Circumcision - what’s wrong with plastic rings?

Millard, Peter S.

doi:10.7196/samj.5419

Cited by 5 publications

(4 citation statements)

References 13 publications

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“…None of them were considered as perfect because of various associated complications 192021. The present study demonstrated fewer post-operative complications when the DCSD was used.…”

Section: Discussionmentioning

confidence: 99%

Disposable circumcision suture device: clinical effect and patient satisfaction

Zhang

Zhu

et al. 2014

Asian J Androl

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In our experience patients undergoing circumcision are mostly concerned about pain and penile appearances. We conducted a prospective randomized trial to assess the benefits of a new disposable circumcision suture device (DCSD). A total of 942 patients were equally divided into three groups (conventional circumcision, Shang ring and disposable suture device group). Patients in the DCSD group were anesthetized with compound 5% lidocaine cream, the others with a 2% lidocaine penile block. Operation time, intra-operative blood loss, incision healing time, intra-operative and post-operative pain, the penile appearance and overall satisfaction degree were measured. Operation time and intra-operative blood loss were significantly lower in the Shang ring and suture device groups compared to the conventional group (P < 0.001). Intra-operative pain was less in the suture device group compared with the other two groups (P < 0.001); whereas post-operative pain was higher in the conventional group compared to the other two groups (P < 0.001). Patients in the suture device (80.57%) and Shang ring (73.57%) groups were more satisfied with penile appearances compared with the conventional circumcision group (20.06%, P < 0.05). Patients in suture device group also healed markedly faster than the conventional group (P < 0.01). The overall satisfaction rate was better in the suture device group (78.66%) compared with the conventional (47.13%) and Shang ring (50.00%) groups (P < 0.05). The combination of DCSD and lidocaine cream resulted in shorter operation and incision healing times, reduced intra-operative and post-operative pain and improved patient satisfaction with the cosmetic appearances.

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“…None of them were considered as perfect because of various associated complications 192021. The present study demonstrated fewer post-operative complications when the DCSD was used.…”

Section: Discussionmentioning

confidence: 99%

Disposable circumcision suture device: clinical effect and patient satisfaction

Zhang

Zhu

et al. 2014

Asian J Androl

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“…Its potential disadvantages include the need for multiple sizes and to wear it for 1 week. It also leaves significant remnants of the mucosal layer of the foreskin, which inhibits its efficacy in HIV prevention [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, novel methods and devices have been developed to overcome these adverse events to improve circumcision effectiveness with enhanced safety. Currently, several novel kits, such as the Shang ring, have been developed to lower operative time [ 16 ]; however, it leaves significant remains of the mucosal layer of the foreskin, which suppresses its efficacy in HIV prevention [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Taiwanese-Population-Based Clinical Study on Determining the Efficacy and Safety of Disposable Circumcision Anastomat

Chou

Laih

2022

JCM

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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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“…[5] They are attractive because they require less skill to place and are more rapid than open surgery, but have a number of serious drawbacks. [10] They remain in place for 1 week, during which time the men have to tolerate the smell of necrotic tissue. Removal is unpleasant and takes more time than placement (10 min v. 7 min for the Prepex device).…”

Section: Discussionmentioning

confidence: 99%

Rapid, minimally invasive adult voluntary male circumcision: A randomised trial of Unicirc, a novel disposable device

et al. 2013

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Background. Voluntary medical male circumcision (VMMC) is a priority HIV preventive intervention. To facilitate VMMC scale-up, the World Health Organization is seeking circumcision techniques that are faster, easier, and safer than open surgical methods. Objective.To compare open surgical circumcision with suturing v. the Unicirc disposable instrument plus tissue adhesive. Methods. We conducted a non-blinded randomised controlled trial at an outpatient primary healthcare clinic in Cape Town, South Africa, with 2:1 allocation ratio of 150 male volunteers who were at least 18 years of age. Our primary outcome was intraoperative time and secondary outcomes were ease of performance, post-operative pain, adverse events, time to healing, patient satisfaction and cosmetic result. Results. The intraoperative time was less with the Unicirc/adhesive technique (median 13 v. 22.6 min, respectively; p<0.001). The intraoperative suturing rate was 17% using the Unicirc device. Other adverse events and wound healing outcomes were similar in both groups, but the cosmetic result was superior in the Unicirc group. Doctors found the Unicirc procedure easier to perform and preferred it to the open surgical technique. Conclusions. This study has important implications for the scale-up of VMMC services. Excising the foreskin with the Unicirc instrument and sealing the wound with cyanoacrylate tissue adhesive in adults is quicker, easier to learn, and is potentially safer than open surgical VMMC. Further studies should be conducted with the optimised device. This new instrument has the potential to facilitate more rapid scale-up and save costs.

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Circumcision - what’s wrong with plastic rings?

Cited by 5 publications

References 13 publications

Disposable circumcision suture device: clinical effect and patient satisfaction

Disposable circumcision suture device: clinical effect and patient satisfaction

A Retrospective Taiwanese-Population-Based Clinical Study on Determining the Efficacy and Safety of Disposable Circumcision Anastomat

Rapid, minimally invasive adult voluntary male circumcision: A randomised trial of Unicirc, a novel disposable device

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