Abstract
In situ device (ISD) and circular disposable device (CDD) are used for optimizing male circumcision (MC), but evidence to explore the characteristics of these two devices is insufficient. In order to explore this issue systematically and provide reliable evidence, ten published randomized controlled trials (RCTs) exploring the safety and efficacy of ISDs and CDDs were included (involving 4649 men). Moderate quality of the RCTs included was found after assessment. Pairwise meta-analyses and network meta-analyses were processed in stata 13.0 and AIDDS v1.16.6 respectively. According to the outcomes that were statistically significant in both pairwise and network meta-analyses, ISD was found to have less intraoperative blood loss (IB), less operative time (OT) and less incidence of wound bleeding (WB) than conventional circumcision (CC); ISD was found to have less WB but more wound healing time (WHT) than CDD; CDD was found to have less IB and less OT than CC. CDD tended to have the best wound healing condition and least pain experience; ISD tended to have the least IB, least OT, least WB, and highest satisfaction rate. With their own superiorities in many aspects, CDD and ISD are both safe and effective devices for optimizing MC.
Highlights
We conducted this systematic review and network meta-analysis to assess the safety and efficacy of ISDs and CDDs
Fifteen trials were retrieved for a detailed evaluation and five were excluded: two non-randomized controlled trials, one trial that compared two application methods of one device, and two trials that used immature[15] and harmful devices[22]
There was a low risk of attrition bias, reporting bias, and other biases in all trials except one[26] that had an incomplete outcome data
Summary
We conducted this systematic review and network meta-analysis to assess the safety and efficacy of ISDs and CDDs. we evaluated the characteristics of these devices for optimizing MC. In network meta-analyses (Table 3), CDD had a higher Cost [SMD: 235 (4.91, 473)] and more WB [SMD: 28.6 (1.17, 1320)] but less WHT [SMD: − 6.58 (− 12.6, − 0.58)] than ISD.
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