OBJECTIVETo compare the clinical effects of conventional, sleeve and Shang Ring circumcisions in the treatment of redundant prepuce and phimosis.

METHODSWe reviewed the clinical data of 918 patients with redundant prepuce or phimosis, 279 treated by conventional circumcision, 354 by sleeve circumcision and 285 by Shang Ring circumcision. We documented the preoperative characteristics, intra-operative blood loss, operation time, 4-hour and 7-day postoperative visual analogue scores, surgeons' satisfaction, incision healing time, degrees of preputial edema, postoperative complications, patients' satisfaction with penile appearance and peri-operative cost, and compared them among the three groups.

RESULTSShang Ring circumcision significantly reduced the operation time and intra-operative blood loss as compared with conventional and sleeve circumcisions (P < 0.05). The postoperative incision healing time was (18.6 +/- 5.2) d in the conventional circumcision group, (11.4 +/- 3.7) d in the sleeve circumcision group and (20.3 +/- 5.7) d in the Shang Ring circumcision group, significantly shorter in the sleeve group than in the other two (P < 0.05). As for the surgeons' satisfaction, postoperative complications, degree of preputial edema and patients' satisfaction with penile appearance, sleeve circumcision showed similar effects to Shang Ring circumcision but significantly better than conventional circumcision (P < 0.05). The 7-day postoperative visual analogue score and peri-operative cost were significantly lower in the conventional and sleeve circumcision groups than in the Shang Ring group (P < 0.05).

CONCLUSIONEach of the three circumcision methods has its own advantages and disadvantages. The treatment decision should be individualized and based on a comprehensive consideration of the patients' age and economic status as well as surgeons' advice and surgical skills.