Male circumcision: a review of the evidence

Dual laser circumcision: a novel technique to improve traditional surgery

Circumcision represents one of the oldest and routinely performed urological surgery. It implies the exeresis of the prepuce due to ethnic, religious and medical reasons. Different authors reported straightforward advantages of this procedure including increased penile hygiene, reduction of penile cancer risks and lower rates of urinary tract infections. Circumcision can be easily performed and reproduced according to different techniques. Nowadays, different types of lasers have been developed and this technology is gaining consensus in the urological community. Aim of this article is to describe our surgical technique for laser circumcision with the Lasemar Eufuton 1500, clarifying the surgical steps and the benefits of this technology.

Need for Increased Awareness of International Male Circumcision Variations and Associated Complications: A Contemporary Review

Male circumcision is a prevalent, straightforward procedure. Cultural, religious, and/or social factors are the main determinants in the decision to undergo circumcision. The method of circumcision and age of the patient at the time of circumcision varies, dependent on the deciding determinant: cultural or religious tradition, personal hygiene, preventive health, or medical need. While circumcision is a relatively simple operation for a trained medical professional with low rates of adverse events, the safety of the operation varies when performed by non-medically trained (traditional) practitioners. This review aims to inform physicians of international circumcision variations and associated complications and to provide history-taking considerations during the review of the genitourinary system. The review revealed a wide variety in 1) training of practitioners performing circumcisions, 2) methods of circumcision, and 3) sterility during the procedure contributing to differing rates of complications. Findings suggest circumcisions should not be viewed equally, and greater emphasis should be placed on genitourinary history, especially circumcision, with patients from areas where traditional circumcisions are prevalent.

Postoperative aesthetic and healing features of postectomy using three different surgical techniques: a randomized, prospective, and interdisciplinary analysis

OBJECTIVE

to compare the postoperative esthetic and healing aspects of postectomy performed by different surgical techniques, based on the evaluation of different specialty expert professionals.

METHODS

prospective and randomized clinical trial enrolling 149 preschool children with a medical indication for circumcision, divided into three groups: postectomy with the hemostatic device Plastibell® (PB group), conventional technique (CV group) and conventional with subcuticular stitches (SC group). Pictures were taken from patients at pre-defined angles on the 30th and 60th postoperative days. Photos were evaluated by three specialists (dermatologist, pediatrician and plastic surgeon), who assigned scores from 1 to 5 regarding the esthetic and healing features at each moment. Grades 4 or 5 from all specialists characterized "best result". Data were analysed to compare the used surgical techniques, the judgments from specialties and postoperative complications.

RESULTS

most of the patients obtained the "best result" regarding healing (70%) and esthetics (56%). The final overall result showed the PB group as the best for healing (p=0.028) and the SC group as the best for esthetics (p=0.002). For the dermatologist, on the 60th postoperative day, the CV group presented the worst aesthetic result, whereas for the pediatrician and the plastic surgeon, the PB group presented the best healing result and the SC group had the best esthetic result. There was no difference between the groups regarding the presence of complications.

CONCLUSION

the most common surgical techniques used to perform postectomy in children were differently assessed regarding healing and esthetic features by distinct medical professionals. The analysis of these two parameters among experts from related areas diverged among them and over time.

Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study

The present study was designed to determine the seroprevalence of hepatitis B and C virus (HBV, HCV) infections and risk factors in the Turkish general population. Participants were enrolled from urban and rural areas of the predetermined 23 EUROSTAT NUTS 2 region. A two-stage stratified sampling method was used to select participants from these regions (n = 5460; 50.9% females; mean (SD) age: 40.8 (14.7) years). Sociodemographics, clinical characteristics and risk factors were recorded at home visits. The seropositivity rates for hepatitis B surface antigen (HBsAg), anti-HCV, anti-HBs and anti-HBc total were 4.0%, 1.0%, 31.9% and 30.6%, respectively. Among HBsAg-positive cases, 94.5% were anti-HBe-positive, 70.2% were HBV-DNA-positive and 2.8% were anti-HDV total positive; 99.1% of HBV infections were of genotype D. Close contact with a hepatitis patient (OR 3.24; 95% CI 2.25-4.66; p < 0.001), living in the southeastern region (OR 2.74; 95% CI 1.7-4.45; p < 0.001), male gender (OR 1.77; 95% CI 1.28-2.46; p < 0.001), being married (OR 1.62; 95% CI 1.02-2.57; p 0.038), educational level less than high school (OR 1.53; 95% CI 1.04-2.26; p 0.03), orodental interventions (OR 1.54; 95% CI 1.01-2.35; p 0.047) and a history of non-disposable syringe use (OR 1.4; 95% CI 1.01-1.96; p 0.045) were significant determinants of HBsAg positivity. Age ≥50 years (OR 2; 95% CI 1.09-4.3; p 0.026) was the only significant predictor of anti-HCV positivity. In conclusion, our findings revealed an HBsAg positivity in 4% and anti-HCV positivity in 1% of the adult population and at least one-third of the population has been exposed to HBV infection in Turkey.

The GoMo study: a randomized clinical trial assessing neonatal pain with Gomco vs Mogen clamp circumcision

OBJECTIVE

Our objective was to compare the pain/stress levels of newborns among the 2 most common circumcision techniques after resident-wide education.

STUDY DESIGN

The study period of this randomized control trial was October 2012 through March 2014. Following informed consent, full-term males from uncomplicated singleton pregnancies were randomized to Gomco (n=137) or Mogen (n=137) devices. Resident-wide education for an obstetrics and gynecology residency program at a single institution was performed to ensure standardized training. All infants received a subcutaneous ring block before the procedure and oral sucrose intraoperatively. The primary outcome was neonatal pain assessed physiologically by salivary cortisol levels (enzyme-linked immunosorbent assay) and clinically by a validated neonatal pain score (crying, requires increased oxygen administration, increased vital signs, expression, sleeplessness [CRIES]). Secondary outcomes were immediate complications, duration of procedure, and short-term outcomes as reported by mothers and pediatricians. A sample size of 274 (accounting for 20% loss of follow-up) was determined sufficient to detect a mean difference of 1.22 μg/dL in cortisol levels (Gomco, SD±3.34; Mogen, SD±0.81) with 80% power, P=.05 level of significance.

RESULTS

A total of 251 infants completed the protocol. There were no significant differences in maternal or neonatal demographics including preoperative heart rate and mean arterial pressure. In the Mogen circumcision, the percentage change of cortisol was significantly lower than Gomco (279.1±498.15 vs 167.75±272.22; P=.049). There were no differences in postoperative CRIES scores. Postoperative heart rate was higher in infants undergoing Gomco circumcision than Mogen circumcision (138.7±16.5 vs 133.4±17.5; P=.015) as was mean arterial blood pressure (63.3±9.2 vs 60.4±8.6; P=.012). Mogen circumcisions were shorter (7.00±2.97 vs 3.65±1.84 minutes; P<.001). There were no significant differences in bleeding complications. A total of 168 maternal surveys were completed, with 98.7% maternal satisfaction in Gomco vs 98.9% in Mogen. There were no reports of bleeding after discharge or circumcision revisions in either group to date.

CONCLUSION

Mogen clamp is associated with less neonatal pain physiologically by significantly lower percentage change in salivary cortisol, lower heart rate, and mean arterial blood pressure. There was no difference in CRIES scores. Mogen clamp circumcision duration is significantly shorter than Gomco clamp. Both methods demonstrate satisfactory maternal and pediatrician short-term follow-up.

Parental evaluation of postoperative outcome of circumcision with Plastibell or conventional dissection by dorsal slit technique: a randomized controlled trial

AIM

To evaluate and compare parental satisfaction after Plastibell and conventional dissection circumcision.

METHODS

198 children were randomly and equally allocated to two groups (PD: Plastibell and CDS: dissection) for circumcision. Follow-up was done at 7th, 15th and 90th day after surgery. Written questionnaires were given to parents at the time of discharge to complete and return at the 15th and 90th day follow-up visits.

RESULTS

Both groups were balanced with respect to various demographic factors, indications for surgery and Kayaba's classification of the prepuce. Surgical duration was significantly shorter for the PD as compared to the CDS group (5.91 ± 1.74 min vs. 23.52 ± 5.94 min; p < 0.0001 H.S.). Swelling, dysuria and infection were the prominent problems reported in both groups in the first 7 days. The Plastibell separated earlier in younger children (p < 0.0001). Postoperatively, children in the PD group required 2.79 fold more analgesic than those in the CDS group. 97.9% of parents in the PD group and 80.2% of parents in the CDS group claimed satisfactory aesthetic results. The PD group parents were statistically significantly more concerned about swelling.

CONCLUSIONS

Plastibell use has comparable outcomes to the conventional dissection technique for paediatric circumcision and has an obvious advantage of shorter surgical duration. However, it is less comfortable in the postoperative period due to swelling, and requires greater use of analgesics.

Prospective randomized trial comparing dissection with Plastibell® circumcision

OBJECTIVE

To compare and evaluate dissection and Plastibell(®) circumcision techniques for the treatment of phimosis.

METHODS

In 2006-2007, 125 children were submitted to circumcision by the same surgeon. The children were randomly divided into two groups (PD: Plastibell(®) and DC: dissection). In both groups the surgery was performed under general anesthesia and dorsal penile block. The dissection circumcision used the double circular incision technique. Follow-up was done on days 15, 45 and 90 after surgery.

RESULTS

Sixty-eight patients were included in DC and 57 in PD. The mean age at surgery was 71.76 ± 31.56 months for DC and 70.95 ± 31.73 months for PD. There was no difference in Kayaba's classification for phimosis or indication for surgery between the groups. Surgical time for DC was 14.64 ± 1.93 min and for PD 3.29 ± 1.48 min (P < 0.001). The incidence of immediate complications was similar, but late complications, especially adhesions, were greater in DC (P < 0.01). The use of pain medication (paracetamol) was similar during the first 2 days after surgery, but was greater in PD from the 3rd day after surgery (P < 0.05).

CONCLUSIONS

Plastibell(®) circumcision has a shorter surgical duration with fewer late complications, but requires more analgesic medication after the 3rd day post surgery.