MP65-13 FEASIBILITY OF NO-FLIP SHANGRING MALE CIRCUMCISION IN ADOLESCENT BOYS WITH PHIMOSIS

Abstract

You have accessJournal of UrologyPediatrics: Hypospadias and Penile Surgery (MP65)1 Apr 2020MP65-13 FEASIBILITY OF NO-FLIP SHANGRING MALE CIRCUMCISION IN ADOLESCENT BOYS WITH PHIMOSIS Omar Al Hussein Alawamlh*, Nahid Punjani, Huixing Chen, Mark A. Barone, Quentin D. Awori, Marc Goldstein, Richard K. Lee, and Philip S. Li Omar Al Hussein Alawamlh*Omar Al Hussein Alawamlh* More articles by this author , Nahid PunjaniNahid Punjani More articles by this author , Huixing ChenHuixing Chen More articles by this author , Mark A. BaroneMark A. Barone More articles by this author , Quentin D. AworiQuentin D. Awori More articles by this author , Marc GoldsteinMarc Goldstein More articles by this author , Richard K. LeeRichard K. Lee More articles by this author , and Philip S. LiPhilip S. Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000940.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The presence of phimosis has historically posed limitations to device-assisted male circumcision (MC). Device-assisted MC has been proposed as a tool to scale up MC services in sub-Saharan Africa for HIV prevention, where there is lack of adequate medical resources and trained healthcare providers. The ShangRing (SR) is the only WHO-prequalified MC device currently in use in sub-Saharan Africa for HIV prevention. In this study, we evaluated the safety and efficacy of no-flip SR MC in adolescents with phimosis. METHODS: A total of 212 males aged 10-17 years were enrolled at two study sites in Kenya. All boys underwent no-flip SR circumcision. This procedure involved the insertion of the inner ring of the device under the foreskin, followed by an outer ring to secure the foreskin and provide hemostatic occlusion. The foreskin distal to the device was then excised. For boys with phimosis, a 1-cm dorsal slit was performed to facilitate inner ring insertion. We compared operative time, postoperative pain scores using the visual analogue pain scale, rate of adverse events (AEs), time to complete wound healing, and satisfaction with the appearance of the healed penis between adolescents with phimosis and adolescents without. RESULTS: Of 212 adolescent males, 26 (12.3%) were found to have phimosis (p<0.01). All (n=212, 100%) participants were successfully circumcised. A dorsal slit was performed for all adolescents with phimosis. The mean operative time with phimosis was 6.94 vs. 6.69 minutes in those without (p=0.66). Pain scores captured 20 minutes postoperatively in adolescents with phimosis was 2.79 vs. 2.78 (p=0.98). Five AEs were seen in boys without phimosis, while a single AE in participants with phimosis (p=0.75). Except for one in the non-phimosis group, all study participants achieved complete wound healing by the last follow up visit on day 42 post-circumcision (99% vs. 100%, p=0.71). Satisfaction with the appearance of the healed penis was expressed by all except for two boys without phimosis (99% vs. 100%, p=0.60). Univariate regression modelling revealed no statistically significant association between phimosis and procedure success, pain scores, operative time, rate of AEs, healing, or satisfaction. Multivariate linear regression demonstrated that increasing age increased operative time (p<0.01). CONCLUSIONS: No-flip SR circumcision can be safely and effectively performed in adolescents with phimosis. Outcomes with regards to procedural success, operative time, pain scores, rate of AEs, healing, and cosmetic satisfaction were comparable between both study groups. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e978-e978 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Omar Al Hussein Alawamlh* More articles by this author Nahid Punjani More articles by this author Huixing Chen More articles by this author Mark A. Barone More articles by this author Quentin D. Awori More articles by this author Marc Goldstein More articles by this author Richard K. Lee More articles by this author Philip S. Li More articles by this author Expand All Advertisement PDF downloadLoading ...