Adolescent ; Adult ; Aged ; Child ; Circumcision, Male ; methods ; Humans ; Male ; Middle Aged ; Young Adult

Male circumcision can reduce men's risk of HIV infection from heterosexual intercourse by 60% and is therefore recommended as an important strategy for HIV prevention in Africa by WHO and UNAIDS. However, rapid expansion of male circumcision efforts could be greatly facilitated by a safer, more effective and acceptable male circumcision surgical technique or device. Shang Ring is a simple technique developed in China. It allows a circumcision to be completed with minimal bleeding, without suturing, and in only 3-5 min and reported complications are few. A standardized adult male circumcision surgical protocol utilizing the Shang Ring device was developed in 2008 in China. Several surgical training courses using this protocol were successfully held in 2009 and 2010 in China. A recent pilot clinical study of the Shang Ring was conducted to evaluate its safety and efficiency in Kenya in 2009. The results and acceptability among study participants were excellent and confirmed many of the advantages seen in the earlier Chinese studies from Wuhu, Ningbo and Xi'an, suggesting that the Shang Ring is safe for further studies in Africa, thus, could facilitate more rapid roll-out of adult male circumcision through task shifting, surgical efficiencies and better acceptability. Further international investigations of the Shang Ring technique have now been planned for Kenya and Zambia in 2011. Moreover, adult male circumcision utilizing the Shang Ring device is now being considered as ope of the potential candidate techniques to be used in the scale-up of adult male circumcision services for HIV prevention in WHO priority countries in Africa. This review article summarizes Shang Ring related clinical studies, seminars and surgical workshops, publications and presentations conducted between February 2008 and December 2010 in China, the United States and Africa.
Africa ; Circumcision, Male ; instrumentation ; methods ; HIV Infections ; prevention & control ; Humans ; Male

OBJECTIVETo compare the effect and safety of Shang Ring circumcision with those of conventional circumcision in the treatment of redundant prepuce or phimosis.

METHODSWe retrieved the randomized controlled trials on Shang Ring circumcision and conventional circumcision for the treatment of redundant prepuce or phimosis published at home and abroad. Relevant data were selected according to the Cochrane Handbook for Systematic Reviews by two reviewers after quality evaluation of the included trials, and the statistical software RevMan 5.0 was used for meta analysis.

RESULTSTotally 8 randomized controlled trials with 2277 cases were included in this study. Compared with conventional circumcision, Shang Ring circumcision showed a shorter operation time (SMD = -5.82, 95% CI [ -7.39, -4.24], P<0.00001), less intraoperative blood loss (SMD = -3.28, 95% CI [ -3.47, -3.09], P<0.00001), lower rate of infection (OR = 0.44, 95% CI [0.26, 0.72], P=0.001), lower rate of postoperative bleeding (OR =0.05, 95% CI [0.02, 0.12], P<0.00001), higher rate of satisfaction with the postoperative penile appearance (OR=12.72, 95% CI [1.30, 124.56], P=0.03), lower intraoperative pain score (SMD = -3.32, 95% CI [ -3.50, -3.14], P<0.00001), and lower 24-hour-postoperative pain score (SMD = -3.28, 95% CI [ - 3.47, - 3.00], P<0.00001), but longer wound healing time (OR=1.46, 95% CI [1.03, 1.90], P<0.00001).

CONCLUSIONIn comparison with conventional circumcision, Shang Ring circumcision has the advantages of shorter operation time, fewer complications, mild pain, and higher rate of satisfaction with the postoperative penile appearance. However, more high-quality randomized controlled trials with large samples are required to lend further support to our findings.

Circumcision, Male ; methods ; Humans ; Male ; Phimosis ; surgery ; Randomized Controlled Trials as Topic ; Treatment Outcome

OBJECTIVETo observe the clinical effects of using the Chinese Shang Ring in circumcision children with either phimosis or redundant prepuce, and to investigate its superiority over the similar devices available.

METHODSA total of 824 children with phimosis or redundant prepuce underwent circumcision with the Shang Ring. The clinical data were assessed concerning the duration of the procedure, incidence of post-operative complications, time of recovery and appearance of the penis.

RESULTSThe procedure duration was (2.6 +/-1.2) min, and the complications included infection in 4 (0.6%), edema in 21 (3.2%), delayed removal of the ring in 10 (1.5%), redundant and asymmetric mucosa attributable to performance in 6 (0.9%) of the cases. The wounds healed and the rings were removed at 13.4 +/- 5.8 days after circumcision, with well-smoothed incision and good cosmetic results.

CONCLUSIONChild circumcision with the Chinese Shang Ring is easy and simple in performance, with less operative time, fewer complications and better cosmetic results.

Adolescent ; Child ; Child, Preschool ; Circumcision, Male ; instrumentation ; methods ; Humans ; Male ; Penis ; surgery ; Phimosis ; surgery ; Treatment Outcome

OBJECTIVETo explore the anatomical features and measure the width of the coronal sulcus of the penis.

METHODSWe observed the coronal sulcus of the penis in 269 males aged 19 -66 (mean 28) years. Among them, 137 had redundant prepuce, 11 had phimosis, 90 were normal men, and 30 had been circumcised for redundant prepuce and 1 for phimosis. The width of the sulcus was measured with the vernier caliper at the 12 o'clock position, i. e. , the middle point of the dorsal. The results were compared among different groups.

RESULTSThe mucosa of the sulcus was relatively flat, smooth and not so active. Generally, the anterior line of the coronal sulcus was indistinct, whereas the posterior line was clear and easy to be identified. The widths of the coronal sulcus were (4.32 +/- 3.44), (4.06 +/- 2.68) and (4.22 +/- 3.06) mm in the redundant prepuce, phimosis and normal groups, with no statistically significant differences among the three (P > 0.05).

CONCLUSIONEnough attention should be paid to the width of the coronal sulcus of the penis in clinical practice. The posterior line of the coronal sulcus should be chosen as the positioning standard for inner incision in circumcision.

Adult ; Aged ; Circumcision, Male ; methods ; Humans ; Male ; Middle Aged ; Penis ; anatomy & histology ; surgery ; Young Adult

OBJECTIVELiteratures on the development and function of prepuce was reviewed. To compare the merit and demerit of treatment for redundant prepuce by conventional circumcision or by removing the root skin of the penis. To investigate the ideal method and time of treatment for redundant prepuce.

METHODSThe extended length of the penis and the extended skin of penis were carefully measured and the excess skin at the root of the penis was removed from the surface of Colle's fascia. Then the remaining distal skin was drew back to suture to the root of the penis. As for the cases complicated with stenosis of prepuce, longitudinal incision was performed along the constricted area to release stenosis, followed by transverse closure of the wound.

RESULTS110 adult cases of simple redundant prepuce and 40 cases complicated with stenosis were treated by this way. Functional and cosmetic results were achieved without any complications in all cases. All patients were satisfied with the result.

CONCLUSIONSRemoval of the excess skin at the root of the penis should be preferred to the conventional circumcision for treatment of redundant prepuce. The ideal time for intervention is at or after adolescence, when the prepuce has developed maturely. Non-operative methods should be taken to treat phimosis and adherent prepuce before adolescence.

Adolescent ; Adult ; Circumcision, Male ; methods ; Humans ; Male ; Middle Aged ; Penis ; surgery ; Young Adult

AIMTo study the clinical effects of a disposable circumcision device in treatment of male patients of different ages with either phimosis or excess foreskin.

METHODSOne thousand two hundred patients between the age of 5 and 95 years underwent circumcision using this procedure in the 2-year period between October 2005 and September 2007. Of these cases, 904 had excess foreskin and 296 were cases of phimosis.

RESULTSIn 96.33% of the cases the incision healed, leaving a minimal amount of the inner foreskin with no scarring and producing good cosmetic results. There were no incidents of device dislocation or damage to the frenulum. The average operative time was 2.5 min for excess foreskin, and 3.5 min for phimosis. During the 7 days of wearing the device, mild to moderate edema occurred in 10.08% of cases with excess foreskin and in 2.58% of those with phimosis. Edema in the frenulum was seen in 1.67% of patients, and only 0.67% had an infection of the incision. A total of 86.25% of patients reported pain due to penile erection. After removal of the device, 0.58% of the cases had minimal bleeding around the incision, and 2.42% had wound dehiscence.

CONCLUSIONThe new device can be applied to an overwhelming majority of patients with phimosis and excess foreskin. This technique is relatively simple to perform, and patients who underwent this surgery had very few complications. Antibiotics were not required and patients reported less pain than those who were circumcised using conventional methods. Circumcision with this device requires minimal tissue manipulation, and is quicker and safer than circumcision using conventional techniques.

Adolescent ; Child ; Child, Preschool ; Circumcision, Male ; methods ; Humans ; Male ; Minimally Invasive Surgical Procedures ; Pain, Postoperative

Phimosis and redundant prepuce, as common problems in andrology, are found in the majority of male neonates. Early treatment of neonatal phimosis and redundant prepuce has the advantages of better cost--effectiveness and higher safety, and contributes much to the prevention of childhood urinary tract infection and adult sexually transmitted diseases, as well as to the improvement of genital hygiene. Neonatal circumcision is commonly performed in some countries, but remains at a low rate in China. This article updates surgical and non-surgical treatments of neonatal phimosis and redundant prepuce, introduces the benefits of neonatal circumcision, and appeals for more attention to the management of neonatal phimosis and redundant prepuce.
Child, Preschool ; Circumcision, Male ; methods ; Humans ; Infant ; Male ; Phimosis ; surgery ; therapy

OBJECTIVETo compare the efficacy and complications of the Shang Ring circumcision with those of conventional surgical procedures.

METHODSA total of 724 patients, 521 with redundant prepuce and 203 with phimosis, were randomly assigned to receive the Shang Ring circumcision (n = 402) and conventional surgical procedures (n = 322). Comparisons were made between the two groups in the surgical duration, blood loss, pain score, as well as postoperative complications, satisfaction with the penile appearance, and the quality of sexual life.

RESULTSThe surgical duration, blood loss, postoperative satisfaction and IIRF-5 score were (4.70 +/- 1.30) min, (2.60 +/- 1.80) ml, 99.50% (400/402) and 23.45 +/- 3.43, respectively, in the Shang Ring group as compared with (25.6 +/- 8.3) min, (11.20 +/- 3.50) ml, 69.57% (224/322) and 23.12 +/- 3.26 in the conventional surgery group, with statistically significant differences in the first three parameters (P < 0.01), but not in IIRF-5 score (P > 0.05).

CONCLUSIONCompared with the conventional surgical procedures, the Shang Ring circumcision has the advantages of shorter operation time, less blood loss, mild pain, fewer complications, better penile appearance, lower expenses, and higher satisfaction and acceptance of the patients.

Adolescent ; Adult ; Circumcision, Male ; methods ; Humans ; Male ; Middle Aged ; Penis ; surgery ; Phimosis ; surgery ; Young Adult

OBJECTIVETo summarize the experience in the application of circumcision anastomat in the treatment of phimosis and redundant prepuce in children.

METHODSA total of 551 children with phimosis or redundant prepuce were treated by circumcision from 2008 to 2010, 342 with circumcision anastomat and the other 209 by traditional circumcision. Their clinical data were retrospectively analyzed.

RESULTSCompared with traditional circumcision, circumcision with the anastomat showed the advantages of less operation time (P < 0.05), fewer complications, no need for dressing, and better cosmetic appearance, but it also exhibited the disadvantages of longer healing time (P < 0.05) and more obvious postoperative pain (P < 0.05).

CONCLUSIONCircumcision with the anastomat and traditional circumcision for the treatment of phimosis and redundant prepuce in children each have their own advantages and disadvantages, but the former is more advantageous and more feasible clinically.

Adolescent ; Anastomosis, Surgical ; Child ; Circumcision, Male ; instrumentation ; methods ; Humans ; Male ; Phimosis ; surgery ; Treatment Outcome