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Longer flights suit later dates."},"follow_up_visits":[{"purpose":"wound_check","requirement":"routine","after":{"min":2,"max":7,"unit":"days","qualifier":"Early wound check, commonly within the first week."}},{"purpose":"result_review","requirement":"routine","after":{"min":14,"max":42,"unit":"days","qualifier":"Healing review after circumcision, including wound and suture assessment."}}],"indications":["Phimosis","Recurrent balanoposthitis","Paraphimosis history","Recurrent urinary tract infections associated with foreskin","Balanitis xerotica obliterans (lichen sclerosus) limited to foreskin"],"main_risks":["Bleeding or hematoma","Infection","Pain and swelling","Excess or insufficient foreskin removal","Skin bridges or adhesions","Meatal stenosis or irritation of the glans","Altered sensitivity","Unsatisfactory cosmetic appearance or scarring","Anesthesia-related reactions"],"pain":"Mild to moderate discomfort for the first few days, controlled with standard oral analgesics; erections at night may be painful early on.","preparation":["Surgical consultation and genital examination","Review of medical history, bleeding tendency and allergies","Treat any active skin infection beforehand","Fasting only if sedation or general anesthesia is chosen","Genital hygiene and hair trimming per clinic","Arrange comfortable loose underwear and a ride home"],"recovery_timeline":[{"phase":"Day 0 (procedure day)","description":"Local anesthesia with same-day discharge once voiding, comfortable and wound dry. Short walks at home the same day.","restrictions":["Arrange a ride home","No driving until anesthesia wears off","Keep dressing as instructed"]},{"phase":"Days 1-3","description":"Swelling, bruising and soreness peak. Short walks and light household activity encouraged.","restrictions":["Rest and avoid strenuous activity","Keep wound clean and dry as instructed","Wear loose underwear"]},{"phase":"Days 4-14","description":"Swelling and pain decrease; sutures dissolve. Many return to desk work by about day 7.","restrictions":["No sexual activity or masturbation","Avoid friction and tight clothing","Avoid heavy lifting and physically demanding work until cleared"]},{"phase":"Weeks 2-6","description":"Wound heals and scar softens. Strenuous exercise and cycling usually resume after about 3-4 weeks, once healed and comfortable.","restrictions":["No sex until healed and cleared, about 4-6 weeks","Resume strenuous exercise gradually after clearance"]},{"phase":"At any time","description":"Seek urgent care for bleeding not stopping with pressure, rapid swelling or pain, fever, spreading redness, pus, inability to urinate, or dark glans.","restrictions":["Do not wait for a scheduled review"]}],"rehabilitation_days":{"min":3,"max":7,"unit":"days","qualifier":"Time to ordinary light activity or desk work. Full healing, exercise and sex come later."},"result_longevity":"Permanent removal of the foreskin.","revision_rate_pct":{"min":0.5,"max":2,"unit":"percent","qualifier":"Unplanned corrective surgery (e.g., skin bridges, redundant skin, scarring, meatal stenosis) within about 2 years of primary adult circumcision."},"scars":"A circumferential scar line at the corona or shaft, usually fine and inconspicuous once matured.","sessions_or_stages":{"sessions":{"min":1,"max":1,"unit":"visits","qualifier":"Single surgical procedure."},"stages":[{"code":"circumcision","label":"Circumcision procedure","after":{"min":0,"max":0,"unit":"days","qualifier":"Performed at the initial visit."}}],"qualifier":"Single-stage procedure; follow-up checks are not counted as treatment sessions."},"success":{"metric":"Foreskin removed, wound healed, no corrective surgery","value":95,"unit":"percent","horizon":"3 months","population":"Adults undergoing sutured circumcision under local anesthesia","evidence_status":"limited"},"techniques":[{"name":"Sutured sleeve (conventional) resection under local anesthesia","suits_whom":"Most adults, including those with phimosis or scarring.","recovery":"Swelling settles over 1-2 weeks; healing about 4-6 weeks."},{"name":"Device-assisted (ring or clamp-type) circumcision","suits_whom":"Adults without significant anatomic abnormality or scarring.","recovery":"Often shorter procedure with fewer sutures; recovery broadly similar."}],"treatment_conditions":["outpatient"],"treatment_duration_hours":{"min":0.25,"max":0.75,"unit":"hours","qualifier":"About 15-45 minutes of operating time for one session, excluding anesthesia preparation and recovery."},"initial_assessment_documents":["Clear photos of the foreskin, retracted and relaxed","Urologist report or prior genital examination notes","Urine test or swab results, if infection suspected","Medication list including blood thinners","Diabetes and HbA1c result (if available)"],"travel_trips":{"min":1,"max":1,"one_trip_possible":true,"qualifier":"Single-stage outpatient surgery; stay about 5-10 days until predeparture wound check clears travel. Later reviews arranged at home."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Confirm your surgeon explains the risks to you before the operation","scope":"procedure","source":{"url":"https://www.nhs.uk/tests-and-treatments/circumcision","host":"nhs.uk","quote":"Your doctor will explain the risks to you before the procedure.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C2","text":"Check whether the surgeon is fully trained in the specific procedure you want, because this can be hard to confirm","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery-abroad/","host":"nhs.uk","quote":"It can be difficult to find out if a surgeon is fully trained in the procedure you want.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C3","text":"Check that you will have two consultations with the treating surgeon before any surgery","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery-abroad/","host":"nhs.uk","quote":"You should have 2 consultations with the surgeon treating you before any surgery.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"C4","text":"Check whether follow-up care is scheduled at the same facility as the procedure","scope":"treatment_abroad","source":{"url":"https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html","host":"cdc.gov","quote":"Medical tourists should also know whether follow-up care is scheduled to occur at the same facility as the procedure.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":403}},{"id":"C5","text":"Check whether the facility and its healthcare professionals hold accreditation or certification","scope":"treatment_abroad","source":{"url":"https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html","host":"cdc.gov","quote":"Some facilities and healthcare professionals abroad might lack accreditation or certification.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":403}}],"checked_at":"2026-11-11","next_check_at":"2027-11-11","version":1},"red_flags":{"status":"ok","items":[{"id":"F1","text":"Pressure to make a quick decision is a warning sign before booking treatment abroad","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"a hard sell, a lack of information, pressure to make a quick decision.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F2","text":"Being unable to put treatment questions to the medical team is a warning sign","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/using-the-nhs/healthcare-abroad/going-abroad-for-treatment/treatment-abroad-checklist/","host":"nhs.uk","quote":"Have you been able to ask them questions about your treatment?","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"F3","text":"Meetings only with sales staff, with no consultation with the surgeon, is a warning sign","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery-abroad/","host":"nhs.uk","quote":"make sure you have a consultation with the surgeon (avoid meetings only with sales people)","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-11","next_check_at":"2027-11-11","version":1},"warning_signs":{"status":"ok","items":[{"id":"W1","text":"Bleeding that does not stop","urgency":"contact_clinic","general":false,"source":{"url":"https://www.nhs.uk/tests-and-treatments/circumcision","host":"nhs.uk","quote":"you have bleeding that does not stop.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"W2","text":"Being unable to pass urine at all","urgency":"emergency","general":false,"source":{"url":"https://www.nhs.uk/tests-and-treatments/circumcision","host":"nhs.uk","quote":"you cannot pee at all.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"W3","text":"Pus with a foul odor around the incisions","urgency":"contact_clinic","general":false,"source":{"url":"https://my.clevelandclinic.org/health/treatments/circumcision","host":"my.clevelandclinic.org","quote":"Pus around their incisions with a foul odor.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"W4","text":"Fever over 38 degrees Celsius","urgency":"contact_clinic","general":true,"source":{"url":"https://my.clevelandclinic.org/health/treatments/circumcision","host":"my.clevelandclinic.org","quote":"A fever over 100 degrees Fahrenheit (38 degrees Celsius).","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-11","next_check_at":"2027-11-11","version":1},"take_home":{"status":"ok","items":[{"id":"T1","text":"Your home doctor needs it to continue your care after surgery abroad","document":"discharge summary","source":{"url":"https://doclibrary-rcht.cornwall.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/PatientInformation/Urology/RCHT3022AdultCircumcision.pdf","host":"doclibrary-rcht.cornwall.nhs.uk","quote":"You will be given a copy of your discharge summary and a copy will also be sent to your GP.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T2","text":"Ask for written details of the procedure before you leave the hospital","document":"written procedure details","source":{"url":"https://rcseng.ac.uk/patient-care/cosmetic-surgery/after-surgery/","host":"rcseng.ac.uk","quote":"After your surgery, before you leave the hospital, ask for written information about the procedure you've had.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T3","text":"Ask for copies of all prescriptions before you leave","document":"prescription copies","source":{"url":"https://travelhealthpro.org.uk/news/699/travelling-abroad-for-treatment","host":"travelhealthpro.org.uk","quote":"Remember to ask for copies of all your treatment records, including prescriptions, scans and x-rays before you leave.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T4","text":"Given at discharge so your home practice nurse can help if needed","document":"letter for the practice nurse","source":{"url":"https://www.leedsth.nhs.uk/patients/resources/circumcision/","host":"leedsth.nhs.uk","quote":"Should the need arise, the day unit staff will give you a letter for the Practice Nurse.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}}],"checked_at":"2026-11-11","next_check_at":"2027-11-11","version":1},"alternatives":{"status":"ok","items":[{"id":"A1","text":"You prefer a nonsurgical treatment for your phimosis","name":"Topical steroid cream","source":{"url":"https://www.aafp.org/afp/2025/0200/cochrane-topical-corticosteroids-phimosis","host":"aafp.org","quote":"In the past decade, studies have suggested that topical corticosteroids may be an effective treatment for phimosis.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200},"operation_id":null}],"checked_at":"2026-11-11","next_check_at":"2027-11-11","version":1},"technique_details":{"status":"ok","items":[{"id":"sutured-sleeve-resection","name":"Sutured sleeve (conventional) 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