Development and implementation of a photographic atlas for parental instruction and guidance after outpatient penile surgery.
OBJECTIVE
To develop and evaluate a visual tool to assist parents in assessing healing after surgical circumcision or revision circumcision (SCRC).


METHODS
Among children undergoing SCRC, photographs were taken on postoperative days 0-1-2-3-5-7-10-14-21, and compiled into an atlas. Atlas utility was assessed during two 1-month periods. During the first period (M1) families received routine postoperative instructions only; during the second period (M2), families received the atlas in addition to routine instructions. Families were surveyed by phone and calls/contacts were tracked.


RESULTS
33 families (among 83 SCRCs) were surveyed during M1, vs 39 families (among 77 SCRCs) during M2 (p = 0.17). Nearly all reported the atlas helpful (59% very helpful, 27% moderately helpful, 9% somewhat helpful). All but one family used the atlas. There was a trend toward families receiving the atlas being more comfortable (64% vs 82% very comfortable, p = 0.12). Survey scores were similar between M1 and M2 for total score, satisfaction, and the number whose expectations were met (58% vs 55%, p = 0.21). Phone contacts decreased between M1 and M2, both in absolute number (M1 = 24 calls vs M2 = 12 calls), and as a proportion of total cases performed (29% vs 16%, p = 0.04).


CONCLUSIONS
The circumcision atlas was well received by families and was associated with a significant decrease in post-surgical telephone calls. The atlas has been put into routine clinical use with excellent response.
Department of Urology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA. caleb.nelson@childrens.harvard.edu
Caleb P
CP
Nelson
Ilina
I
Rosoklija
Rosemary
R
Grant
Alan B
AB
Retik
D000556:Ambulatory Surgical Procedures; D001271:Atlases as Topic; D002944:Circumcision, Male / Q000379:methods*; D005500:Follow-Up Studies; D017408:Guidelines as Topic / Q000592:standards*; D006801:Humans; D007223:Infant; D008297:Male; D010290:Parents / Q000193:education*; D010413:Penis / Q000601:surgery; D010781:Photography; D011182:Postoperative Care / Q000193:education*; D013997:Time Factors