To assess safety of the no-flip ShangRing male circumcision technique and to determine clinical course and safety of spontaneous detachment (i.e., allowing the device to fall off), we conducted a case series of no-flip ShangRing circumcision combined with a randomized controlled trial of removal 7 days postcircumcision versus spontaneous detachment at two health facilities in Kenya. The primary outcome was the safety of the no-flip technique based on moderate and severe adverse events (AEs) during the procedure and through 42-day follow-up. A main secondary outcome was clinical course and safety of spontaneous detachment. Two hundred and thirty males 10 years and older underwent no-flip circumcision; 114 randomized to 7-day removal and 116 to spontaneous detachment. All circumcisions were successfully completed. Overall 5.3% (6/114) of participants in the 7-day group and 1.7% (2/116) in the spontaneous group had an AE; with no differences when compared to the 3% AE rate in historical data from African studies using the original flip technique (P = 0.07 and P = 0.79, respectively). Overall 72.4% (84/116) of participants in the spontaneous group wore the ShangRing until it detached. Among the remaining (27.6%; 32/116), the ring was removed, primarily at the participants' request, due to pain or discomfort. There was no difference in AE rates (P = 0.169), visit day declared healed (P = 0.324), or satisfaction (P = 0.371) between randomization groups. The median time to detachment was 14.0 (IQR: 7-21, range: 5-35) days. The no-flip technique and spontaneous detachment are safe, effective, and acceptable to boys and men 10 years and older. Phimosis and penile adhesions do not limit successful ShangRing circumcision with the no-flip technique.
Adolescent ; Adult ; Child ; Circumcision, Male/methods* ; Humans ; Kenya ; Male ; Middle Aged ; Patient Satisfaction ; Treatment Outcome ; Wound Healing ; Young Adult

Objective: To investigate the effect of the frenulum identification positioning method with a disposable suture device in circumcision for the prevention of postoperative penile frenulum malposition. METHODS: Totally 212 patients with phimosis or redundant prepuce underwent circumcision from March 2015 to September 2016, including 109 cases of conventional circumcision (the control group) and 103 cases treated by frenulum identification positioning with a disposable suture device (the observation group). We observed the postoperative position of the penile frenulum and median raphe and compared the deviation angles of the frenulum between the two groups of patients. RESULTS: The median of penile frenulum deviation angle (interquartile range) was 0 (3.56) in the observation group, significantly smaller than 12.41 (19.59) in the control (P <0.001, P = 0.000). And the rate of frenulum deviation was remarkably lower in the former (8.74% ［9/103］) than in the latter group (66.06% ［72/109］) (P <0.01). CONCLUSIONS Circumcision using the frenulum identification positioning method with a disposable suture device can effectively avoid postoperative penile frenulum malposition. With the advantages of safety and easy operation, it deserves clinical application and popularization.
Circumcision, Male ; instrumentation ; methods ; Disposable Equipment ; Foreskin ; surgery ; Humans ; Male ; Penis ; surgery ; Phimosis ; surgery ; Postoperative Complications ; prevention & control ; Suture Techniques ; instrumentation ; Sutures

Objective: To investigate the attitudes of the parents toward circumcision for 6－14 years old children and their satisfaction with the results. METHODS: We performed circumcision in the Department of Urology of Zhongda Hospital for 220 children aged 6－14 years from 220 families between January 2010 and August 2016, including 70 cases of traditional and 150 cases of Shang Ring circumcision. We conducted telephone follow-ups among the parents of the patients concerning the decision-maker, reasons and regret for circumcision, acceptance of a second operation, source of information, satisfaction with surgical results, and reasons for dissatisfaction. RESULTS: Most decisions for circumcision were made by the father, chiefly for health and hygiene. Their main sources of information on circumcision were Internet and friends. The parents of 29 patients were dissatisfied for long recovery or peri- and post-operative pain, including 19 cases (27.1%， 19/70) of traditional and 10 cases (6.7%， 10/150) of Shang Ring circumcision, with statistically significant differences between the two groups (P <0.05). CONCLUSIONS Most parents were satisfied with circumcision, and the main reasons for dissatisfaction were long recovery and pain. The rate of satisfaction with Shang Ring circumcision was higher than that with traditional circumcision. Shang Ring circumcision is recommended for children aged 6－14 years old.
Adolescent ; Asian Continental Ancestry Group ; Attitude ; Child ; China ; Circumcision, Male ; methods ; psychology ; Convalescence ; psychology ; Fathers ; Humans ; Male ; Pain, Postoperative ; psychology ; Parents ; psychology ; Personal Satisfaction ; Phimosis ; Time Factors

OBJECTIVETo study the effects of skin wound induction gel on the glans scabbing rate, class-A wound healing rate, and wound healing time of circumcision for phimosis in pediatric patients.

METHODSWe randomly assigned 48 six to thirteen years old children with phimosis to an experimental group (n = 25) and a control group (n = 23) to be treated by circumcision. After surgery, the patients in the experimental group received application of skin wound induction gel while those in the control group received that of povidone iodine only to the glans and incision. We recorded and compared the glans scabbing rate, class-A wound healing rate, and wound healing time between the two groups of patients.

RESULTSGlans scabbing was observed in 3 cases in the experimental group and 17 cases in the control group (12.0% vs 73.9%, P < 0.01). No statistically significant differences were found in the rate of class-A wound healing between the two groups (100% vs 91.3%, P > 0.05). The wound healing time was significantly shorter in the experimental than in the control group ([10.7 ± 1.7] d vs [11.9 ± 2.1] d, P < 0.05).

CONCLUSIONPost-circumcision application of skin wound induction gel to the glans and incision can effectively reduce glans secreta, alleviate inflammatory reaction, and shorten the healing time in the treatment of phimosis in children.

Adolescent ; Child ; Circumcision, Male ; Gels ; administration & dosage ; Humans ; Induction Chemotherapy ; methods ; Inflammation ; prevention & control ; Male ; Phimosis ; drug therapy ; Postoperative Complications ; prevention & control ; Wound Healing ; drug effects

OBJECTIVETo compare the clinical effects of circumcision and the foreskin-deglove plus shaft-fix (FDSF) procedure in the treatment of phimosis or redundant prepuce in obese adult males (body mass index [BMI] ≥ 28 kg/m²).

METHODSForty-four obese adult men with phimosis or redundant prepuce underwent circumcision (n = 24) or FDSF (n = 20) according to their own wishes. The patients in the circumcision and FDSF groups were aged (26.38 ± 4.24) and (26.90 ± 3.14) years, with BMIs of (27.77 ± 0.77) and (28.07 ± 2.28) kg/m² and penis lengths of (3.51 ± 0.46) and (3.50 ± 0.59) cm, respectively. The operations were performed under local anesthesia with lidocaine plus ropivacaine mesylate.

RESULTSThe operation time of circumcision was (28.04 ± 2.65) min and that of FDSF was (45.45 ± 3.49) min. At 6 months after surgery, normal penile erection was found in all the patients, the penis length was significantly longer in the FDSF than in the circumcision group ([5.01 ± 0.73] vs [3.70 ± 0.47] cm) , and the rate of satisfaction with penile appearance was markedly higher in the former than in the latter group (3.25 ± 0.71 vs 2.83 ± 0.56).

CONCLUSIONThe foreskin-deglove plus shaft-fix procedure under local anesthesia with lidocaine and ropivacaine mesylate may achieve desirable penile erection and appearance in the treatment of phimosis or redundant prepuce in obese adult patients.

Adult ; Amides ; Anesthetics, Local ; Body Mass Index ; Circumcision, Male ; methods ; Foreskin ; abnormalities ; surgery ; Humans ; Lidocaine ; Male ; Mesylates ; Obesity ; complications ; Operative Time ; Penile Erection ; Penis ; abnormalities ; Phimosis ; surgery

OBJECTIVETo compare the clinical effects of the circumcision stapler, circumcision cerclage, and traditional circumcision in the treatment of phimosis and redundant prepuce.

METHODSUsing the circumcision stapler (group A), foreskin cerclage (group B), and traditional circumcision (group C), we treated 276 patients with phimosis or redundant prepuce. We made comparisons among the three groups in the operation time, intraoperative blood loss, intraoperative and 24-hour postoperative pain scores, and incidence of postoperative complications. Results: The operation time, intraoperative blood loss, and intraoperative pain score were (6.52 ± 2.45) min, (1.93 ± 0.82) ml, and 1.37 ± 0.68 in group A and (7.24 ± 1.86) min, (1.51 ± 0.72) ml, and 1.20 ± 0.79 in group B, all significantly lower than (28. 36 ± 4.22) min, (9.52 ± 3.29) ml, and 3.06 ± 0.75 in group C (P <0.05). The 24-hour postoperative pain score was remarkably higher in group B than in A and C (3. 18 ± 0. 82 vs 1. 85 ± 0. 63 and 1. 82 ± 0. 75, P <0. 05). The incidence rate of postoperative complications was markedly lower in group A than in B (5. 43% vs 14. 13%, P < 0.05), but with no significant differences between either A and C or B and C (P >0.05).

CONCLUSIONThe circumcision stapler, with its advantages of simple operation, minimal invasiveness, fewer complications, and better cosmetic result, deserves a wider clinical application.

Blood Loss, Surgical ; Circumcision, Male ; adverse effects ; instrumentation ; methods ; Foreskin ; Humans ; Incidence ; Male ; Pain Measurement ; Pain, Postoperative ; diagnosis ; Penis ; abnormalities ; Phimosis ; therapy ; Postoperative Complications ; Postoperative Period

OBJECTIVETo observe the clinical effect and safety of circumcision stapler in the treatment of phimosis and redundant prepuce.

METHODSWe treated 120 patients with redundant prepuce or phimosis using circumcision stapler and another 60 by conventional dorsal-incision circumcision. We observed intraoperative blood loss, operation time, postoperative pain, wound healing time, cosmetic appearance of the penis, and postoperative complications and compared them between the two groups of patients.

RESULTSStapler circumcision showed obvious advantages over the conventional method in intraoperative blood loss ([2. 3 ± 1. 3] vs [15.6 ± 2.9] ml), operation time ([7.1 ± 1.4] vs [22.6 ± 4.6] min), wound healing time ([12.0 ± 2.9] as [16.3 ± 3. 1] d), postoperative pain score (1. 9 ± 1. 3 vs 5. 2 ± 1. 7), incision edema, and cosmetic appearance of the penis (all P <0. 05). Besides, stapler circumcision exempted the patients from stitch-removal pain. However, the incidence rate of postoperative local ecchymosis was significantly higher in the circumcision stapler group than in the conventional circumcision group (20. 8% vs 8. 3% , P <0. 05).

CONCLUSIONCircumcision stapler, with its advantages of easier manipulation, shorter operation time, better cosmetic penile appearance, less pain, and fewer complications, is superior to conventional circumcision in the treatment of phimosis and redundant prepuce.

Blood Loss, Surgical ; Circumcision, Male ; instrumentation ; methods ; Ecchymosis ; etiology ; Humans ; Male ; Pain, Postoperative ; Penis ; abnormalities ; Phimosis ; therapy ; Postoperative Complications ; Postoperative Period ; Surgical Staplers ; adverse effects ; Wound Healing

OBJECTIVETo evaluate the effect of penile frenulum lengthening in the treatment of premature ejaculation (PE).

METHODSThirty-four males with PE were enrolled in this study, of whom 8 had received circumcision six months before and 4 had redundant prepuce, all with short frenulum. Those with a history of circumcision underwent reconstruction and lengthening of the frenulum, and those without received frenulum lengthening only.

RESULTSCompared with the baseline, the intravaginal ejaculation latency time (IELT) was significantly increased at 1 month after operation ([1.35 ± 0.49] vs [5.71 ± 2.69] min, t = -9.42, P <0.01), (1.42 ± 0.5) vs (5.31 ± 2.74) min in the patients without circumcision (t = -7.41, P <0.01), (1.12 ± 0.35) vs (7.00 ± 2.20) min in those with circumcision (t = -7.24, P <0.01), and (1.50 ± 0.58) vs (4.75 ± 1.71) min in those with redundant prepuce (t = -3.81, P <0.05). Totally, 94% of the patients were satisfied with their sexual intercourse postoperatively.

CONCLUSIONPenile frenulum plays an important role in penile erection. Reconstruction and/or lengthening of the frenulum can prolong penile erection and IELT in PE patients.

Adult ; Circumcision, Male ; rehabilitation ; Coitus ; Ejaculation ; Foreskin ; surgery ; Humans ; Male ; Penile Erection ; Premature Ejaculation ; surgery ; Reconstructive Surgical Procedures ; methods

OBJECTIVETo investigate the pathogenesis and treatment of penile necrosis resulting from microwave diathermy following circumcision.

METHODSWe retrospectively analyzed the clinical data about 9 cases of penile necrosis resulting from postoperative microwave diathermy following circumcision. The 9 males, aged 20 - 39 (mean 26) years, underwent traditional circumcision for redundant prepuce or phimosis in other hospitals, followed by microwave diathermy for 30 - 60 minutes daily, which resulted in penile necrosis. With no response to conservative therapy, the patients were referred to our hospital at 3 -30 days postoperatively. Of the 9 patients, 5 presented with dry gangrene and 4 with moist gangrene. Six of the patients underwent partial penectomy, including 1 that received penis lengthening.3 months later, while the other 3 underwent total penectomy for total penile necrosis followed by penile reconstruction 3 months later, with deep inferior epigastric perforator (DIEP) flaps and by implantation of the 12th costal cartilage in 2 cases and with epigastric groin island flaps and by urethroplasty in the other.

RESULTSThe patients were followed up for 2 - 8 years, and all could urinate smoothly in the standing position. Of the 6 men treated by partial penectomy, 1 received penis lengthening and achieved a penile length of 7 cm and 5 had the remaining penile length of 3 -5 cm, 4 with erectile function and the other 2 capable of sexual intercourse. The 3 men treated by total penectomy achieved nearly normal external appearance of the penis, with a finalized length of (11.7 ± 1.3) cm, a circumference of (11.4 ± 2.1) cm, and a normal feel of the skin. Of the 3 cases of penile reconstruction, 2 achieved sufficient erectile hardness of the penis (grade 3) for sexual intercourse, while the other 1 remained impotent.

CONCLUSIONPost-circumcision microwave diathermy may result in penile necrosis, for the management of which, early debridement is necessitated and penile lengthening or reconstruction can be performed according to the severity of the lesion and needs of the patient.

Adult ; Circumcision, Male ; methods ; Coitus ; Costal Cartilage ; transplantation ; Diathermy ; adverse effects ; methods ; Humans ; Male ; Microwaves ; adverse effects ; Penis ; abnormalities ; surgery ; Phimosis ; surgery ; Postoperative Period ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Young Adult

OBJECTIVETo compare the effect and safety of the no-flip method versus the external method in Shang Ring circumcision.

METHODSWe searched relevant randomized controlled trials published in China and abroad comparing the no-flip method and external method of Shang Ring circumcision. Based on the Cochrane Handbook for systematic review, two reviewers independently eval- uated the quality of the included studies and abstracted relevant data, followed by a meta-analysis using the statistical software Review Manager 5.1.0.

RESULTSTotally 7 studies with 1 200 cases were included. Compared with the external method, the no-flip method was associated with a lower total rate of complications (RR = 0.40, 95% CI: 0.18, 0.87, P = 0.02), a lower incidence of postop- erative edema (RR = 0.28, 95% CI: 0.09, 0.81, P = 0.02), and a lower 24 h postoperative pain score (MD = -0.35, 95% CI: -0.55, -0.14, P < 0.001).

CONCLUSIONThe no-flip method of Shang Ring circumcision was superior to the external method for its advantages of fewer complications, lower incidence of postoperative edema, and mild postoperative pain. However, our findings need further support by more high-quality randomized controlled trials.

China ; Circumcision, Male ; adverse effects ; instrumentation ; methods ; Edema ; epidemiology ; Humans ; Male ; Pain Measurement ; Pain, Postoperative ; epidemiology ; Randomized Controlled Trials as Topic