Circumcision

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Abdominal hernia in adults Adult Snoring Surgery (in the absence of Obstructive Sleep Apnoea) Arthroscopic shoulder decompression for subacromial shoulder pain Arthroscopic surgery for meniscal tears Artificial urinary sphincters for post-prostatectomy incontinence Assisted Conception Benign Skin and Subcutaneous Lesions Commissioning Policy Blepharoplasty (upper and lower lid) including brow lift Botulinum Toxin A for the management of focal hyperhidrosis Breast implants - removal and replacement Breast reduction surgery Carpal tunnel syndrome (surgery) Cataract Surgery Chronic rhinosinusitis with or without polyps Circumcision Cosmetic Treatments Cryopreservation to Preserve Fertility Dilatation and curettage for heavy menstrual bleeding in women Dupuytren's contracture treatment Ear Wax Removal Femoro–Acetabular Impingement, open or arthroscopic surgery Fusion surgery for non-specific, mechanical back pain Haemorrhoids in adults Hallux Valgus (Bunion) - Commissioned pathway Heavy Menstrual Bleeding - Referral for Surgical Management Hip and knee replacement surgery in obese patients (those with a body mass index of 30 or greater) Individual Funding Requests (IFRs) Injections for non-specific low back pain without sciatica Knee arthroscopy for patients with osteoarthritis Lumbar spine procedures – for simple lumber back pain Meibomian cysts (chalazia) Myringotomy/grommets with or without adjuvant adenoidectomy for the management of otitis media in children under 12 years Myringotomy with and without grommets in adults and children aged 12 years+ Open Magnetic Resonance Imaging (MRI) Scanning Radiofrequency Denervation Reversal of male and female sterilisation Spinal injections for sciatica Surgery for ganglion cyst Surgical procedures for the treatment of LUTS caused by BPH Tonsillectomy Trigger finger release in adults Varicose vein referral

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This is a summary of the NHS Devon commissioning policy for Circumcision.

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Referral Criteria

Circumcision is routinely commissioned in Devon for:

Physiological phimosis:
- In children approaching puberty and adults with persistent symptoms (discomfort, pain, difficulty with self-hygiene, recurrent paraphimosis) despite non-operative management (6-week course of topical corticosteroids).
  OR
- In children with a diagnosed abnormality of the urinary tract where circumcision is part of secondary management to reduce urinary tract infections.

Clinical diagnosis of pathological phimosis (balanitis xerotica obliterans / lichen sclerosus).
Recurrent balanitis or balanoposthitis (3 or more episodes within 12 months despite treatment with topical corticosteroids).
Acquired trauma where reconstruction is not feasible (e.g., following zipper trauma or dorsal slit for paraphimosis).

Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of NHS Devon upon receipt of a completed application from the patient's GP, consultant or clinician.

Applications cannot be considered from patients personally.

NHS Devon Circumcision commissioning policy

Exceptional /Individual Funding Requests (IFR).