can develop paraphimosis. This can be an emergency if the foreskin cannot be brought back to its normal position.


    Treatment options include:

    Resting from sexual activity for a few days. Unfortunately, this provides short term relief. The underlying problem is still there. Most men who start having foreskin irritation and pain after sex will have it again once they resume activities.


    Steroid cream. This can reduce irritation and inflammation. If the foreskin is able to heal, patients can recover. If the patient has other risk factors causing poor blood flow to the foreskin like diabetes, this is also usually temporary.


    Antifungal medication. Patients may sometimes develop an infection because of the moisture generated under the foreskin. Mixture with urine and semen can compound the problem. Cleaning under the foreskin with water can help reduce the chance of these infections. 


    Removal of the frenulum. This procedure can be done in the office. It is called a frenulectomy and it is useful if the tongue of the foreskin is mostly causing the pain. We can do a frenulectomy with or without the circumcision.


    The foreskin can hurt after sexual activity. Usually, this happens in men who may have had an infection known as balanitis, prior trauma, or diabetes. The foreskin has a tongue of tissue at the bottom known as the frenulum. The frenulum can hurt after sex as well. 

     

    Men may complain about this after rough sex or a prolonged period of sex. The foreskin is pulled back automatically during intercourse. This can cause swelling because the folding over of the foreskin causes self constriction. Blood flows in, but cannot flow out. After a while, the patient can develop paraphimosis. This can be an emergency if the foreskin cannot be brought back to its normal position.

     

    Treatment options include:

    Resting from sexual activity for a few days. Unfortunately, this provides short term relief. The underlying problem is still there. Most men who start having foreskin irritation and pain after sex will have it again once they resume activities.

     

    Steroid cream. This can reduce irritation and inflammation. If the foreskin is able to heal, patients can recover. If the patient has other risk factors causing poor blood flow to the foreskin like diabetes, this is also usually temporary.

     

    Antifungal medication. Patients may sometimes develop an infection because of the moisture generated under the foreskin. Mixture with urine and semen can compound the problem. Cleaning under the foreskin with water can help reduce the chance of these infections. 

     

    Removal of the frenulum. This procedure can be done in the office. It is called a frenulectomy and it is useful if the tongue of the foreskin is mostly causing the pain. We can do a frenulectomy with or without the circumcision.

     

    Circumcision. If you notice repeated issues with foreskin pain that prevents you from enjoying sex or causes your partner anxiety, you should consider circumcision. Patients do better the sooner the procedure is done. Waiting too long can lead to skin that is very tough and difficult to circumcise. We can perform circumcision comfortably in the office for many patients, sparing the expensive hospital or surgery center fees. We do these office cases when patients are not using insurance to help save costs.

  • Is an erection made through drugs before doing a circumcision?

    It is important to ensure that a circumcision is comfortable in its flaccid and erect state while also meeting aesthetic preferences. To make this possible, it is important that the proper amount of skin is removed. With an ink marker, I mark the incision lines on the inner mucosal and outside portions of the foreskin while ensuring both points meet each other comfortably. I choose this method over using drugs to induce an erection due to several reasons:

    -When the penis is erect, the veins are dilated which causes more blood flow during the procedure.

    -When an erection is made through the drugs, I am unable to alternate between the flaccid and erect positions to determine the most optimal incision lines.

    -If incision lines are made through an erect penis, there runs the risk of removing an improper amount of skin.

  • How does an adult circumcision differ from a neonatal circumcision?

    The most common difference between a neonatal circumcision and an adult circumcision is the use of clamps. Clamps are used during neonatal circs to stop bleeding by pinching them, eliminating the use of sutures. The clamps are able to pinch the skin together tight enough so stitches are not needed. This technique is not an option for adults as an erection would be too forceful and tear apart the pressed edges from the clamp. Therefore, adults require sutures to keep the wound closed. Stitches allow for customized scar lines through fine line suturing that can be hidden and leave minimal scarring. 

    Another notable difference is that neonatal circumcisions only use local anesthesia if any at all as it is usually a very quick procedure. Adult circumcisions are lengthier and require more anesthesia than a newborn. When a circumcision is done in our office, we provide local anesthesia as well as nitrous gas (laughing gas) to ease any anxiety and pain from the treatment. When the procedure is booked in a surgical facility which is required through insurance, you would be given general anesthesia through an anesthesiologist. 


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