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Jin XD, Lu JJ, Liu WH, Zhou J, Yu RK, Yu B, Zhang XJ, Shen BH. Adult male circumcision with a circular stapler versus conventional circumcision: A prospective randomized clinical trial. ACTA ACUST UNITED AC 2015; 48:577-82. [PMID: 25831203 PMCID: PMC4470318 DOI: 10.1590/1414-431x20154530] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/28/2015] [Indexed: 02/07/2023]
Abstract
Male circumcision is the most frequently performed procedure by urologists. Safety and efficacy of the circumcision procedure requires continual improvement. In the present study, we investigated the safety and efficacy of a new male circumcision technique involving the use of a circular stapler. In total, 879 consecutive adult male patients were randomly divided into 2 groups: 441 underwent stapler circumcision, and 438 underwent conventional circumcision. The operative time, pain score, blood loss volume, healing time, treatment costs, and postoperative complications were compared between the two groups. The operative time and blood loss volume were significantly lower in the stapler group than in the conventional group (6.8 ± 3.1 vs 24.2 ± 3.2 min and 1.8 ± 1.8 vs 9.4 ± 1.5 mL, respectively; P<0.01 for both). The intraoperative and postoperative pain scores were significantly lower in the stapler group than in the conventional group (0.8 ± 0.5 vs 2.4 ± 0.8 and 4.0 ±0.9 vs 5.8 ± 1.0, respectively; P<0.01 for both). Additionally, the stapler group had significantly fewer complications than the conventional group (2.7% vs 7.8%, respectively; P<0.01). However, the treatment costs in the stapler group were much higher than those in the conventional group (US$356.60 ± 8.20 vs US$126.50 ± 7.00, respectively; P<0.01). Most patients (388/441, 88.0%) who underwent stapler circumcision required removal of residual staple nails. Overall, the present study has shown that stapler circumcision is a time-efficient and safe male circumcision technique, although it requires further improvement.
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Affiliation(s)
- X D Jin
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - J J Lu
- Department of Urology, Beilun People's Hospital, Ningbo, China
| | - W H Liu
- Department of Urology, Beilun People's Hospital, Ningbo, China
| | - J Zhou
- Department of Urology, Beilun People's Hospital, Ningbo, China
| | - R K Yu
- Department of Urology, Beilun People's Hospital, Ningbo, China
| | - B Yu
- Department of Urology, Yuyao People's Hospital, Ningbo, China
| | - X J Zhang
- Department of Urology, Xiangshan First People's Hospital, Ningbo, China
| | - B H Shen
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Mavhu W, Frade S, Yongho AM, Farrell M, Hatzold K, Machaku M, Onyango M, Mugurungi O, Fimbo B, Cherutich P, Rech D, Castor D, Njeuhmeli E, Bertrand JT. Provider attitudes toward the voluntary medical male circumcision scale-up in Kenya, South Africa, Tanzania and Zimbabwe. PLoS One 2014; 9:e82911. [PMID: 24801632 PMCID: PMC4011678 DOI: 10.1371/journal.pone.0082911] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 10/29/2013] [Indexed: 11/19/2022] Open
Abstract
Background Countries participating in voluntary medical male circumcision (VMMC) scale-up have adopted most of six elements of surgical efficiency, depending on national policy. However, effective implementation of these elements largely depends on providers' attitudes and subsequent compliance. We explored the concordance between recommended practices and providers' perceptions toward the VMMC efficiency elements, in part to inform review of national policies. Methods and Findings As part of Systematic Monitoring of the VMMC Scale-up (SYMMACS), we conducted a survey of VMMC providers in Kenya, South Africa, Tanzania, and Zimbabwe. SYMMACS assessed providers' attitudes and perceptions toward these elements in 2011 and 2012. A restricted analysis using 2012 data to calculate unadjusted odds ratios and 95% confidence intervals for the country effect on each attitudinal outcome was done using logistic regression. As only two countries allow more than one cadre to perform the surgical procedure, odds ratios looking at country effect were adjusted for cadre effect for these two countries. Qualitative data from open-ended responses were used to triangulate with quantitative analyses. This analysis showed concordance between each country's policies and provider attitudes toward the efficiency elements. One exception was task-shifting, which is not authorized in South Africa or Zimbabwe; providers across all countries approved this practice. Conclusions The decision to adopt efficiency elements is often based on national policies. The concordance between the policies of each country and provider attitudes bodes well for compliance and effective implementation. However, study findings suggest that there may be need to consult providers when developing national policies.
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Affiliation(s)
- Webster Mavhu
- Zimbabwe AIDS Prevention Project-UZ, Department of Community Medicine UZ, Harare, Zimbabwe
- * E-mail: mailto:
| | - Sasha Frade
- Centre for HIV and AIDS Prevention Studies, Johannesburg, South Africa
| | - Ann-Marie Yongho
- Tulane School of Public Health and Tropical Medicine, Department of Global Health Systems and Development, New Orleans, LA, USA
| | - Margaret Farrell
- Tulane School of Public Health and Tropical Medicine, Department of Global Health Systems and Development, New Orleans, LA, USA
| | | | | | | | | | - Bennett Fimbo
- Ministry of Health and Social Welfare, Dar es Salaam, Republic of Tanzania
| | | | - Dino Rech
- Centre for HIV and AIDS Prevention Studies, Johannesburg, South Africa
| | - Delivette Castor
- United States Agency for International Development, Washington, DC, USA
| | | | - Jane T. Bertrand
- Tulane School of Public Health and Tropical Medicine, Department of Global Health Systems and Development, New Orleans, LA, USA
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Bertrand JT, Rech D, Omondi Aduda D, Frade S, Loolpapit M, Machaku MD, Oyango M, Mavhu W, Spyrelis A, Perry L, Farrell M, Castor D, Njeuhmeli E. Systematic Monitoring of Voluntary Medical Male Circumcision Scale-up: adoption of efficiency elements in Kenya, South Africa, Tanzania, and Zimbabwe. PLoS One 2014; 9:e82518. [PMID: 24801374 PMCID: PMC4011576 DOI: 10.1371/journal.pone.0082518] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 10/23/2013] [Indexed: 11/18/2022] Open
Abstract
Background SYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-up, tracked the implementation and adoption of six elements of surgical efficiency— use of multiple surgical beds, pre-bundled kits, task shifting, task sharing, forceps-guided surgical method, and electrocautery—as standards of surgical efficiency in Kenya, South Africa, Tanzania, and Zimbabwe. Methods and Findings This multi-country study used two-staged sampling. The first stage sampled VMMC sites: 73 in 2011, 122 in 2012. The second stage involved sampling providers (358 in 2011, 591 in 2012) and VMMC procedures for observation (594 in 2011, 1034 in 2012). The number of VMMC sites increased significantly between 2011 and 2012; marked seasonal variation occurred in peak periods for VMMC. Countries adopted between three and five of the six elements; forceps-guided surgery was the only element adopted by all countries. Kenya and Tanzania routinely practiced task-shifting. South Africa and Zimbabwe used pre-bundled kits with disposable instruments and electrocautery. South Africa, Tanzania, and Zimbabwe routinely employed multiple surgical bays. Conclusions SYMMACS is the first study to provide data on the implementation of VMMC programs and adoption of elements of surgical efficiency. Findings have contributed to policy change on task-shifting in Zimbabwe, a review of the monitoring system for adverse events in South Africa, an increased use of commercially bundled VMMC kits in Tanzania, and policy dialogue on improving VMMC service delivery in Kenya. This article serves as an overview for five other articles following this supplement.
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Affiliation(s)
- Jane T. Bertrand
- Tulane School of Public Health and Tropical Medicine, Department of Global Health Systems and Development, New Orleans, Louisiana, United States of America
- * E-mail:
| | - Dino Rech
- Centre for HIV/AIDS Prevention Studies, Johannesburg, South Africa, Nairobi, Kenya
| | | | - Sasha Frade
- Centre for HIV/AIDS Prevention Studies, Johannesburg, South Africa, Nairobi, Kenya
| | | | | | | | - Webster Mavhu
- Zimbabwe AIDS Prevention Project, Department of Community Medicine UZ, Harare, Zimbabwe
| | - Alexandra Spyrelis
- Centre for HIV/AIDS Prevention Studies, Johannesburg, South Africa, Nairobi, Kenya
| | - Linnea Perry
- Tulane School of Public Health and Tropical Medicine, Department of Global Health Systems and Development, New Orleans, Louisiana, United States of America
| | - Margaret Farrell
- Tulane School of Public Health and Tropical Medicine, Department of Global Health Systems and Development, New Orleans, Louisiana, United States of America
| | - Delivette Castor
- United States Agency for International Development, Washington, District of Columbia, United States of America
| | - Emmanuel Njeuhmeli
- United States Agency for International Development, Washington, District of Columbia, United States of America
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MacLaren D, Tommbe R, Mafile’o T, Manineng C, Fregonese F, Redman-MacLaren M, Wood M, Browne K, Muller R, Kaldor J, McBride WJ. Foreskin cutting beliefs and practices and the acceptability of male circumcision for HIV prevention in Papua New Guinea. BMC Public Health 2013; 13:818. [PMID: 24015786 PMCID: PMC3846639 DOI: 10.1186/1471-2458-13-818] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 09/05/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Male circumcision (MC) reduces HIV acquisition and is a key public health intervention in settings with high HIV prevalence, heterosexual transmission and low MC rates. In Papua New Guinea (PNG), where HIV prevalence is 0.8%, there is no medical MC program for HIV prevention. There are however many different foreskin cutting practices across the country's 800 language groups. The major form exposes the glans but does not remove the foreskin. This study aimed to describe and quantify foreskin cutting styles, practices and beliefs. It also aimed to assess the acceptability of MC for HIV prevention in PNG. METHODS Cross-sectional multicentre study, at two university campuses (Madang Province and National Capital District) and at two 'rural development' sites (mining site Enga Province; palm-oil plantation in Oro Province). Structured questionnaires were completed by participants originating from all regions of PNG who were resident at each site for study or work. RESULTS Questionnaires were completed by 861 men and 519 women. Of men, 47% reported a longitudinal foreskin cut (cut through the dorsal surface to expose the glans but foreskin not removed); 43% reported no foreskin cut; and 10% a circumferential foreskin cut (complete removal). Frequency and type of cut varied significantly by region of origin (p < .001). Most men (72-82%) were cut between the ages of 10-20 years. Longitudinal cuts were most often done in a village by a friend, with circumferential cuts most often done in a clinic by a health professional. Most uncut men (71%) and longitudinal cut men (84%) stated they would remove their foreskin if it reduced the risk of HIV infection. More than 95% of uncut men and 97% of longitudinal cut men would prefer the procedure in a clinic or hospital. Most men (90%) and women (74%) stated they would remove the foreskin of their son if it reduced the risk of HIV infection. CONCLUSION Although 57% of men reported some form of foreskin cut only 10% reported the complete removal of the foreskin, the procedure on which international HIV prevention strategies are based. The acceptability of MC (complete foreskin removal) is high among men (for themselves and their sons) and women (for their sons). Potential MC services need to be responsive to the diversity of beliefs and practices and consider health system constraints. A concerted research effort to investigate the potential protective effects of longitudinal cuts for HIV acquisition is essential given the scale of longitudinal cuts in PNG.
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Affiliation(s)
- David MacLaren
- School of Medicine and Dentistry, James Cook University, McGregor Road, Smithfield, Cairns 4878, Queensland, Australia
| | - Rachael Tommbe
- School of Health Science, Pacific Adventist University, Port Moresby, National Capital District, Papua New Guinea
| | - Tracie Mafile’o
- Deputy Vice Chancellor, Pacific Adventist University, Port Moresby, National Capital District, Papua New Guinea
| | - Clement Manineng
- Faculty of Health Science, Divine Word University, Madang, Madang Province, Papua New Guinea
| | - Federica Fregonese
- Global Health Unit, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Michelle Redman-MacLaren
- School of Medicine and Dentistry, James Cook University, McGregor Road, Smithfield, Cairns 4878, Queensland, Australia
| | - Michael Wood
- School of Arts and Social Science, James Cook University, Cairns, Queensland, Australia
| | - Kelwyn Browne
- Rural Primary Health Services Delivery Project, National Department of Health, Port Moresby, Papua New Guinea
| | - Reinhold Muller
- School of Public Health, Tropical Medicine and Rehabilitation Science, James Cook University, Cairns, Queensland, Australia
- Tropical Health Solutions, Townsville, Australia
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - William John McBride
- School of Medicine and Dentistry, James Cook University, McGregor Road, Smithfield, Cairns 4878, Queensland, Australia
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Morse J, Chipato T, Blanchard K, Nhemachena T, Ramjee G, McCulloch C, Blum M, Saleeby E, Harper CC. Provision of long-acting reversible contraception in HIV-prevalent countries: results from nationally representative surveys in southern Africa. BJOG 2013; 120:1386-94. [PMID: 23721413 DOI: 10.1111/1471-0528.12290] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To analyse the current provision of long-acting reversible contraception (LARC) and clinician training needs in HIV-prevalent settings. DESIGN Nationally representative survey of clinicians. SETTING HIV-prevalent settings in South Africa and Zimbabwe. POPULATION Clinicians in South Africa and Zimbabwe. METHODS Nationally representative surveys of clinicians were conducted in South Africa and Zimbabwe (n = 1444) to assess current clinical practice in the provision of LARC in HIV-prevalent settings. Multivariable logistic regression was used to analyse contraceptive provision and clinician training needs. MAIN OUTCOME MEASURE Multivariable logistic regression of contraceptive provision and clinician training needs. RESULTS Provision of the most effective reversible contraceptives is limited: only 14% of clinicians provide copper intrauterine devices (IUDs), 4% levonorgestrel-releasing IUDs and 16% contraceptive implants. Clinicians' perceptions of patient eligibility for IUD use were overly restrictive, especially related to HIV risks. Less than 5% reported that IUDs were appropriate for women at high risk of HIV or for HIV-positive women, contrary to evidence-based guidelines. Only 15% viewed implants as appropriate for women at risk of HIV. Most clinicians (82%), however, felt that IUDs were underused by patients, and over half desired additional training on LARC methods. Logistic regression analysis showed that LARC provision was largely restricted to physicians, hospital settings and urban areas. Results also showed that clinicians in rural areas and clinics, including nurses, were especially interested in training. CONCLUSIONS Clinician competency in LARC provision is important in southern Africa, given the low use of methods and high rates of unintended pregnancy among HIV-positive and at-risk women. Despite low provision, clinician interest is high, suggesting the need for increased evidence-based training in LARC to reduce unintended pregnancy and associated morbidities.
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Affiliation(s)
- J Morse
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
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