Does Circumplast Ring Offer Safe Alternative to Standard Plastibell Ring for Infant Male Circumcision?

Abstract

Purpose: This study evaluated the early postoperative complications in Circumplast® and Plastibell® techniques for infant male circumcision in two community clinics. Materials and Methods: We retrospectively reviewed the outcome of infant male circumcision (n=649) over 1 year (Jan 2021 to Feb 2022) performed under local anaesthesia by a single urologist. The technique was non-randomly selected. Data were collected retrospectively, and early postoperative complications were compared between Circumplast® and Plastibell® circumcisions. Both parents consented to the procedure. The 24-telephone support and follow-up were provided if required. Results: All records of infants were reviewed with Circumplast® circumcision (CC) n=302 and Plastibell® circumcision (PC) n=347 during this period. The mean age was 52.33 +/- 44.16 days in CC and 38.64 ± SD 30.39 days in PC. Three infants were excluded. There was no major complication and minor complications were lower in CC (0.99% n=3/302) versus PC (2.9% n=10/347). Delayed ring separation happened in PC (2.3% n=8/347), which was separated by a bone cutter in the clinic and no ring impaction occurred in CC. One infant in CC had bleeding after 24 hours, which was managed by removal of the ring and revision of circumcision. Two infants required separation of coronal adhesions in CC and two required revisions of circumcision in PC. Discussion: This is the first study to report the results of early experience involving the use of Circumplast® ring to perform pediatric circumcision. Our findings reflect the use of this device as a safe alternative to Plastibell®. A randomised controlled trial (RCT) would be required to document the relative superiority of either device. The reduced number of ring impactions among CC may be attributed to its unique design. Conclusion: Infant male circumcision by the Circumplast® device has a lower risk of early postoperative minor complications especially migration/impaction and may offer a safe alternative.