Circumcision Technique Research Articles

Comparative Study of Circumcision

Background: Male circumcision is a significant practice in Muslim tradition and is widely performed for religious reasons, especially in Muslim-majority countries like Bangladesh. Objective: This study aims to compare different surgical techniques of male circumcision in children and highlight the complications arising from procedures performed by non-qualified practitioners Quack (Hazam) in Bangladesh. Method: A comparative study was conducted at Sher-E-Bangla Medical College Hospital, Barisal, from December 2022 to February 2023. Two hundred male children were included, with 100 circumcised by pediatric surgeons using guillotine and dorsal slit techniques, and 100 presented with complications from circumcision performed by non-qualified quacks. Results: Out of 200 children, 50% underwent circumcision by quacks using the guillotine method, resulting in complications such as infection (10%), bleeding (4%), glans injury (1%), urethrocutaneous fistula (1%), and incomplete circumcision (4%). Among the 100 children circumcised by pediatric surgeons, complications were minimal, with 2% minor infections, 2% minor bleeding, 1% respiratory distress, and 1% vomiting. The guillotine and dorsal slit techniques performed in the hospital setting demonstrated significantly lower complication rates compared to procedures conducted by quacks. Conclusion: Circumcision performed by trained medical professionals under aseptic conditions is safe and associated with fewer complications. Public awareness and discouragement of procedures by quacks are essential to prevent circumcision mishaps.

Device-based circumcision: advantages, choice of device and surgical technique

Introduction. Circumcision is one of the most common surgical procedures for men. WHO programs aimed at reducing HIV transmission have led to the development of various circumcision devices designed to standardize surgical techniques, reduce operating time and the number of complications.Objective. To examine available data on the efficacy and safety of different methods of device-based circumcision.Materials & methods. The results of a search in scientific databases such as eLibrary and PubMed were analyzed using the keywords: "circumcision", "circumcision device", and "phimosis". The search was conducted without regard to date or language of publication. After reviewing the literature, 25 articles were selected that best reflect the topic of device-assisted circumcision for further analysis.Results. Device-based circumcision can significantly reduce surgical time, regardless of the type of device used. Device-based circumcision is the safe treatment method; however, it may have a higher incidence of adverse events compared to the standard circumcision technique. The use of self-suturing devices is preferred over ring devices due to fewer complications, better cosmetic results, and greater patient satisfaction. The article is supplemented with a description of the surgical technique of various options for device-based circumcision.Conclusion. Device-based circumcision is effective and safe treatment method on an outpatient basis, which successfully competes with conventional circumcision of the foreskin.

Alisklamp versus Conventional Dorsal Slit Circumcision: A Multicentric Randomized Controlled Trial.

Background: There are numerous methods of circumcision performed worldwide, typically classified into two main groups: conventional surgical techniques and various device-assisted techniques. Each method has its own advantages, limitations, and potential complications. The aim of this study was to compare outcomes of the Alisklamp technique versus the dorsal slit technique in male circumcision procedures. Method: This multicenter RCT compared the dorsal slit and Alisklamp techniques for circumcision, assessing patient demographics and intraoperative and postoperative outcomes. All patients, under local anesthesia via dorsal penile nerve block, were discharged on the same day and followed up at 24-48 h, 1 week, and 1 month. Results: A total of 180 patients enrolled, and 166 patients were included. The study compared postoperative outcomes between the Alisklamp (AK) and dorsal slit (DS) circumcision techniques in 166 patients. Key findings included significantly higher penile edema in the DS group (19%) compared to the AK group (2.4%) (p < 0.001), with severe edema occurring only in the DS group. Wound gaping was more common in the AK group (8.3%) compared to the DS group (1.2%) (p = 0.030). Skin tunnels were observed only in the DS group (9.5%) (p = 0.004). There were no significant differences in nausea, vomiting, bleeding, necrosis, infection, wound dehiscence, chordee, rotational anomalies, or secondary phimosis between the groups. Mean operation time was lower in the AK group than the DS group (7.8 min vs. 15.5 min; p < 0.001). Conclusions: The Alisklamp technique is recommended as the preferred method for circumcision because it minimizes complications, shortens the procedure time, and is easy to apply.

Preliminary study of a new magnetic compression technique for circumcision in dogs: An experimental animal model

IntroductionTraditional/ritual/medical circumcision can be associated with considerable intraoperative blood loss and a prolonged postoperative healing course. This study investigated the feasibility of the magnetic compression technique (MCT) for circumcision in beagle dogs. MethodsA set of magnetic rings including a daughter magnetic ring (DMR) and a parent magnetic ring (PMR) were designed for circumcision. In eight beagle dogs as the animal model, the DMR was placed between the penis and the foreskin through the glans, and then the PMR was placed outside the penis. The DMR and PMR automatically attracted together to compress the foreskin. The necrosis of the prepuce of the anterior penis was observed daily. The operation time and time to magnetic ring shedding were recorded. Healing of the foreskin stump was visually observed. ResultsThe magnetic rings were successfully installed in all eight dogs, and the operation process was without complication. The average operation time was 3.13 ± 0.92 min (range, 2–4.5 min). Postoperative X-rays showed good attraction of the magnetic rings. Daily post-operative observation showed progressive ischemic necrosis of the anterior foreskin and mild edema of the proximal foreskin. The dogs were generally in good condition and urinated freely. The magnetic rings fell off spontaneously 8–12 days after the operation, and the stump of the foreskin healed well. ConclusionThe MCT may be a new approach for circumcision in a canine model, which suggests its potential for use in humans.

Comparative analysis of two methods in circumcision: a new disposable device versus classic sleeve technique

PurposeCircumcision is the most common surgical procedures performed in males. Medical circumcision is recommended for diseases such as phimosis, paraphimosis, balanoposthitis and common urinary tract infections, although there is no exact indication. Conversely, Jewish and Muslim individuals commonly undergo circumcision regardless of medical necessity. Circumcision devices are designed to shorten surgery time, achieve an aesthetic appearance and ensure safe surgery. The aim of this study is to evaluate the effectiveness of the NeoAlis clamp, a disposable circumcision device, by comparing it with the sleeve technique in children.Materials and methodsBetween 2017 and 2023, retrospective evaluation of 2626 patients who underwent circumcision using either the NeoAlis clamp (group 1) or the sleeve technique (group 2) was conducted. Operation time, results, cost, complications were compared between the two groups.ResultsThe study encompassed 2626 patients who fulfilled the inclusion criteria. Group 1 comprised 2403 patients, whereas Group 2 consisted of 223 patients. The overall complication rate, as denoted by n = 47, was 1.7%. Group 1 operation time was shorter than group 2. Bleeding, the most feared complication in the early period, was higher in the second group. No statistically significant difference was observed between the two groups regarding cost comparison.ConclusionThe primary concern during circumcision is to avoid complications related to general anesthesia in newborns and infants. The use of disposable ring devices has been facilitated by the shorter operation time and the absence of the need for sutures when performing circumcision under local anesthesia. However, knowledge of advanced surgical circumcision techniques is necessary in cases of bleeding and inappropriate ring placement.

Reverse circumcision foreskin advancement flap for reconstructing penile shaft skin defects in adults with burn injuries in the perineal region

AimGenital burns are rare injuries. Reconstruction of penile skin defects should consider cosmetic and functional outcomes. Skin grafts can develop scar contractures and carry hair follicles, causing unwanted results. These downsides remain unsolved issues. This work aimed to describe a new foreskin advancement flap method for completely reconstructing penile shaft skin defects in severely burned patients. Materials and methodsFrom 2021 to 2023, four patients with third-degree burns in the genital area were enrolled in this investigation. We describe a series of cases with deep burns to the penile shaft and surrounding area that needed debridement and reconstruction using a novel technique called “reverse circumcision,” which consists of tangential excision of the penis and a foreskin advancement flap without longitudinal cuts with less morbidity, preservation of function, and a better aesthetic appearance. The patients had an average follow-up of nine months. ResultsThe reverse circumcision technique was established for patients with severe burns in the genital area. The four patients were satisfied with the postoperative results and the aesthetic results of the procedure without reporting any complications. No scarring or contractures were observed on the glans or penile shaft after surgery. ConclusionsCompared with other flap methods, the use of a reverse circumcision foreskin advancement flap was more straightforward, feasible, and effective. In adults, the foreskin tissue completely covers the penile shaft skin defect. It is a viable reconstructive surgical technique that is easily reproducible and has excellent aesthetic and functional results. For this surgical technique, tissue transfers, bulky regional flaps, or skin grafts were not needed.

THREAD OR STAPLE: A COMPARATIVE ANALYSIS OF SURGICAL TECHNIQUES IN CIRCUMCISION SURGERY

Introduction: Male circumcision was one of the earliest operations performed by humans.The circular stapler, is a new disposal circumcision device discovered in China. It is a novel technique showing quicker procedure time, lesser complication, and sutureless. Methods: A study was conducted on 50 Adult males undergoing circumcision surgery under local anesthesia in a tertiary hospital in Navi Mumbai. They were randomized into 2 groups. In Group A conventional suturing was done and in Group B with staplers. Time efficacy calculated by stopwatch(s). Post-operative complications along with cost-effectiveness between the two techniques. Cost-effectiveness between two techniques. Results: The operative time is quicker in group B compared to conventional suturing. The intraoperative and postoperative pain scores were significantly lower in the stapler group compared to conventional suturing. It is observed that in Stapler group had higher treatment costs than conventional suturing. In group B receiving stapler had fewer post-operative complications than the conventional group. Conclusion: The present study has demonstrated that the stapler circumcision technique is superior to the conventional suturing technique. The stapler technique is quicker and less complicated with good patient compliance. A drawback is a costly approach and training in manual skills that require a precise application. The study needs to be on a larger scale with a larger population for further improvement.

Wound Healing and Cosmetic Outcomes in Neonatal Circumcision Using Three Different Techniques.

Circumcision of a male child is an integral part of some African cultures. An ideal technique of neonatal circumcision should be simple, safe and heal satisfactorily with good cosmetic appeal. The aim was to compare conventional dissection (CD), Plastibell (PB) and Gomco (GM) techniques of circumcision in neonates in terms of wound healing, wound healing complications, cosmetic outcome and parental satisfaction. A total of 144 male neonates were randomised into three study groups: CD, GM and PB groups. All procedures were performed under local anaesthesia as day case. Superficial wound healing was assessed on the 7 th post-operative day. The cosmetic outcome of the three techniques was assessed by a plastic surgeon and the parents using a 4-point Likert scale on the 4 th post-operative week. The three groups were comparable in terms of age ( P = 0.207) and weight ( P = 0.098) at circumcision. There was satisfactory wound healing in 48 (100%) patients in the GM group, compared to 47 (97.8%) in the CD group and 45 (93.8%) in the PB group ( P = 0.324). Wound healing complications were recorded in seven patients, 1 (2.1%) in the CD group with wound infection, 5 (10.4%) in the PB group with moderate pain despite the use of analgesia and 1 (2.1%) patient with skin bridge in the CD group. The plastic surgeon and the parents rated the cosmetic outcome of CD higher than the other two techniques. There is no significant difference in superficial wound healing amongst the three circumcision techniques. The cosmetic outcome of CD was significantly better than that of GM and PB circumcisions.

Surgical Management of Prepucial Prolapse in 6 – Male Breeding Bulls

6 - Male breeding bulls were presented to VCC of CVAS Bikaner with the history of preputial prolapse and its hardening and paraphemosis. All the six breeding bulls under study had similar anatomical injury and had IV degree prolapse. Initially medicinal treatment was carried out in all bulls to reduce the swelling and infection. In all the animals antibiotic injection Streptopenicillin 5.0 g IM was given for 5 days and; injection Meloxicam @ 0.2 mg/kg IM for 3 days and antiseptic dressing of the prepuce was done with Povidone iodine solution for 5 days to reduce the infection and thereafter surgery was performed. Preputial prolapse was repaired successfully via circumcision technique. After the surgery all bulls were given 60 days of sexual rest. No post-operative complications and recurrence were recorded.

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

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.

Effect of Modifecations of Plastibell Circumcision Technique on Bleeding and Extraskin Complications in Infants

Effect of Modifecations of Plastibell Circumcision Technique on Bleeding and Extraskin Complications in Infants

Newborn Male Circumcision.

This symposium includes twelve personal narratives from parents about making the decision whether to circumcise their infant male children. The authors of the narratives include five fathers and seven mothers. Nine of the 12 parent authors opted to circumcise their infant sons, though the reasons they stated for doing so varied. Most of the parent authors relied on cultural or social beliefs, religious guidance, or a desire for sameness with the infant's father. Parents who didn't circumcise their male infants discuss their convictions about autonomy, bodily rights, and the medical benefits of circumcision versus the harm or pain caused by the procedure. The symposium includes four expert commentaries on the narratives that are informed and enriched by the commentators' expertise in pediatric bioethics, healthcare ethics, gender studies, Jewish law and tradition, and the medical and surgical techniques of circumcision.

Questionnaire regarding community awareness of circumcision-related aspects in Saudi Arabia

Objective: The aim was to evaluate different aspects related to early male circumcision, community awareness, and family satisfaction. Methods: A questionnaire-based survey was conducted with the following items on circumcision; time, technique, the performing medical practitioner, and where the circumcision was conducted. Alongside, other questions regarding family satisfaction and cases needing redo circumcision were also included in the questionnaire. Results: The number of participants was 1,118. Timing of circumcision most commonly was neonatal period, first year circumcision, then later throughout their life. Circumcisions were mostly performed in hospitals and carried out by pediatric surgeons. Complications of circumcisions were encountered in 6.9% of cases and circumcision was not affected by the physician&amp;apos;s specialty, timing, place, or technique of circumcision. Conclusion: Ritual circumcision (circumcision in community) is the most common practice. Family counselling regarding postoperative care and sequelae is of utmost importance. Revising practice and audits on circumcision are to be encouraged.

A comparative study of distal hypospadias repair combined with preputioplasty vs repair using conventional circumcision technique

Background: Hypospadias is one of the most common congenital anomalies characterised by underdevelopment of the ventral anatomical structures of the penis including skin, urethra, corpora spongiosum and prepuce and urethral opening can occur anywhere from the perineum to the ventral aspect of penis. This study evaluated and compared short-term cosmetic and functional outcomes and complications of distal hypospadias repair combined with preputioplasty with the repair using circumcision. Materials &amp; Methods: Patients were divided in two groups with 25 patients in either group. Group A patients underwent urethroplasty with circumcision whereas Group B patients were offered preputioplasty as an additional procedure. Clinical examination included location of the urethral meatus on the ventral aspect of the penis, presence or absence of associated chordee, stretched penile length, penile circumference, glans girth, depth of the navicular fossa or glans groove, urethral plate width, status of the preputial hood and testicular examination. Post-operatively, penis was examined for the location and shape of the neo-meatus, any complications in the form of meatal stenosis, urethrocutaneous fistula, preputial dehiscence and phimosis. Results: Both the groups were comparable with respect to the age at presentation and status of the urinary stream. Distal penile hypospadias predominated in both the groups and it was present in 21 patients in group A and 24 patients in group B. Rest of the babies had sub-coronal hypospadias. Preputial hood and navicular fossa/glans groove were good in either group. Mean stretched penile length in group A was 5.14 cm and it was 4.78 cm in group B children (p value- 0.141). Mean penile circumference of group A and group B patients ware 3.88 cm and 3.68 cm respectively (p value- 0.139). Girth of the glans and mean urethral plate width were also comparable (p values- 0.258 and 0.621 respectively). Final meatal appearance was slit shaped and wide in 22 patients in group A and 21 patients in group B. Urethro-cutaneous fistula was observed in two babies in group A and a single child in group B. One of the children was noted to have preputial dehiscence after two weeks. Prepuce was retracting well in 24 children during the 3rd follow up whereas one patient developed phimosis and thus results of the preputioplasty as an adjunct procedure were found to be satisfactory. Conclusion: Preputioplasty is a safe procedure and should be offered to all children undergoing single-stage distal penile hypospadias repair as it provides a near normal penile appearance at the cost of additional approximately 8% foreskin related complication rate.

Does using a laser improve outcomes of conventional circumcision in adult and children populations? Results from a systematic review and meta-analysis.

Male circumcision is a well-known old surgery, and several recently developed techniques have been scaled up, including the introduction of laser technology, as alternative approaches to overcome morbidity of conventional surgery scalpel/suture method OBJECTIVES: We aimed to perform a systematic review and meta-analysis of studies comparing laser circumcision versus conventional circumcision technique in terms of perioperative outcomes and efficacy (complications, unacceptable appearance, reoperation rate) both in children and adults. This review was performed following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Continuous variables were analyzed using the inverse variance of the mean difference with a random effect, 95% confidence interval (CI), and p-value. The incidence of complications, unacceptable appearance, and reoperation rate were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as odds ratio (OR), 95% CI, and p-value. Significance was set at p-value ≤0.05 and 95%CI. Seven studies were included. In comparison to the conventional circumcision, laser circumcision shoved lower visual analogue score at 24-h, and 7 days after surgery, a lower rate of overall complication rate (OR 0.33, 95% CI 0.24-0.47, p<0.001), scarring (OR 0.09, 95% CI 0.02, 0.41, p=0.002), and unacceptable appearance (OR 0.09, 95% CI 0.05, 0.15, p<0.001). We found no statistically significant difference in surgical time, and incidence of bleeding, infection, wound dehiscence, and reoperation rate. Our review infers that laser-assisted circumcision is certainly a safe and strong contender as the procedure of choice in both children and adult populations.

Thoracic Spine Deformity Post Tetanus: A Case Report of Tetanus Post Circumcision

Tetanus is caused by clostridium tetani bacteria through skin breach. The tetanus is characterized by tonic contraction and muscle spasm which can cause vertebral fracture in some patients. we are reporting a young male patient who after ring circumcision technique had tetanus complicated into thoracic vertebral fracture with severe kyphotic deformity and lower limb functional impairment. The surgical management was performed in two stages: First stage consisted of Shwab 2 osteotomy, pedicle screws and rod fixation with good result for deformity correction. The second stage of surgery involved left transpedicular T6 and T5 corpectomies (Shwab 3 osteotomy) plus interbody titanium cage fixation which provided good spinal cord decompression. Tetanus is still a major complication of circumcision, tetanus complication may be devastating Early surgical deformity correction and spinal cord decompression provide favorable neurological and functional outcome for patients with spine deformity post tetanus. The Patient was able to walk with crutches 3 months post-surgery.

The “ARM” principle and practice: Preventing postoperative complications of circumcision

BackgroundAs one of the most commonly performed surgical procedures, circumcision may lead to complications. However, studies on preventing postoperative complications are scarce and still insufficient to draw any conclusions. This retrospective study aimed to summarize the surgical principles and consideration for preventing complications after circumcision. MethodsWe reviewed 28 patients (aged 3–45 years; median age, 24 years) with prepuce hyperplasia or phimosis treated with our modified circumcision technique. In our modified technique, an accurate incision design is made through the stretch test, the stenosis is released, and veins and lymphatic tissues in the fascia are maintained. These surgical details for preventing complications were abbreviated to “ARM.” ResultsNone of the patients had complications at the 6-month follow-up postoperatively. Only mild prepuce edema was observed, which returned to the normal condition spontaneously within 2–3 weeks. The diameter of the distal penis increased by 0.4 ​± ​0.1 ​cm 6 months after the procedure. ConclusionThe “ARM” principle may help surgeons to prevent postoperative complications of circumcision. Maintaining the fascia during the procedure can increase the diameter of the surgical region.

Dual laser circumcision: a novel technique to improve traditional surgery

Circumcision represents one of the oldest and routinely performed urological surgery. It implies the exeresis of the prepuce due to ethnic, religious and medical reasons. Different authors reported straightforward advantages of this procedure including increased penile hygiene, reduction of penile cancer risks and lower rates of urinary tract infections. Circumcision can be easily performed and reproduced according to different techniques. Nowadays, different types of lasers have been developed and this technology is gaining consensus in the urological community. Aim of this article is to describe our surgical technique for laser circumcision with the Lasemar Eufuton 1500, clarifying the surgical steps and the benefits of this technology.

Super ring modern circumcision training with free needle injection anesthesia in improving the skills of health workers

The development of circumcision techniques in the world, including Indonesia, is very rapid. One of them is super ring modern circumcision with free needle injection anesthesia. Efforts to improve the skills of health workers such as doctors and nurses through training are carried out in collaboration with LKP Sunat Modern Indonesia. The methods used are question and answer lectures, demonstrations, FGDs, and the practice of performing circumcision on patients directly with the assistance and supervision of the instructor. The result of this activity is an increase in understanding and skills in performing super ring modern circumcision with free needle injection anesthesia, and producing entrepreneurs in this field.

Meatal stenosis following three types of circumcision with frenular artery preservation (FAP), the Plastibell device (PD), and frenular artery ligation (FAL): a long-term follow-up.

Despite the simplicity of male circumcision, complications occur frequently. Post-circumcision meatal stenosis is a concerning complication that might require several interventions. This study aims to evaluate the incidence of meatal stenosis in long-term follow-up, following three common circumcision methods: frenular artery preservation, frenular ligation, and the Plastibell device. This study is the continuation of the previous randomized clinical trial, the preliminary abstract of which has been accepted in the annual meeting of the American Urological Association in 2011. However, in this paper, we only included the patients with results of long-term follow-up. Patients were followed for a median of 11years (range, 7-17). Follow-ups were recorded by evaluation of meatus and signs and symptoms of meatal stenosis. Two hundred six boys (80 neonates and 126 non-neonates) at the time of procedure were included in this study. The circumcision was conducted on 23.3% (48/206) of boys with the Plastibell device (PD) and 39.3% (81/206) of cases with frenular artery preservation (FAP) and 37.4% (77/206) of cases with frenular artery ligation (FAL). Meatal stenosis presented in 13 children during follow-up. Considering the three methods of circumcision, a significant difference in the incidence of meatal stenosis among the types of circumcisions was observed (6.3% in PD and 1.2% in FAP, 11.7% in FAL, P = 0.026). The present study revealed that the technique preserving the frenular artery is associated with a significantly lower incidence of meatal stenosis. Hence, the FAP is the recommended technique for circumcision as compared to two other methods.