Primary care
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Neonatal circumcision is one of the most common elective surgical procedures in the United States and globally. This procedure, to remove part of the penile prepuce or foreskin, is done for a variety of personal, social, and medical reasons. ⋯ Three equally safe and effective methods are used for circumcision, and each uses unique equipment: the Gomco clamp, the Mogen clamp, and the Plastibell device. Choice of technique should be guided by operator training and comfort.
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Insertion of urinary catheters (most often Foley catheters) can be performed in outpatient settings to manage acute urinary obstruction without referral to emergency services, as well as to obtain urine samples in patients not able to provide a clean catch urine sample. For patients with established suprapubic urinary catheters, routine exchange can also occur safely in primary care settings. Excision of a thrombosed external hemorrhoid can be performed in the office setting with local anesthesia. The procedure offers better clinical outcomes than symptomatic treatment if performed within the first 72 hours from the onset of symptoms.
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Embedded fishhooks, digital ring entrapment, and foreign bodies of the ear, nose, and superficial eye and conjunctiva may present to primary care clinics and can often be managed there. This review is a guide for primary care clinicians for effective, pragmatic, and safe techniques to address these scenarios in the office and when to refer them to a surgeon.