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Zhang G, Luo Y, Cheng S, Tu Y, Meng X, Wu L, Li G, Chen X. Optimizing treatment strategies for pediatric phimosis and redundant prepuce: a comparative study of traditional circumcision and disposable circumcision stapler. Front Pediatr 2024; 12:1394403. [PMID: 39105162 PMCID: PMC11298388 DOI: 10.3389/fped.2024.1394403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/11/2024] [Indexed: 08/07/2024] Open
Abstract
Objective To investigate the surgical outcomes and complication rates of traditional circumcision and disposable circumcision stapler in the treatment of pediatric patients with phimosis and redundant prepuce. Methods A retrospective analysis was conducted on pediatric patients with phimosis or preputial redundancy treated at our pediatric surgery department from January 2022 to December 2023. The patients were divided into two groups: treated with traditional circumcision (control group) and treated with a disposable circumcision stapler (experimental group). Surgical parameters (operation time, intraoperative bleeding), postoperative outcomes (postoperative pain scores, wound healing time, severe edge swelling, wound dehiscence, postoperative rebleeding, postoperative infection, aesthetic satisfaction), were compared between the two groups. Results A total of 301 pediatric patients were included in our study, with 146 in the traditional group and 155 in the stapler group. The stapler group showed significantly lower values in operation time, intraoperative bleeding, and postoperative rebleeding compared to the traditional group (P < 0.05). However, the traditional group had a significant advantage in postoperative wound healing time and the occurrence of severe edge swelling (P < 0.05). There were no significant differences between the two groups in terms of anesthetic drug dosage, postoperative pain level, postoperative infection rate, wound dehiscence, and aesthetic satisfaction (P > 0.05). Conclusion In the treatment of pediatric phimosis and redundant prepuce, the advantage of traditional circumcision lies in faster postoperative recovery and less severe edge swelling. The disposable circumcision stapler excels in thorough hemostasis, easy and safe operation, suitable for primary medical use, but lags behind in postoperative recovery compared to the traditional method. Each treatment approach has its own advantages, and the choice should be based on the actual condition and circumstances of the patient. Personalized treatment decisions should be made collaboratively to achieve the best therapeutic outcomes.
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Affiliation(s)
- Guoyan Zhang
- Physical examination and Rehabilitation Department, Kunming City Maternal and Child Health Hospital, Kunming, Yunnan, China
| | - Yongliang Luo
- Surgery, Yunnan Maternal and Child Health Hospital, Kunming, Yunnan, China
| | - Shangchao Cheng
- Surgery, Yunnan Maternal and Child Health Hospital, Kunming, Yunnan, China
| | - Yonglang Tu
- Surgery, Yunnan Maternal and Child Health Hospital, Kunming, Yunnan, China
| | - Xiangyu Meng
- Surgery, The First Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi, China
| | - Linde Wu
- Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Gang Li
- Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiyuan Chen
- Surgery, Honghe Autonomous Prefecture 3rd Hospital, Gejiu, Yunnan, China
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Ahmad I, Tang J, Khondker A, Malik A, Chua M, Rickard M, Lorenzo AJ, Dos Santos J. Evaluating Safety of Ring Versus Clamp Devices in Neonatal Circumcision: A Meta-Analysis. J Pediatr Surg 2024:S0022-3468(24)00373-7. [PMID: 38987062 DOI: 10.1016/j.jpedsurg.2024.06.015] [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: 04/14/2024] [Revised: 06/02/2024] [Accepted: 06/17/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND While device-based circumcision is considered non-inferior to traditional dissection, there is no consensus on the efficacy and safety of ring devices in comparison with clamp devices. We aimed to compare the safety outcomes of ring-based versus clamp-based circumcision techniques in neonates. METHODS MEDLINE, EMBASE, Scopus, and CINAHL were searched following the Cochrane collaboration (PRISMA guidelines), without language restrictions, to identify relevant randomized controlled trials. Adverse events, bleeding events, infection events, and procedure time were extracted and analyzed from the selected studies. RESULTS From 1661 citations, seven trials were included, encompassing 3390 patients. These studies compared ring-based to clamp-based circumcision devices in neonates. No significant difference was found in overall adverse events between the two groups. However, ring devices showed significantly fewer bleeding events compared to clamp devices. Infection events and procedure time were similar for both groups. CONCLUSIONS Both ring and clamp devices have similar safety profiles, with ring devices potentially offering a reduced risk of bleeding. A comprehensive understanding of ring-specific complications and cosmetic outcomes is necessary for a more complete evaluation of these circumcision techniques. Our analysis is limited from a lack of detailed examination of ring-specific complications and their impact on cosmetic results. The included studies varied in quality, and some exhibited a risk of bias. LEVEL OF EVIDENCE Level IV Treatment Study.
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Affiliation(s)
- Ihtisham Ahmad
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Janet Tang
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Adree Khondker
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Aleena Malik
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Chua
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mandy Rickard
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Joana Dos Santos
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
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Bocchino AC, Fernández-Pascual E, Toribio-Vázquez C, Manfredi C, Urdaneta G, Balmori C, Lledó E, Martínez-Ballesteros C, Cocci A, Mondaini N, Martínez-Salamanca JI. Efficacy and safety of two disposable circumcision suture devices for circumcision in adults: a prospective comparative multicenter study. Int J Impot Res 2024:10.1038/s41443-024-00933-3. [PMID: 38886594 DOI: 10.1038/s41443-024-00933-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/01/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
The objective of this study was to evaluate and compare efficacy and safety of two different Disposable circumcision suture devices (DCSDs). A prospective comparative non-randomized multicenter study was performed between November 2019 and February 2023. Patients underwent circumcision using a DCSD (CircCurerTM or the ZSR® device) according to the surgeon preference and device availability. A total of 378 patients were circumcised; 184 using CircCurerTM and 194 patients using ZSR®. No differences in baseline characteristics were observed. CircCurer and ZSR Groups showed similar rates of operative time (7.7 ±2.1 vs 7.3 ±2.0 min), surgical site infection (1.1% Vs 1.5%), edema (13% Vs 8.2%), hematomas (2.7% Vs 1.1%), and postoperative pain (2.5 Vs 2.0 points). ZSR Group had a significantly higher rate of clip fallout (62.9% Vs 38%, p < 0.001). At 2 months, patients of both groups reported a median satisfaction of 9 (8-9) points. Main limitation consist in non-randomized study. DCSDs seem to be effective and safe, with short operative times, uncommon and mild complications, and high patient satisfaction. ZSR® device has a higher rate of spontaneous staple dropout.
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Affiliation(s)
| | - Esaú Fernández-Pascual
- LYX Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain.
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain.
| | | | - Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Guillermo Urdaneta
- LYX Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain
| | - Carlos Balmori
- LYX Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain
| | - Enrique Lledó
- LYX Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Claudio Martínez-Ballesteros
- LYX Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Andrea Cocci
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Nicola Mondaini
- Department of Urology, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Juan Ignacio Martínez-Salamanca
- LYX Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
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Wu YR, Lai YH, Wang CC. Type 2 diabetes mellitus increases the risk of circumcision among men aged between 30 and 69 years using a nationwide population-based dataset in Taiwan: a five-year follow-up study. BMC Urol 2024; 24:3. [PMID: 38172825 PMCID: PMC10765904 DOI: 10.1186/s12894-023-01392-6] [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: 05/27/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Diabetes is an important factor in the development of penile inflammation. We studied whether type 2 diabetes (DM), with/without hypertension and hyperlipidemia increased the risk of circumcision among men aged between 30 and 69 using a population-based dataset in Taiwan during a 5-year follow-up period. METHODS The research data in this study were obtained from Taiwan's National Health Insurance Research Database between 1997 and 2010. We identified 23,197 patients who had a new diagnosis of DM and randomly matched 115,985 subjects as controls. We observed whether circumcision was the treatment after a new DM diagnosis. The initial step involved analyzing the data using Poisson regression analysis. To address potential confounding factors, this study employed propensity score matching based on three variables. Additionally, a Cox regression with a Gamma frailty was utilized to compare outcomes between different groups. RESULTS Poisson regression analysis showed that DM (RR = 1.75, 95CI = 0.10 ~ 1.22), but not hypertension (RR = 1.14, 95CI=-0.44 ~ 0.70), hyperlipidemia (RR = 0.94, 95CI=-0.66 ~ 0.53), or age (RR = 0.83, 95CI=-0.43 ~ 0.62), had an impact on circumcision treatment. Cox regression with a frailty model found that DM was a risk factor associated with circumcision (HR = 2.31, 95% CI = 1.74 ~ 3.06, p-value < 0.01), whereas no significant difference was noted between circumcision and hypertension (HR = 1.10, 95% CI = 0.80 ~ 1.51), hyperlipidemia (HR = 1.05, 95% CI = 0.79 ~ 1.40), or age (HR = 1.00, 95% CI = 0.99 ~ 1.02). CONCLUSIONS Type 2 diabetes mellitus, but not hypertension, hyperlipidemia or age increases the risk of circumcision in men aged between 30 and 69 years.
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Affiliation(s)
- Yun-Rui Wu
- Department of Urology, College of Medicine, En Chu Kong Hospital, National Taiwan University, 399 Fu-hsing Road, Sanxia District, New Taipei City, 23702, Taiwan
| | - Yi-Horng Lai
- Department of Healthcare Administration, Asia Eastern University of Science and Technology, New Taipei City, 22061, Taiwan
| | - Chung-Cheng Wang
- Department of Urology, College of Medicine, En Chu Kong Hospital, National Taiwan University, 399 Fu-hsing Road, Sanxia District, New Taipei City, 23702, Taiwan.
- Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, 32023, Taiwan.
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Wang D, Li Z, Chen X, Wang H. Wound healing rates and wound problems of conventional circumcision compared with ring circumcision: A meta-analysis. Int Wound J 2023; 20:3699-3707. [PMID: 37303303 PMCID: PMC10588352 DOI: 10.1111/iwj.14262] [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: 04/26/2023] [Revised: 05/09/2023] [Accepted: 05/20/2023] [Indexed: 06/13/2023] Open
Abstract
A meta-analysis investigation was executed to measure the wound healing rates (WHRs) and wound problems (WPs) of conventional circumcision (CC) compared with ring circumcision (RC). A comprehensive literature investigation till March 2023 was applied and 2347 interrelated investigations were reviewed. The 16 chosen investigations enclosed 25 838 individuals, with circumcision, were in the chosen investigations' starting point, 3252 of them were RC, and 2586 were CC. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the WHRs and WPs of CC compared with RC by the dichotomous or continuous approaches and a fixed or random model. RC had a significantly lower wound infection rate (WIR) (OR, 0.58; 95% CI, 0.37-0.91, P = .002) and wound bleeding rate (WBR) (OR, 0.22; 95% CI, 0.12-0.42, P < .001) compared with those with CC. However, RC and CC had no significant difference in WHR (OR, 2.18; 95% CI, -0.73 to 5.09, P = .14), wound edema rate (WER) (OR, 1.11; 95% CI, 0.92-1.33, P = .28), and wound dehiscence rate (WDR) (OR, 0.98; 95% CI, 0.60-1.58, P = .93). RC had significantly lower WIR, and WBR, however, no significant difference in WHR, WER, and WDR compared with those with CC. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations for the meta-analysis.
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Affiliation(s)
- Daya Wang
- Urology DepartmentWenzhou Central HospitalZhejiangChina
| | - Zhijia Li
- Urology DepartmentWenzhou Central HospitalZhejiangChina
| | - Ximeng Chen
- Urology DepartmentWenzhou Central HospitalZhejiangChina
| | - Haibo Wang
- Urology DepartmentWenzhou Hospital of Traditional Chinese MedicineZhejiangChina
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Chou AC, Laih CY, Ku FY. A Retrospective Taiwanese-Population-Based Clinical Study on Determining the Efficacy and Safety of Disposable Circumcision Anastomat. J Clin Med 2022; 11:jcm11206206. [PMID: 36294527 PMCID: PMC9605481 DOI: 10.3390/jcm11206206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
Abstract
Traditional approaches for male circumcision are tedious and could lead to complications such as peri-/postoperative pain, bleeding, and infection. Thus, for the first time, we investigated the surgical outcomes of recently the discovered Disposable Circumcision Anastomat Type A (Dongguan ZSR Biomedical Technology Company Ltd., China), a disposable circumcision suture device (DCSD), in terms of the operation time, surgical complexity, safety, satisfaction, and aesthetic outcomes and most importantly the prognostic factors for postoperative infection. A total of 394 individuals were circumcised, with a mean age, body mass index (BMI), stretched penile length (SPL), and penile circumference of 30.1 ± 7.05 years, 25.47 ± 4.73, 10.12 ± 1.61, and 7 ± 0.73 cm, respectively. Associated comorbidities included diabetes mellitus (6.09%), hypertension (2.03%), gout (1.02%), end-stage renal disease (ESRD, 0.25%), and HIV (0.25%). The mean operation time, average postoperative bleeding, and wound infection rate was 31.4 ± 9.96 min, 2.54%, and 9.39%, respectively. The mean VAS postoperative pain scores at D0 and D1 were 4.4 ± 2.4 and 1.9 ± 1.6, respectively. Moreover, 1.27% of subjects required reoperation, and a 2.03% rate of instrument malfunction was noted. The significant factors associated with the post-operative infection group were age (p = 0.0313), BW (p = 0.0081), BMI (p = 0.0026), penile circumference (p = 0.0343), and DM (p ≤ 0.001). Multivariate analyses revealed only DM as a statistically significant factor (p < 0.001). Our box−whisker plot revealed no significant difference between the HbA1c level of infection (Hb1Ac = 7.77 ± 1.39) and non-infection groups (Hb1Ac = 6.92 ± 1.84). However, a trend of higher glycemic index in the infection group was observed. Conclusively, DSCD could be an effective and safe alternative to performing circumcision. However, in the population with advanced aging, phimosis, elevated BMI, and DM (HbA1C > 9%), users should be highly cautious due to the increased risk of infection, dehiscence, and hematoma.
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Affiliation(s)
- An-Chi Chou
- Department of Urology, Taipei Medical University Hospital, Taipei 11031, Taiwan
| | - Chun-Yo Laih
- Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan
| | - Fang-Yu Ku
- Department of Urology, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Correspondence: ; Tel.: +886-933511212
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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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Hohlfeld ASJ, Ebrahim S, Zaki Shaik M, Kredo T. Circumcision devices versus standard surgical techniques in adolescent and adult male circumcisions: a Cochrane review. BJU Int 2021; 130:26-34. [PMID: 34587354 PMCID: PMC9297972 DOI: 10.1111/bju.15604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the effects of device-based circumcisions compared with standard surgical techniques in adolescent and adult males (10 years old and above). METHODS We performed a comprehensive search with no restrictions to the language of publication or publication status. We included randomised controlled trials (RCTs) of device-based circumcisions compared to standard surgical dissection-based circumcision conducted by health professionals in a medical setting. We reported study results as risk ratios (RRs) or mean differences (MDs) using 95% confidence intervals (CIs) and a random-effects model. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to evaluate the overall certainty of the evidence for each outcome. RESULTS A total of 18 trials met the inclusion criteria. These trials did not report severe adverse events (AEs; 11 trials, 3472 participants). There may be a slight increase in moderate AEs for devices compared to surgical techniques (RR 1.31, 95% CI 0.55-3.10; I2 = 68%; 10 trials, 3370 participants; low-certainty evidence); this corresponds to eight more (ranging from 15 fewer to 84 more) moderate AEs per 1000 participants. We are uncertain about the difference in mild AEs between groups when devices are used compared to surgical techniques (RR 1.09, 95% CI 0.44-2.72; I2 = 91%; 10 trials, 3370 participants; very low-certainty evidence). CONCLUSIONS We found no serious AEs using a circumcision device compared to surgical techniques. Still, they may slightly increase moderate AEs, and it is unclear whether there is a difference in mild AEs. High-quality trials evaluating this intervention are needed to provide further certainty regarding the rates of AEs. Clinicians, patients, and policymakers can use these results combined with their contextual factors to inform the best approach that suits their healthcare settings.
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Affiliation(s)
| | - Sumayyah Ebrahim
- Department of Surgery, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Muhammed Zaki Shaik
- Department of Surgery, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Clinical Pharmacology Division, Department of Medicine, Stellenbosch University, Cape Town, South Africa
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Jiang W, Fu JL, Guo WL, Yan ZC, Zheng RQ, Lu JR, Lai XD. A Modified Pressure Dressing to Avoid Severe Bleeding After Circumcision With a Disposable Circumcision Suture Device and a Discussion on the Mechanism of Bleeding With the Disposable Circumcision Suture Device. Sex Med 2021; 9:100288. [PMID: 33765458 PMCID: PMC8072179 DOI: 10.1016/j.esxm.2020.100288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION A novel type of a disposable circumcision suture device (DCSD) has been proved to be effective and safe; however, a few cases of severe bleeding took place after circumcisions. AIM To evaluate the effectiveness of a modified double-layer pressure dressing to avoid severe bleeding after circumcision with the DCSD, in our department in a prospective randomized controlled study, and discuss the mechanism of bleeding with DCSD. METHODS Patients with redundant foreskin or phimosis were included between September 2018 and November 2019 and divided into 2 groups: In group A, the conventional pressure dressing was performed; in group B, an modified double-layer pressure dressing was performed. MAIN OUTCOME MEASURE The main outcomes and complications (surgical time, incidence of glans ischemia, severe bleeding rate, infection rate, pain level, total cost, and overall satisfaction) were collected and analyzed. RESULTS A total of 624 patients were recruited for this study. There was no difference in the average age and body mass index between 2 groups. No patient suffered obvious glans ischemia. In group B, lower pain level, lower incidences of severe bleeding, and better satisfaction were recorded. CONCLUSION The mechanism of bleeding with the DCSD was discussed in this study, and the modified pressure dressing was proved effective, safe, and easy to perform. W Jiang, J-li Fu, W-l Guo, et al. A Modified Pressure Dressing to Avoid Severe Bleeding After Circumcision With a Disposable Circumcision Suture Device and a Discussion on the Mechanism of Bleeding With the Disposable Circumcision Suture Device. Sex Med 2021;9:100288.
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Affiliation(s)
- Wei Jiang
- Department of Urology, Dongying People's Hospital, Dongying, China.
| | - Jia-Li Fu
- Department of Urology, Dongying People's Hospital, Dongying, China
| | - Wen-Liang Guo
- Surgery Department, Health Center of Qingzhou Economic Development Zone, Qingzhou, China
| | - Zai-Chun Yan
- Department of Urology, Dongying People's Hospital, Dongying, China
| | - Ru-Qiang Zheng
- Department of Urology, Dongying People's Hospital, Dongying, China
| | - Ji-Ru Lu
- Department of Urology, Dongying People's Hospital, Dongying, China
| | - Xiao-Dong Lai
- Department of Urology, Dongying People's Hospital, Dongying, China
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Hohlfeld A, Ebrahim S, Shaik MZ, Kredo T. Circumcision devices versus standard surgical techniques in adolescent and adult male circumcisions. Cochrane Database Syst Rev 2021; 3:CD012250. [PMID: 33786810 PMCID: PMC8095026 DOI: 10.1002/14651858.cd012250.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Medical circumcisions are among the most common surgical procedures performed in males. The usual indications are phimosis (inability to completely retract the foreskin and expose the glans due to a congenital or acquired constriction of the prepuce), paraphimosis (when the foreskin is not pulled back over the glans after retraction resulting in a tight constricting band which causes swelling of the distal penis and acute discomfort), balanoposthitis (erythema and edema of the prepuce and glans) and balanitis (inflammation is confined to the glans; the foreskin is usually non-retractile). Circumcision devices have been developed to shorten the operative time, simplify techniques, and improve safety and cosmetic outcomes. The devices generally aim to crush the foreskin while simultaneously creating hemostasis, the foreskin is then excised or allowed to slough off. Their use is supposedly safer and easier to replicate than the standard dissection techniques. There are at least 20 devices for male circumcision on the market, yet their effectiveness has not been reviewed to date. OBJECTIVES To assess the effects of device-based circumcisions compared with standard surgical techniques in adolescent and adult males (10 years old and above). SEARCH METHODS We performed a comprehensive search with no restrictions to the language of publication or publication status. We searched the Cochrane Library, MEDLINE (PubMed), Embase, Web of Science, trials registries, grey literature sources and conference proceedings up to 16 April 2020. SELECTION CRITERIA We included randomized controlled trials of device-based circumcisions (crush or ligature circumcision devices) compared to standard surgical dissection-based circumcision conducted by health professionals in a medical setting. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed study eligibility and extracted data from the included studies. We classified adverse events into serious, moderate or mild. We reported study results as risk ratios (RR) or mean differences (MD) using 95% confidence intervals (CI) and a random-effects model. We used the GRADE approach to evaluate the overall certainty of the evidence for each outcome. MAIN RESULTS Eighteen trials met the inclusion criteria. Trials were conducted in China, South Africa, Kenya and Zambia, Mozambique, Rwanda, Uganda and Zimbabwe. Primary outcomes Serious adverse events: there were no serious adverse events in either treatment arm (11 trials, 3472 participants). Moderate adverse events: there may be a slight increase in moderate adverse events when devices are used compared to standard surgical techniques (RR 1.31, 95% CI 0.55 to 3.10; I²= 68%; 10 trials, 3370 participants; low-certainty evidence); this corresponds to 8 more (ranging from 15 fewer to 84 more) moderate adverse events per 1000 participants. We downgraded the certainty of the evidence for study limitations and imprecision. Secondary outcomes Mild adverse events: we are uncertain about the difference in mild adverse events between groups when devices are used compared to standard surgical techniques (RR 1.09, 95% CI 0.44 to 2.72; I² = 91%; 10 trials, 3370 participants; very low-certainty evidence). We downgraded the certainty of the evidence for study limitations, imprecision and unexplained inconsistency. Operative time: operative time is probably about 17 minutes shorter when using a device rather than standard surgical techniques, which constitutes a clinically meaningful decrease in a procedure (MD -17.26 minutes, 95% CI -19.96 to -14.57; I² = 99%; 14 trials, 4812 participants; moderate-certainty evidence). We downgraded the certainty of the evidence for serious study limitations. The standard surgical technique generally takes about 24 minutes. There may be less postoperative pain during the first 24 hours when circumcision devices are used compared to standard surgical techniques (measured using a visual analog scale [VAS]; MD 1.30 cm lower, 95% CI 2.37 lower to 0.22 lower; I² = 99%; 9 trials, 3022 participants; low-certainty evidence). We downgraded the certainty of the evidence for study limitations and unexplained heterogeneity. There may be little or no difference in postoperative pain experienced during the first seven days when compared with standard surgical techniques (measured using a VAS; MD 0.11 cm higher, 95% CI 0.89 lower to 1.11 higher; I² = 94%; 4 trials, 1430 participants; low-certainty evidence). We downgraded the certainty of the evidence for study limitations and unexplained inconsistency. A higher score on the VAS indicates greater pain. Participants may slightly prefer circumcision devices compared to standard surgical techniques (RR 1.19, 95% CI 1.04 to 1.37; I² = 97%; 15 trials, 4501 participants; low-certainty evidence). We downgraded the certainty of the evidence for study limitations and unexplained inconsistency. We recorded satisfaction as a dichotomous outcome. Higher rates reflected greater satisfaction. AUTHORS' CONCLUSIONS We found that there were no serious adverse events reported when using a circumcision device compared to standard surgical techniques, but they may slightly increase moderate adverse effects, and it is unclear whether there is a difference in mild adverse effects. Use of circumcision devices probably reduces the time of the procedure by about 17 minutes, a clinically meaningful time saving. For patients, use of the circumcision device may result in lower pain scores during the first 24 hours and patients may be slightly more satisfied with it compared with standard surgical techniques. Clinicians, patients and policymakers can use these results in conjunction with their own contextual factors to inform the approach that best suits their healthcare settings. High-quality trials evaluating this intervention are needed to provide further certainty regarding the rates of adverse effects and postoperative pain of using devices compared to standard approaches.
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Affiliation(s)
- Ameer Hohlfeld
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Sumayyah Ebrahim
- School of Clinical Medicine, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Muhammed Zaki Shaik
- School of Clinical Medicine, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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11
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Rao JM, Huang H, Chen T, Yang CG, Pan CZ, Deng GC, Shen LJ, Qian XH, Peng MK, Zhou HD, Peng HL. Modified Circumcision Using the Disposable Circumcision Suture Device in Children: A Randomized Controlled Trial. Urology 2020; 143:206-211. [PMID: 32593627 DOI: 10.1016/j.urology.2020.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate and compare the surgical outcomes and complications of the modified circumcision using disposable circumcision suture device (device group) and the conventional dorsal slit circumcision (conventional group) in children. METHODS A total of 284 patients were randomized to either device group or conventional group. All patients were preoperatively assessed and evaluated at 4 weeks after surgery. The perioperative data and postoperative outcomes were compared between the 2 groups. RESULTS No statistical differences were observed in the average age and indications between the 2 groups preoperatively (P > .05). Compared with the conventional group, patients in the device group were shorter mean operative time, less blood loss, lower intraoperative and postoperative pain score, faster incision healing time and a higher satisfaction rate of penile cosmetic appearance (P < .01). Similarly, the incidences of complication were significantly lower in the device group than in the conventional group (4.3% vs 12.3%, P < .05). CONCLUSIONS The modified circumcision using disposable circumcision suture device is a simple, safe, faster, and effective procedure and may become the attractive alternative to the conventional technique for the children, with a relatively lower complication rate and better cosmetic results. With the improvement of disposable circumcision suture device, the modified circumcision using disposable circumcision suture device has the potential to be widely used in the world.
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Affiliation(s)
- Jian-Ming Rao
- Department of Urology, Fourth Hospital of Changsha, Hunan Normal University, Changsha, Hunan Province, China; Department of Urology, The Second Hunan Provincial People's Hospital, Hunan Traditional Chinese Medical University, Changsha, Hunan Province, China
| | - He Huang
- Department of Urology, Fourth Hospital of Changsha, Hunan Normal University, Changsha, Hunan Province, China
| | - Tao Chen
- Department of Urology, Fourth Hospital of Changsha, Hunan Normal University, Changsha, Hunan Province, China.
| | - Chun-Gang Yang
- Department of Urology, Fourth Hospital of Changsha, Hunan Normal University, Changsha, Hunan Province, China
| | - Ci-Zhong Pan
- Department of Urology, Fourth Hospital of Changsha, Hunan Normal University, Changsha, Hunan Province, China
| | - Guang-Cheng Deng
- Department of Urology, Fourth Hospital of Changsha, Hunan Normal University, Changsha, Hunan Province, China
| | - Long-Jiang Shen
- Department of Urology, Fourth Hospital of Changsha, Hunan Normal University, Changsha, Hunan Province, China
| | - Xiao-Hui Qian
- Department of Urology, Fourth Hospital of Changsha, Hunan Normal University, Changsha, Hunan Province, China
| | - Mei-Kang Peng
- Department of Urology, Fourth Hospital of Changsha, Hunan Normal University, Changsha, Hunan Province, China
| | - Hui-Dong Zhou
- Department of Urology, Fourth Hospital of Changsha, Hunan Normal University, Changsha, Hunan Province, China
| | - Hong-Liang Peng
- Department of Urology, Fourth Hospital of Changsha, Hunan Normal University, Changsha, Hunan Province, China
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12
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Jiang ZL, Sun CW, Sun J, Shi GF, Li H. Subcutaneous tissue-sparing dorsal slit with new marking technique: A novel circumcision method. Medicine (Baltimore) 2019; 98:e15322. [PMID: 31008987 PMCID: PMC6494260 DOI: 10.1097/md.0000000000015322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Circumcision is a very common surgical procedure that is performed for medical and traditional purposes in the world. However, many technical of circumcision is needed to improve. Thus, this study introduced a novel method of circumcision that is a refined version of the sleeve technique, termed subcutaneous tissue sparing dorsal slit with new marking, and evaluated the safety and efficacy of this novel method of circumcision.The randomized clinical trial included 93 adult patients with redundant foreskin or phimosis treated from May 2015 to March 2017. Patients were randomly divided into the novel circumcision method (n = 45) or conventional dissection (n = 48). The groups were compared regarding rates of intraoperative hemorrhage, operative time, pain, healing, satisfaction with penis appearance, and relevant adverse events.No patient suffered any obvious complication. Compared with the patients given conventional dissection, the patients who underwent the new surgical device experienced significantly less wound healing time, scar width, and recovery time (P <.05). The new method resulted in greater intraoperative bleeding volume and surgical time (P <.05). The rate of satisfaction with appearance of the penis was significantly higher in the group treated with the novel technique. In addition, the cost of surgery of these 2 methods was similar.Based on the above research, we found that subcutaneous tissue-sparing dorsal slit with new marking technique was an effective and safe procedure for circumcision, and deserved further application in clinical practice.
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Affiliation(s)
| | - Cheng-Wen Sun
- Department of Urology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Jian Sun
- Department of Urology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | | | - Hu Li
- Department of Plastic Surgery
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13
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夏 慧, 吴 荷, 薛 康, 杨 诚, 杨 建. [Clinical effectiveness of disposable circumcision suture in children: a prospective randomized controlled trial]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:884-887. [PMID: 33168504 PMCID: PMC6765532 DOI: 10.3969/j.issn.1673-4254.2018.07.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess the clinical efficacy of disposable circumcision suture device (DCSD) in children receiving circumcision. METHODS Children with phimosis and redundant prepuce undergoing circumcision in our hospital were prospectively enrolled in this study hospital and randomized into DCSD group and conventional circumcision (CC) group. A total of 236 boys were enrolled, including 132 in DCSD group and 104 in CC group. The use of local anesthesia, operation time, intraoperative blood loss, intraoperative and postoperative pain scores, penile appearance satisfaction rates, postoperative complications, healing time of the incision, and the overall satisfaction rate were compared between the two groups. RESULTS Compared with CC group, DCSD group had a significantly higher proportion of local anesthesia (P < 0.01), shorter operative time (P < 0.001), less intraoperative blood loss (P < 0.001), lower intraoperative and postoperative pain scores (P < 0.001), higher penile appearance satisfaction rates (P=0.03), less postoperative complications (P=0.04), shorter healing time (P < 0.001), and a higher overall satisfaction rate (P < 0.005). CONCLUSIONS The use of DCSD can shorten the operative time and is associated with good tolerance of local anesthesia, less pain, quick recovery, and higher penile appearance satisfaction rates in children receiving circumcision.
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Affiliation(s)
- 慧 夏
- />南方医科大学第三附属医院泌尿外科,广东 广州 510630Department of Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 荷花 吴
- />南方医科大学第三附属医院泌尿外科,广东 广州 510630Department of Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 康颐 薛
- />南方医科大学第三附属医院泌尿外科,广东 广州 510630Department of Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 诚 杨
- />南方医科大学第三附属医院泌尿外科,广东 广州 510630Department of Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
| | - 建昆 杨
- />南方医科大学第三附属医院泌尿外科,广东 广州 510630Department of Urology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
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