A qualitative study of parental preferences for postcircumcision care education

Proximal migration of Plastibell circumcision: two case reports and review of the literature

Background

Male circumcision is one of the oldest and most commonly performed surgical procedures in the world; in fact, one of every 3 males in the world is circumcised. Plastibell circumcision is the commonest procedure performed worldwide with higher rates of satisfaction and lower rates of complications.

Case presentation

We present two cases, 4 and 5 months old with proximal migration of Plastibell ring with penile incarcerations that were managed successfully. We aim to highlight the necessary precautions needed to avoid serious complications after a minor surgical procedure.

Conclusions

Plastibell circumcision is a minor surgical procedure that is underestimated with the potential for major and serious complications. The implementation of the law against the practice of non-professional individuals, standardization of the procedure, and improvement of communication are highly recommended to avoid unnecessary and serious complications. Plastibell ring circumcision still needs further studies to examine ring antimigration, re-designing, and the best types and sizes of threads used. Lastly, studies are also needed to determine a cost-effective routine follow-up visit post-Plastibell circumcision procedures.

Gomco vs. plastibell office circumcision: No difference in overall post-procedural complications and healthcare utilization

INTRODUCTION

Gomco clamp and Plastibell ring are common methods of office circumcision. While they possess similar features, the Plastibell is retained after the procedure which could impact perceived and true outcomes of the procedure.

OBJECTIVE

This study evaluated differences in complications, interventions, and healthcare utilization between Gomco and Plastibell office circumcision techniques.

STUDY DESIGN

We retrospectively reviewed urology office performed circumcisions (January 2015-August 2018), limiting analysis to patients with follow-up. Patient demographics and circumcision technique were recorded. Complications, interventions, phone calls, emergency department (ED)/urgent care (UC) visits, and unplanned office visits directly related to the circumcision were recorded. Descriptive statistics for the number of patients experiencing an event and the number of days to event were summarized. Survival analysis with inverse probability of treatment weights was used to estimate hazard and incidence rate ratios (HR and IRR, respectively).

RESULTS

746 patients were included for analysis. Median time of follow-up was 2.7 weeks (interquartile range 2-5). 257 (34%) patients underwent Gomco circumcision; 489 (66%) underwent Plastibell circumcision. The techniques did not significantly differ for complications (HR = 0.9, p = 0.497), interventions (HR = 0.89, p = 0.498), and hospital visits (HR = 1.0, p = 0.985) (Table), although Plastibell patients presented to the ED/UC more (odds ratio = 1.6, p = 0.02). Plastibell patients generated proportionally more post-procedural phone calls (63 vs. 52%), though not significantly (IRR = 1.11; p = 0.426).

DISCUSSION

Overall, the type of device used for office circumcision, between Gomco clamp and Plastibell ring, does not appear to impact the outcome of circumcision. Providers should perform the method of office circumcision with which they are familiar and comfortable. There is an overall reliance on healthcare resources suggesting poor family preparation of the post-procedural course regardless of the technique, necessitating better patient education. Limitations of this study include its retrospective nature, variability in follow-up between techniques, and variety of providers, limited to pediatric urologists, performing circumcision.

CONCLUSIONS

Gomco and Plastibell office circumcision techniques do not significantly differ in post-procedural complications, interventions, unplanned hospital visits, and office phone calls. Plastibell patients do present more often to the ED/UC perhaps as a result of increased anxiety and perceived immediacy of concerns with the device.