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Kılıç S. Comparative analysis of two methods in circumcision: a new disposable device versus classic sleeve technique. BMC Urol 2024; 24:126. [PMID: 38877524 PMCID: PMC11177422 DOI: 10.1186/s12894-024-01513-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/10/2024] [Indexed: 06/16/2024] Open
Abstract
PURPOSE Circumcision is the most common surgical procedures performed in males. Medical circumcision is recommended for diseases such as phimosis, paraphimosis, balanoposthitis and common urinary tract infections, although there is no exact indication. Conversely, Jewish and Muslim individuals commonly undergo circumcision regardless of medical necessity. Circumcision devices are designed to shorten surgery time, achieve an aesthetic appearance and ensure safe surgery. The aim of this study is to evaluate the effectiveness of the NeoAlis clamp, a disposable circumcision device, by comparing it with the sleeve technique in children. MATERIALS AND METHODS Between 2017 and 2023, retrospective evaluation of 2626 patients who underwent circumcision using either the NeoAlis clamp (group 1) or the sleeve technique (group 2) was conducted. Operation time, results, cost, complications were compared between the two groups. RESULTS The study encompassed 2626 patients who fulfilled the inclusion criteria. Group 1 comprised 2403 patients, whereas Group 2 consisted of 223 patients. The overall complication rate, as denoted by n = 47, was 1.7%. Group 1 operation time was shorter than group 2. Bleeding, the most feared complication in the early period, was higher in the second group. No statistically significant difference was observed between the two groups regarding cost comparison. CONCLUSION The primary concern during circumcision is to avoid complications related to general anesthesia in newborns and infants. The use of disposable ring devices has been facilitated by the shorter operation time and the absence of the need for sutures when performing circumcision under local anesthesia. However, knowledge of advanced surgical circumcision techniques is necessary in cases of bleeding and inappropriate ring placement.
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Affiliation(s)
- Sinan Kılıç
- Department of Pediatric Surgery, Private Gebze Yuzyil Hospital, Clinic of Pediatric Surgery, Gebze, Kocaeli, Turkey.
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Comparison of NeoAlis™ disposable circumcision device and sleeve technique in circumcision: Results from a referral health-care center in Turkey. J Pediatr Urol 2021; 17:856.e1-856.e10. [PMID: 34696964 DOI: 10.1016/j.jpurol.2021.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/15/2021] [Accepted: 09/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Circumcision has been one of the most commonly performed surgical procedures worldwide since ancient times. Given the popularity of this procedure, the aim of this study was to evaluate the effectiveness, reliability, and results of circumcision performed using the NeoAlis™ clamp and compare them with those obtained using the sleeve technique. STUDY DESIGN The results of 2259 patients circumcised using the two techniques were evaluated retrospectively. The patients who were circumcised using the plastic NeoAlis™ device were classified as group 1 and those circumcised using the sleeve technique were designated as group 2. The groups were compared in terms of operation time, results, cost, complications, and cosmetic satisfaction scores. RESULTS A total of 1947 patients who met the inclusion criteria were included in the study. Group 1 consisted of 1454 patients, while group 2 comprised 493 patients. The total rate of complications, excluding bleeding in the form of oozing that stopped spontaneously, was 9.5% (n = 185). In group 1, the operation time was shorter, tolerability of local anesthesia was higher, satisfaction questionnaire scores were higher, cost was lower, and rates of early adhesion and meatal stenosis were lower. All of these parameters were significantly different from those in group 2. Notably, secondary phimosis was significantly higher in group 1. Although the bleeding that stopped with follow-up was significantly higher in group 2, there was no significant difference between the groups in terms of bleeding that required surgical intervention. DISCUSSION Our study, which reports the results of circumcisions performed using the NeoAlis clamp, has the largest sample size in the literature. Moreover, this is the only study in the literature wherein the results of sleeve circumcision, which is a time-tested surgical procedure, and the results of NeoAlis clamp circumcision, which we applied to a large number of patients, were compared with each other and with the literature. The retrospective design that focused on relatively short-term (one month) results is the major limitation of this study. CONCLUSION Mass circumcision performed with a plastic clamp technique is safe, timesaving, easily teachable, and cosmetically advantageous.
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SÜZEN A, KARAKUŞ SC, ERTÜRK N. Circumcision with plastic Alisclamp technique in 4733 boys: our experiences to reduce complications. Turk J Med Sci 2021; 51:1324-1330. [PMID: 33610140 PMCID: PMC8283466 DOI: 10.3906/sag-2011-199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/20/2021] [Indexed: 12/03/2022] Open
Abstract
Background/aim We aim to report the outcomes of circumcisions performed with Alisclamp and our experiences to reduce the complications. Material and methods Complications among circumcised males with Alisclamp between 2015 and 2018 were retrospectively analyzed. Patients were divided into two groups: Group 1 (n = 1429); patients circumcised in 2015–2016 and Group 2 (n = 3304); patients circumcised in 2017–2018. The different technical approaches in Group 2 are as follows: 1) Prevention of bleeding: In Group 2, we didn’t pull the ventral prepuce to reduce the risk of frenulum injury and the foreskin was excised approximately 1–2 mm above the base. 2) Prevention of secondary phimosis: In Group 2, regular manual pressure had been applied to mons pubis and we postponed some of the overweight children’s circumcision. 3) Prevention of excessive foreskin: The clamp was placed carefully to prevent the glans from moving back and forth. Results Secondary phimosis was significantly lower in Group 2 (p = 0.003). Total bleeding and bleeding requiring suturing were significantly lower in Group 2 (p = 0.001 and p = 0.026, respectively). Conclusion Technique-specific complications of Alisclamp can reduce with technique-specific modifications.
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Affiliation(s)
- Alev SÜZEN
- Department of Pediatric Surgery, Muğla Sıtkı Koçman University, Faculty of Medicine, MuğlaTurkey
| | - Süleyman Cüneyt KARAKUŞ
- Department of Pediatric Surgery, Muğla Sıtkı Koçman University, Faculty of Medicine, MuğlaTurkey
| | - Nazile ERTÜRK
- Department of Pediatric Surgery, Muğla Sıtkı Koçman University, Faculty of Medicine, MuğlaTurkey
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Tuncer AA, Erten EEA. Examination of short and long term complications of thermocautery, plastic clamping, and surgical circumcision techniques. Pak J Med Sci 2017; 33:1418-1423. [PMID: 29492070 PMCID: PMC5768836 DOI: 10.12669/pjms.336.13640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective: In this study, thermocautery, plastic clamping, and conventional (open surgical) circumcision techniques were compared in terms of their complications. Methods: Male patients who underwent circumcisions between May 2014 and May 2015 in two separate pediatric surgery clinics were retrospectively analyzed using the hospital registry system. These patients were evaluated in terms of age, accompanying pathologies, anesthesia techniques, complication rates, duration of surgery, and circumcision techniques. A statistical analysis of the data was performed, with a P<0.05 considered to be statistically significant. Results: The patients were divided into three groups according to the circumcision method: conventional surgical circumcision (n=833), thermocautery (n=1011), and plastic clamp (n=218). Complications were observed in 21 cases (1%): bleeding (11), infection (2), trapped penis (6), meatitis (1), and scrotal injury (1). There were significantly fewer complications in the thermocautery technique when compared to the clamping and surgical circumcision techniques. The plastic clamping and thermocautery techniques were superior to a surgical circumcision in terms of the operation time. Conclusion: The thermocautery circumcision technique can be used easily in both the operating theatre and in designated circumcision rooms, with a lower complication rate, when compared to plastic clamping and surgical circumcisions.
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Affiliation(s)
- Ahmet Ali Tuncer
- Dr. Ahmet Ali Tuncer, Assistant Professor, Department of Pediatric Surgery, a.Medical Faculty, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Elif Emel Ayar Erten
- Dr. Elif Emel Ayar Erten, MD, Clinic of Pediatric Surgery, Hakkari State Hospital, Hakkari, Turkey
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Seck M, Sagna A, Guéye MS, Faye BF, Sy D, Touré SA, Sall A, Touré AO, Diop S. Circumcision in hemophilia using low quantity of factor concentrates: experience from Dakar, Senegal. BMC HEMATOLOGY 2017; 17:8. [PMID: 28451435 PMCID: PMC5402675 DOI: 10.1186/s12878-017-0080-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 04/10/2017] [Indexed: 12/27/2022]
Abstract
Background Circumcision in hemophiliacs is a delicate surgery because of bleeding risks that could be avoided by adequate substitution of coagulation factor. This practice is very challenging in countries where anti hemophilic treatment is inaccessible. The study aimed to evaluate a circumcision protocol in hemophilia A using low quantities of factor concentrates. Methods This prospective study included 26 hemophiliacs A who underwent circumcision in 2014. Medical treatment protocol using low quantity of factor concentrates was drafted by physicians of the Hemophilia Treatment Center and the surgical protocol by experienced surgeons. Assessment criteria were: number of hospitalization days, number of exposure days to factor concentrates, delay to healing and occurrence of bleeding events. Results Mean age was 9.6 years (1–30). Hemophiliacs patients were classified as severe (n = 8), moderate (n = 9) and mild form (n = 9). Mean number of exposure days to factor VIII concentrates was 6.9 days (5–12) in children and 10.75 days (7–16) in adults (p = 0.0049); mean number of hospitalization days was 3.68 days (2–10) in children and 13.5 days (13–15) in adults (p = 0.0000); delay to healing was 26.47 days (20–35) in children and 25.25 days (22–30) in adults (p = 0.697); five haemophiliacs (19.2%) presented bleeding events after the circumcision. The mean amount of FIII concentrates used per patient was 1743 IU (810–2340). Conclusion The study shows treatment protocol using low quantity of factor concentrates is efficient in hemophilia patients who underwent circumcision.
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Affiliation(s)
- Moussa Seck
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Aloïse Sagna
- Pediatric Surgical Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Mame Sokhna Guéye
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Blaise Félix Faye
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Diariétou Sy
- Hematology Service, National Blood Transfusion Center, Dakar, BP 5005 Senegal
| | | | - Abibatou Sall
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Awa Oumar Touré
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
| | - Saliou Diop
- Hematology Service, Cheikh Anta Diop University, Dakar, BP 5005 Senegal
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Meel BL. License to cut and kill practice: a case report on botched circumcision in Mthatha region of South Africa. S Afr Fam Pract (2004) 2016. [DOI: 10.1080/20786190.2014.978116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Barone MA, Li PS, Awori QD, Lee R, Goldstein M. Clinical trials using the Shang Ring device for male circumcision in Africa: a review. Transl Androl Urol 2016; 3:113-24. [PMID: 26816759 PMCID: PMC4708291 DOI: 10.3978/j.issn.2223-4683.2014.01.09] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Male circumcision (MC) reduces the risk of HIV and other sexually transmitted infections (STIs), including human papillomavirus (HPV) and herpes simplex virus type 2 (HSV-2), and is recommended as an important component of a comprehensive package of HIV prevention interventions. While computer modeling has demonstrated that substantial reductions in HIV could be achieved with rapid scale-up of MC services in sub-Saharan Africa, scale-up has lagged due to scarcity of trained providers coupled with relative technical difficulty of recommended surgical MC techniques. Simplified techniques, such as devices, have the potential to allow for a more rapid roll-out of MC. One such device is the Shang Ring, a novel disposable MC device that eliminates the need for suturing and has been on the Chinese market since 2005. Results from Chinese studies have demonstrated that the Shang Ring is both safe and easy to use. Since 2008, a series of studies using the Shang Ring for adult MC have been carried out in Kenya, Uganda and Zambia, according to guidelines established by World Health Organization (WHO) for clinical evaluation of new devices for adult MC. These include a proof of concept study, a study of delayed removal of the Shang Ring, two studies comparing Shang Ring circumcision to conventional surgical approaches, and a large field trial to evaluate safety of Shang Ring circumcision during routine service delivery. Results from these studies demonstrate that the Shang Ring has an excellent safety profile and that Shang Ring circumcision is relatively easy to teach and learn, making Shang Ring MC an appealing technique for use in sub-Saharan Africa where doctors are in short supply and non-physician providers such as nurses and clinical officers are playing a major role in providing MC through task shifting. Shang Ring MC and device removals were uneventfully performed by trained nurses and clinical officers, who preferred the Shang Ring to conventional surgical techniques. Adverse event rates were similar to those observed with conventional surgical circumcision and were managed with, at most, minor interventions, resolving with no long-term sequale. Perhaps one of the biggest advantages of the Shang Ring is the relatively short 3-6 minutes procedure time. Importantly, men also preferred the Shang Ring compared to conventional circumcision and satisfaction with cosmetic appearance of their circumcised penis was very high. The vast majority of participants in studies in Africa as well as China have reported few problems and little disruption to daily life while wearing the device. The Shang Ring holds great promise as an innovative technology that has the potential to facilitate the safe and effective scale-up of circumcision services in settings where MC is not widely used and where the burden of HIV-disease is high.
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Affiliation(s)
- Mark A Barone
- 1 EngenderHealth, New York, NY, USA ; 2 Center for Male Reproductive Medicine and Microsurgery, Department of Urology, Weill Cornell Medical College, New York, NY, USA ; 3 EngenderHealth, Nairobi, Kenya
| | - Philip S Li
- 1 EngenderHealth, New York, NY, USA ; 2 Center for Male Reproductive Medicine and Microsurgery, Department of Urology, Weill Cornell Medical College, New York, NY, USA ; 3 EngenderHealth, Nairobi, Kenya
| | - Quentin D Awori
- 1 EngenderHealth, New York, NY, USA ; 2 Center for Male Reproductive Medicine and Microsurgery, Department of Urology, Weill Cornell Medical College, New York, NY, USA ; 3 EngenderHealth, Nairobi, Kenya
| | - Richard Lee
- 1 EngenderHealth, New York, NY, USA ; 2 Center for Male Reproductive Medicine and Microsurgery, Department of Urology, Weill Cornell Medical College, New York, NY, USA ; 3 EngenderHealth, Nairobi, Kenya
| | - Marc Goldstein
- 1 EngenderHealth, New York, NY, USA ; 2 Center for Male Reproductive Medicine and Microsurgery, Department of Urology, Weill Cornell Medical College, New York, NY, USA ; 3 EngenderHealth, Nairobi, Kenya
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Bossio JA, Pukall CF, Steele S. A review of the current state of the male circumcision literature. J Sex Med 2014; 11:2847-64. [PMID: 25284631 DOI: 10.1111/jsm.12703] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Male circumcision is one of the most commonly performed surgical procedures worldwide and a subject that has been the center of considerable debate. Recently, the American Association of Pediatrics released a statement affirming that the medical benefits of neonatal circumcision outweigh the risks. At present, however, the majority of the literature on circumcision is based on research that is not necessarily applicable to North American populations, as it fails to take into account factors likely to influence the interpretability and applicability of the results. AIMS The purpose of this review is to draw attention to the gaps within the circumcision literature that need to be addressed before significant changes to public policy regarding neonatal circumcision are made within North America. METHODS A literature review of peer-reviewed journal articles was performed. MAIN OUTCOME MEASURES The main outcome measure was the state of circumcision research, especially with regard to new developments in the field, as it applies to North American populations. RESULTS This review highlights considerable gaps within the current literature on circumcision. The emphasis is on factors that should be addressed in order to influence research in becoming more applicable to North American populations. Such gaps include a need for rigorous, empirically based methodologies to address questions about circumcision and sexual functioning, penile sensitivity, the effect of circumcision on men's sexual partners, and reasons for circumcision. Additional factors that should be addressed in future research include the effects of age at circumcision (with an emphasis on neonatal circumcision) and the need for objective research outcomes. CONCLUSION Further research is needed to inform policy makers, health-care professionals, and stakeholders (parents and individuals invested in this debate) with regard to the decision to perform routine circumcision on male neonates in North America.
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Randomized controlled trial of the shang ring versus conventional surgical techniques for adult male circumcision: safety and acceptability. J Acquir Immune Defic Syndr 2014; 65:447-55. [PMID: 24583615 DOI: 10.1097/qai.0000000000000061] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare clinical profiles of Shang Ring versus conventional circumcisions. DESIGN Parallel group open-label randomized controlled trial with one-to-one allocations in 2 sites. METHODS We enrolled HIV-negative men aged 18-54 years in Homa Bay, Kenya, and Lusaka, Zambia and followed them at 2, 7, 14, 21, 28, 42, and 60 days after Shang Ring versus conventional circumcision. We compared the duration of surgery, postoperative pain using a visual analog scale, adverse events rates, time to complete wound healing by clinical assessment, participant acceptability, and provider preferences between circumcision groups. RESULTS We randomized 200 men to each group; 197 and 201 contributed to the Shang Ring and conventional surgery analyses, respectively. Adverse event rates were similar between groups. Pain scores at most time points were similar, however, the Shang Ring group reported higher scores for worst pain during erections (3.5 ± 1.9 vs. 2.3 ± 1.7; P < 0.001). Significantly more men were satisfied with the cosmetic appearance following Shang Ring male circumcision (MC), 95.7% versus 85.9% (P = 0.02) in Kenya, and 96.8% versus 71.3% (P < 0.01) in Zambia. Although median time to complete wound healing was 43 days in both groups, conventional circumcisions healed on average 5.2 days sooner (P < 0.001). Shang Ring procedures took one-third the time of conventional MC, 7 versus 20 minutes. All circumcision providers preferred the Shang Ring. CONCLUSIONS Safety profiles of the 2 techniques were similar, all MC providers preferred the Shang Ring technique, and study participants preferred the Shang Ring's cosmetic results. The Shang Ring should be considered for adult MC as programs scale-up.
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Bastos Netto JM, Gonçalves de Araújo J, Noronha MFDA, Passos BR, Lopes HE, Bessa JD, Figueiredo AA. A prospective evaluation of plastibell® circumcision in older children. Int Braz J Urol 2014; 39:558-64. [PMID: 24054384 DOI: 10.1590/s1677-5538.ibju.2013.04.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 07/01/2013] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Circumcision is one of the oldest surgical procedures and one of the most frequently performed worldwide. It can be done by many different techniques. This prospective series presents the results of Plastibell® circumcision in children older than 2 years of age, evaluating surgical duration, immediate and late complications, time for plastic device separation and factors associated with it. MATERIALS AND METHODS We prospectively analyzed 119 children submitted to Plastic Device Circumcision with Plastibell® by only one surgeon from December 2009 to June 2011. In all cases the surgery was done under general anesthesia associated with dorsal penile nerve block. Before surgery length of the penis and latero-lateral diameter of the glans were measured. Surgical duration, time of Plastibell® separation and use of analgesic medication in the post-operative period were evaluated. Patients were followed on days 15, 45, 90 and 120 after surgery. RESULTS Age at surgery varied from 2 to 12.5 (5.9 ± 2.9) years old. Mean surgical time was 3.7 ± 2.0 minutes (1.9 to 9 minutes). Time for plastic device separation ranged from 6 to 26 days (mean: 16 ± 4.2 days), being 14.8 days for children younger than 5 years of age and 17.4 days for those older than 5 years of age (p < 0.0001). The diameter of the Plastibell® does not interfered in separations time (p = 0,484). Late complications occurred in 32 (26.8%) subjects, being the great majority of low clinical significance, especially prepucial adherences, edema of the mucosa and discrete hypertrophy of the scar, all resolving with clinical treatment. One patient still using diaper had meatus stenosis and in one case the Plastibell® device stayed between the glans and the prepuce and needed to be removed manually. CONCLUSIONS Circumcision using a plastic device is a safe, quick and an easy technique with low complications, that when occur are of low clinical importance and of easy resolution. The mean time for the device to fall is shorter in children under 6 years of age and it is not influenced by the diameter of the device.
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Morris BJ, Krieger JN. Does male circumcision affect sexual function, sensitivity, or satisfaction?--a systematic review. J Sex Med 2013; 10:2644-57. [PMID: 23937309 DOI: 10.1111/jsm.12293] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Circumcision of males is commonly carried out worldwide for reasons of health, medical need, esthetics, tradition, or religion. Whether circumcision impairs or improves male sexual function or pleasure is controversial. AIMS The study aims to conduct a systematic review of the scientific literature. METHODS A systematic review of published articles retrieved using keyword searches of the PubMed, EMBASE, and Cochrane databases was performed. MAIN OUTCOME MEASURES The main outcome measure is the assessment of findings in publications reporting original data relevant to the search terms and rating of quality of each study based on established criteria. RESULTS Searches identified 2,675 publications describing the effects of male circumcision on aspects of male sexual function, sensitivity, sensation, or satisfaction. Of these, 36 met our inclusion criteria of containing original data. Those studies reported a total of 40,473 men, including 19,542 uncircumcised and 20,931 circumcised. Rated by the Scottish Intercollegiate Guidelines Network grading system, 2 were 1++ (high quality randomized controlled trials) and 34 were case-control or cohort studies (11 high quality: 2++; 10 well-conducted: 2+; 13 low quality: 2-). The 1++, 2++, and 2+ studies uniformly found that circumcision had no overall adverse effect on penile sensitivity, sexual arousal, sexual sensation, erectile function, premature ejaculation, ejaculatory latency, orgasm difficulties, sexual satisfaction, pleasure, or pain during penetration. Support for these conclusions was provided by a meta-analysis. Impairment in one or more parameters was reported in 10 of the 13 studies rated as 2-. These lower-quality studies contained flaws in study design (11), selection of cases and/or controls (5), statistical analysis (4), and/or data interpretation (6); five had multiple problems. CONCLUSION The highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction.
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Affiliation(s)
- Brian J Morris
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
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Arslan D, Kalkan M, Yazgan H, Ünüvar U, Şahin C. Collective Circumcision Performed in Sudan: Evaluation in Terms of Early Complications and Alternative Practice. Urology 2013; 81:864-7. [DOI: 10.1016/j.urology.2012.11.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 11/09/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
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Hedjazi A, Zarenezhad M, Hosseini SMV, Fereidooni M, Ghadipasha M, Rad BS, Daghi JG, Shogaee A, Hoseinzadeh A. Epidemiology of Circumcision-Related Mortality in Iran: A 10-year Survey. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 4:608-10. [PMID: 23181239 PMCID: PMC3503386 DOI: 10.4103/1947-2714.103338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Arya Hedjazi
- Iranian Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran. E-mail:
| | - Mohammad Zarenezhad
- Iranian Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran. E-mail:
| | | | - Mehran Fereidooni
- Iranian Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran. E-mail:
| | - Masoud Ghadipasha
- Iranian Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran. E-mail:
| | - Bahram Samadi Rad
- Iranian Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran. E-mail:
| | - Jaber Ghareh Daghi
- Iranian Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran. E-mail:
| | - Ahmad Shogaee
- Iranian Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran. E-mail:
| | - Amin Hoseinzadeh
- Iranian Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran. E-mail:
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HIV prevention: male circumcision comparison between a nonsurgical device to a surgical technique in resource-limited settings: a prospective, randomized, nonmasked trial. J Acquir Immune Defic Syndr 2012; 61:49-55. [PMID: 22739133 DOI: 10.1097/qai.0b013e3182631d69] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Randomized controlled trial studies have shown that male circumcision (MC) can reduce the risk of HIV infection by 53%-60%. The Joint United Nations Program on HIV and AIDS announced a 5-year plan to voluntarily circumcise 20 million men by 2015. There are more than 38 million males in sub-Saharan Africa that could benefit from MC for HIV prevention by 2015. Surgical MC is impractical for nation-wide coverage in resource-limited settings. Rwanda intends to launch a voluntary MC program to reach 2 million adult men in 2 years, an unattainable goal with surgical MC. This study was designed to compare a new nonsurgical device with surgical MC to assess nonsurgical MC suitability for scale-up. METHODS Prospective, randomized controlled trial in Rwanda in which the PrePex device was used for nonsurgical MC and the dorsal-slit method for surgical MC (ratio: 2:1). Subjects were healthy adult male volunteers aged 21-54 years. The primary endpoint, set by World Health Organization, was total MC procedure time. FINDINGS Of 217 eligible subjects, 144 were randomized to the PrePex/nonsurgical arm and 73 to the surgical arm. All subjects were circumcised in 10 working days. Nonsurgical MC was bloodless, without anesthesia, sutures, or sterile setting and with mean procedure time of 3.1 minutes (skin to skin), was significantly shorter than mean surgical procedure time (15.4 minutes skin to skin) (P < 0.0001). There were no device-related adverse events. Healing time of the PrePex arm was longer than the surgical arm. CONCLUSION PrePex, the nonsurgical MC, takes significantly less time than surgical, is as safe, does not require injections or sterile settings, is bloodless and seems to be suitable for nurses.
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Peng M, Meng Z, Yang ZH, Wang XH. The ultrasonic harmonic scalpel for circumcision: experimental evaluation using dogs. Asian J Androl 2012; 15:93-6. [PMID: 23042449 DOI: 10.1038/aja.2012.67] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Male circumcision is one of the most commonly performed operations worldwide, and many novel techniques have been developed for better postoperative outcomes. The purpose of this study was to explore the feasibility of applying the ultracision harmonic scalpel (UHS) for circumcision by using dogs. Sixteen adult male dogs were divided into two groups: the UHS group and the control group. The dogs were circumcised with either the UHS or a conventional scalpel. The UHS circumcision procedure and the effects were imaged 1 week after surgery. The two groups were compared with respect to the operative time and volume of blood loss. Postoperative complications, including oedema, infection, bleeding of the incision and wound dehiscence, were recorded for both groups. The mean operative time for the UHS group was only 5.1 min compared with the 35.5 min of the conventional group. The mean blood loss was less than 2 ml for the UHS group and 15 ml for the conventional group. There was only one case of mild oedema in the UHS group, but the postoperative complications in the conventional group included two cases of mild oedema, one infection of the incision and one case of bleeding of the incision. In conclusion, circumcision using UHS is a novel technique to treat patients with phimosis and excessive foreskin, and this method has a short operative time, less blood loss and fewer complications than the conventional scalpel method. This small animal study provides a basis for embarking on a larger-scale clinical trial of the UHS.
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Affiliation(s)
- Mou Peng
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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Senel FM. Editorial Comment from Dr Senel to circumcision with a novel disposable device in Chinese children: a randomized controlled trial. Int J Urol 2012; 20:227-8. [PMID: 22973875 DOI: 10.1111/j.1442-2042.2012.03158.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pan F, Pan L, Zhang A, Liu Y, Zhang F, Dai Y. Circumcision with a novel disposable device in Chinese children: a randomized controlled trial. Int J Urol 2012; 20:220-6. [PMID: 22974480 DOI: 10.1111/j.1442-2042.2012.03132.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 07/26/2012] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To compare the outcomes and complications of three methods of circumcision in a Chinese pediatric population. METHODS A total of 120 children were randomly assigned to three groups. Group I was submitted to circumcision using the Shenghuan disposable device according to Yan's method; group II was submitted to circumcision using the same device, but according to Peng's methods; group III was operated on by using the conventional scalpel/suture technique. The three groups were compared mainly by the following outcomes: duration of surgery, intraoperative bleeding, postoperative pain, cosmetic effect, and the rates of edema, dehiscence, scarring, adhesion and infection. RESULTS Groups I and II had less intraoperative bleeding. In terms of the duration of surgery, group I was the quickest. Pain scores in using the Shenghuan disposable device were higher at 6 h after surgery compared with the conventional scalpel/suture technique. The percentage of patients using paracetamol in group II was higher than that in group III at 12 h after surgery. Other complications were similar, and all three groups had successful outcomes. CONCLUSIONS Circumcision using the Shenghuan disposable device represents a safer and time-saving option compared with the conventional scalpel/suture technique, with better cosmetic outcomes. Yan's method seems to be better than Peng's method when using the Shenghuan disposable device for circumcision in children.
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Affiliation(s)
- Feng Pan
- Department of Urology, Affiliated Drum Tower Hospital, Nanjing University, School of Medicine, Nanjing, China
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Randomized trial of the Shang Ring for adult male circumcision with removal at one to three weeks: delayed removal leads to detachment. J Acquir Immune Defic Syndr 2012; 60:e82-9. [PMID: 22343180 DOI: 10.1097/qai.0b013e31824ea1f2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess healing with Shang Ring removal at different prespecified times; whether spontaneous detachment occurs with delayed removal; problems, complaints, and acceptability of wearing the device; satisfaction among participants; and acceptability of the procedure among providers. METHODS Fifty HIV-negative men underwent a Shang Ring circumcision in Kenya. Men were randomly assigned for device removal at 7 (15 men), 14 (15 men), or 21 days (20 men). Follow-up visits were at 7, 14, 21, 28, and 42 days after circumcision and 2 days after removal. RESULTS Circumcision and device removal were conducted without significant problems. Mean times for circumcision and device removal were 6.5 (SD = 2.4) and 2.5 (SD = 0.8) minutes, respectively. Complete detachment of the device occurred in 22 (66.7%) men who wore it more than 7 days. Seven men (14.0%) with partial detachments requested removal 8-14 days postcircumcision due to pain/discomfort. Healing progressed normally in all participants; cumulative probabilities of complete healing were similar across groups. No severe or serious adverse events occurred. Acceptability among participants was high. Providers reported that Shang Ring circumcision was "very easy" compared with the forceps-guided procedure. CONCLUSION The Shang Ring is safe and easy to use according to label instructions (7 day removal). Detachments occurred without significant problems, although some men requested removal of partially detached rings. Removal time had little effect on healing. These data help allay concerns about men not returning for ring removal and expand the evidence base suggesting the Shang Ring could facilitate rapid male circumcision rollout in sub-Saharan Africa.
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