Plastibell Device Research Articles

Surgical approach to penile reconstruction for shaft skin excision from circumcision

Circumcision is one of the most frequently performed surgical procedures. Complications are infrequent, including bleeding, though can be significant such as shaft skin excision. The aim of this study was to identify mechanism of injury and reconstructive techniques for skin excision using a full thickness skin graft (FTSG) or with the novel application of tissue expanders (TE). Patients who underwent penile reconstruction following shaft skin excision from an overzealous circumcision were retrospectively reviewed. The penis was covered using a FTSG, harvested from the groin/hip, or using TE, with expanders placed in residual shaft skin. Twelve patients experienced significant skin loss (range 65-95%) including 2 with partial glans loss. Ten were reconstructed using a FTSG and 2 with TE. Injury was most frequently from a Mogen clamp (n = 9), or from a Gomco clamp, Plastibell device, and electrocautery burns. Six FTSG patients experienced complications with lymphedema (n = 3) most common. Shaft skin excision is a devastating complication with risk greatest from Mogen clamp use. TE is preferred as this avoids donor site morbidity which reassures parents but requires sufficient residual skin that can be expanded. Both techniques effectively provide soft tissue coverage with acceptable appearance and long-term function.

Can the ShangRing bring us closer to endorsing early infant male circumcision in sub-Saharan Africa?

Can the ShangRing bring us closer to endorsing early infant male circumcision in sub-Saharan Africa?

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.

Broadening candidate office circumcision patients: A comparison of outcome in children based on age and weight

Office circumcision with a clamp or Plastibell device is often restricted in practice by patient age and size. This is thought to ensure the patient fits appropriately on the restraining device and limit complications. To compare the outcomes of office circumcision in children ≤3 months of age and ≤5.1kg in weight to those who do not fit this criterion. A retrospective chart review was performed of all office circumcisions in children ≤6 months of age performed in our urology clinic between January 2015-August 2018. Patients were divided into two groups: Group 1 (≤3 months old and ≤5.1kg) and Group 2 (all others). Patient demographics and circumcision technique were recorded. The number of patients with complications and requiring an intervention related to circumcision were compared between groups, as well as the number of patients requiring unplanned hospital visits. Differences in outcomes were evaluated using Pearson's chi-square test. A total of 205 circumcisions were performed in Group 1 and 498 circumcisions were performed in Group 2. All circumcisions were performed by either Gomco clamp or Plastibell device with no significant difference in method between groups (p=0.5). There was no difference in median follow-up between groups (Group 1: 19 days [IQR 14; 34]; Group 2: 19 days [IQR 14; 36]; p=0.6). There were no significant differences between groups in the number patients with complications or requiring an intervention (p=0.08 and p=0.12, respectively). Significantly more patients in Group 2 required an unplanned hospital visit (p=0.02) (Table). After categorizing those composing Group 2 into three disjoint sets (children >3 months and ≤5.1kg, or ≤3 months and >5.1kg, or >3 months and >5.1kg), no significant difference across all four groups in regards to complications (p=0.12) or intervention (p=0.2) was found. There was a significant difference in unplanned hospital visits (p<0.001). Performing office circumcisions in children outside of age and weight restrictions of ≤3 months and ≤5.1kg did not significantly increase the risk of complications or need for interventions. Those outside of age and weight restrictions, however, had more unplanned hospital visits. Tailoring parent expectations in this patient group may be needed. While we found older and heavier children had more unplanned post-procedural related hospital visits, their rates of overall complications and need for subsequent interventions were not significantly higher than younger and lighter children.

Plastibell Circumcision of Babies with Hooded Prepuce: New Technique (Traction and Closure) and Case Series

Background: Circumcision is the most common procedure in the neonatal period. PD was adopted for circumcision for a long time, and it underwent many modifications during the last decades. In this paper, we review retrospectively our practice in babies with isolated hooded prepuce that been circumcised with PD by using a new technique called (Traction and closure). Materials and methods: Between April 2019 and April 2021, 676 cases of circumcision were performed in the pediatric surgery clinic, 398 cases by Winkelmann clamp, and 289 done with Plastibell device. Five cases of hooded prepuce were detected on routine physical examination without hypospadias or meatal anomaly. These cases are characterized by deficient ventral preputial skin comparing to the dorsal preputial skin. All babies were in the neonatal period (less than one month of age) except for one who was 32 days old. The mean age of babies was 15.4 days. Circumcision was accomplished with PD by a new technique (Traction and closure). Results: Postoperatively no bleeding or urinary retention was noticed in all babies. Upon follow-up, all patients did not have slippage or retention of the ring where the ring fell smoothly over an expected time duration (7-11 days, mean: 9.25 days). Also, good favorable outcomes and parental satisfaction were both obtained in all cases. Conclusion: PD with technique (traction and closure) is a safe and suitable method for circumcision in babies diagnosed with an isolated hooded prepuce

Plastibell Circumcision of Babies with Hooded Prepuce: New Technique (Traction and Closure) and Case Series

Background: Circumcision is the most common procedure in the neonatal period. PD was adopted for circumcision for a long time, and it underwent many modifications during the last decades. In this paper, we review retrospectively our practice in babies with isolated hooded prepuce that been circumcised with PD by using a new technique called (Traction and closure). Materials and methods: Between April 2019 and April 2021, 676 cases of circumcision were performed in the pediatric surgery clinic, 398 cases by Winkelmann clamp, and 289 done with Plastibell device. Five cases of hooded prepuce were detected on routine physical examination without hypospadias or meatal anomaly. These cases are characterized by deficient ventral preputial skin comparing to the dorsal preputial skin. All babies were in the neonatal period (less than one month of age) except for one who was 32 days old. The mean age of babies was 15.4 days. Circumcision was accomplished with PD by a new technique (Traction and closure). Results: Postoperatively no bleeding or urinary retention was noticed in all babies. Upon follow-up, all patients did not have slippage or retention of the ring where the ring fell smoothly over an expected time duration (7-11 days, mean: 9.25 days). Also, good favorable outcomes and parental satisfaction were both obtained in all cases. Conclusion: PD with technique (traction and closure) is a safe and suitable method for circumcision in babies diagnosed with an isolated hooded prepuce

Implementation of an infant male circumcision programme, Pakistan.

ObjectiveTo retrospectively review outcomes of a health provider-led infant circumcision programme in Pakistan.MethodsBased on World Health Organization guidelines, we trained surgical technicians and midwives to perform circumcisions using the Plastibell device at two Indus Health Network facilities. Programme tools include a training manual for health providers, information brochures for families, an enrolment form and standardized forms for documenting details of the procedure and outcomes. Infants aged 1–92 days were eligible for the study. Health workers contacted families on days 1 and 7 after the procedure to record any adverse events. We compared the characteristics of infants experiencing adverse events with infants facing no complications using multivariate logistic regression.FindingsBetween August 2016 and August 2018, 2822 circumcised male infants with mean age 22.8 days were eligible for the study. Of these, 2617 infants (92.7%) were followed up by telephone interviews of caretakers. Older infants were more likely to experience adverse events than infants circumcised between 1–30 days of age: 31–60 days: adjusted odds ratio, aOR: 2.03; 95% confidence interval, CI: 1.31–3.15; 61–92 days: aOR: 2.14; 95% CI: 1.13–4.05. Minor adverse events (100 infants; 3.8%) included failure of the bell to shed (90 infants) and minimal bleeding (10 infants). Major adverse events (eight infants; 0.3%) included bleeding that required intervention (four infants), infection (three infants) and skin tear (one infant).ConclusionStandardized training protocols and close monitoring enabled nonphysician health providers to perform safe circumcisions on infants aged three months or younger.

English

BACKGROUND Conventional Dissection Surgery (CDS) and Plastibell Device (PD) are the commonly used techniques for male circumcision. We wanted to evaluate and compare the postoperative problems and aesthetic results, and the patient’s / parent’s acceptance, of the two techniques of circumcision in boys. METHODS This was a prospective study in which children in the age group 0 - 12 years attending the surgery outpatient department for various indications of circumcision were enrolled on the basis of a predefined inclusion and exclusion criteria. The subjects were randomized and allocated into two groups, group PD and group CDS. Group PD was subjected to circumcision by Plastibell device technique. Group CDS was subjected to circumcision by conventional dissection technique. Duration of the circumcision and intra-operative complications if any were recorded, from starting the retraction of prepuce to completion of the procedure. Early and late complications were also compared during follow-up visits. Statistical analysis was performed using the Strata Software Version 10.0. P value less than 0.05 was taken as statistically significant. RESULTS The mean age of children in PD and CDS group was found to be 5.30 ± 3.29 years and 5.58 ± 3.66 years respectively. The mean age of patients in both the groups was found to be comparable with no statistically significant difference. According to Kayaba’s classification type 1 and type 2 (41.4 %) prepuce were most common in both the groups. Phimosis, ballooning of prepuce and recurrent urinary tract infection were common indications for circumcision in our study. Mean surgical time was 5.91 ± 1.74 in the P D group and 23.52 ± 5.94 in the CDS group which was statistically highly significant (P = 0.0000). Bleeding, cicatricial scar and adhesions were more common in CDS group, whereas dysuria and swelling were more common PD group and the difference was statistically significant. Children required less analgesia in CDS group. The average rate of late complications was significantly less in PD group as compared to CDS group (P = 0.006). CONCLUSIONS Circumcision by Plastibell device was comparable with conventional dissection technique in paediatrics age group. However, from aesthetic perspective, parents of Plastibell group appeared to be more satisfied than conventional dissection group. KEYWORDS Circumcision, Plastibell Device, Conventional Dissection Surgery, Complications

Bone cutter versus plastibell device in neonatal circumcision: A randomized trial

Background: Several techniques and devices have been described for circumcision each with its own pros and cons. The objective of this study was to compare the outcome of neonatal circumcision between bone-cutter and plastibell devices at our institution. Methods: This is a randomized trial (unregistered) conducted at the Pediatric Surgical Unit of a tertiary teaching hospital situated in a semi-urban setting, between January 2019 and December 2019. The uncircumcised neonates underwent circumcision by either bone-cutter or plastibell device. Demographic characteristics, operative time, estimated blood loss, and postoperative complications were compared. A p-value of &lt;0.05 was considered significant. Results: The age ranged between 7 days and 30 days with a mean of 15.9±5.5 days. The mean age and weight of both groups were well matched (p &gt;0.05). The operative time in the bone cutter technique was 4.2±0.9 minutes compared to 5.8±1.2 minutes in the plastibell device method (p &lt;0.001). Blood loss was lesser with bone cutter (0.27 ±0.32mls versus 0.51 ±0.44mls in the plastibell device, p &lt;0.001). The complication rates were comparable in both study groups (p =1.000). The overall complication rate was 5.8%. The penile perception score and the Hollander wound evaluation score for bone-cutter were 15.7±0.8 and 5.7±0.84 while in the plastibell device were 15.4±1.1 and 5.4±1.1, respectively (p &gt;0.05). Conclusion: Operative time and blood loss were less with bone cutter compared to plastibell device. However, the complication rate, penile perception score, and Hollander wound evaluation scores were similar.

Plastibell circumcision in neonates: A review of procedure and analysis of complications

Introduction: Male circumcision involves surgical removal of prepuce that covers the glans penis. Plastibell, Gomco clamp, Mogens clamp are most commonly used devices in neonatal circumcision. Aims: The aim of this restrospective study was to evaluate circumcision done by Plastibell device in neonates. We reviewed the outcomes including the appearance, ease and safety of use and the complications of this procedure. The nuances of this simple procedure are described and the need for skilled surgeons to perform it to make it free of the serious complications has been emphasized. Methodology: This retrospective study included 108 physiologically stable neonates with low to normal birth weight who underwent Plastibell circumcision by a single surgeon at hospitals across National Capital Region, India. Neonates with congenital abnormalities like hypospadias, sick, very low birth weight were not taken for operation. Results: Complications occurred in above mentioned cases were- redundant skin [02/108], ring slippage with bleeding [01/108], early ring fell off [02/108], infection [0/108], fringe of skin left [01/108]. All [06/108] complications could be managed satisfactorily. Discussion: Plastibell circumcision is a safe procedure and can be done under local anaesthesia. It has got superior cosmetic results and parental acceptance is very high. It requires an experienced surgeon to do the procedure with best results. To avoid rare life threatening or serious complications this is not the preferred method in older children as there is limitation of available sizes, higher chances of slippage and requirement of sedation even if the size is suitable.

A controlled trial of Gomco versus Plastibell for neonatal circumcisions in Saudi Arabia.

BackgroundGomco or Plastibell devices are the most widely used method for circumcision. The present work was aimed to assess the incidence of complications in infants of ages up to six months in two used methods.MethodsIt was a prospective randomized study conducted at a pediatric surgery clinic in 3 hospitals in Jeddah, Saudi Arabia. Eight hundred and five children, their ages were less than 6 months were enrolled for the present work. Children were randomized into two groups: Groups P and G using Plastibell and Gomco Circumcision methods, respectively. Statistical analysis of data was performed by using SPSS Version 17. Chi-square test and independent sample t-test was applied to compare both qualitative and quantitative variables, respectively. P-value was considered as significant difference at <0.05.ResultsSeven hundred eighty three children were were enrolled in this investigation. Plastibell method was concomitant with low volume of bleeding in comparison with Gomco method (P < 0.001). Incidence of complications including infection, penile edema, proximal migration and redundant skin was higher in Plastibell device method (P<0.05).ConclusionGomco circumcision is the safer method and is accompanied with lowest rate of complication.

Assessment of meatal stenosis in neonates undergoing circumcision using Plastibell Device with two different techniques

PurposeIt was intended to compare meatal stenosis (MS) as a late complication of neonatal circumcision by using two different methods of Plastibell Device circumcision.Materials and methodsA total of 2,307 healthy term newborns (6–36 hours) who were born between 2007 and 2009 in Niknafs Medical Center of Rafsanjan, Iran, were simply randomized into two groups in a controlled, nonblinded clinical trial. In group A (1,102 neonates), the frenulum was maintained intact without any manipulation, and in group B (1,205 neonates) frenular hemostasis was performed in all cases by thermal cautery. MS was assessed by follow-up visits that were made for all cases at the 24–72 hours, 60th day, 12th month, and 16th month after circumcision.ResultsAt 2 months follow-up visit, the rate of MS in group A was 4.9% (54) and in group B was 5.9% (71), which was not statistically significant. After 12 months, MS in group A was 8.5% (94) and in group B was 13.7% (165), which was statistically significant (P<0.001). At 16 months after circumcision, in the frenulum intact group, MS was 13.8% (152) and in the cautery group, it was 18.9% (228), which was compatible with significant difference (P=0.001).ConclusionOur experience with large group of cases revealed that neonatal circumcision by using Plastibell Device with intact frenulum technique decreases the rate of delayed MS.

Circumcision: postoperative complications that required reoperation.

ABSTRACTObjective To evaluate post-operative complications of circumcision requiring surgical reintervention.Methods Retrospective analysis of medical records of patients submitted to circumcision from May 1st, 2015 to May 31st, 2016.Results A total of 2,441 circumcisions were performed; in that, 1,940 using Plastibell and 501 by the classic technique. Complications requiring surgical reintervention were found in 3.27% of patients. When separated by surgical technique, 3.4% of circumcisions using Plastibell device required reoperation, as compared to 3% of conventional technique (p=0.79). Preputial stenosis was most frequently found in classic circumcision, with statistical significance (p<0.001). Bleeding was more frequent when using Plastibell device, but the difference was not statistically different (p=0.37). Patients’ age was also evaluated to investigate if this variable influenced on the postoperative outcome, but no significant difference was found.Conclusion There was no statistically significant difference when comparing complications between the different techniques performed at this hospital. Preputial stenosis was most frequently found in the classic circumcision, while bleeding was more prevalent when using Plastibell device. Patients’ age did not influence in complications.

Meatal stenosis following circumcision with Plastibell device and conventional dissection Surgery; a prospective investigation

Introduction: Meatal stenosis is a late complication of circumcision. Objectives: This study was designed to determine its prevalence, its relationship with age of circumcision and its applied method. Material and Methods: This prospective study was conducted between December 2006 and January 2012. A total of 2389 boys, equal to or less than 6 years were circumcised using the Plastibell device (PD) or conventional dissection surgery (CDS). They followed up 12 months after surgery. Signs and symptoms of meatal stenosis recorded and the meatus evaluated for stenosis. Results: Meatal stenosis was diagnosed in 41 boys (1.7%). Twenty-five of patients were asymptomatic (61%). The difference between the mean age of circumcision in patients with meatal stenosis and the others were statistically significant. In newborns the prevalence of meatal stenosis was more than the other ages (15% versus 1.4%, P < 0.01). Concerning the method of circumcision, a significant difference on the prevalence of meatal stenosis was detected too (0.8% in PD versus 3.6% in CDS; P < 0.001). The mean interval between circumcision and diagnosis of meatal stenosis was 9.59 months. Conclusion: Symptomatic presentation of meatal stenosis may be late and it needs long-term follow-up. Its prevalence is higher in younger boys. Thus, circumcision in younger boys, especially in neonates is not recommended. Using PD has lower rate of meatal stenosis in comparison to CDS. Hence, the result of this study showed, the PD is preferable in younger boys.

Comparison between the bone cutter with thermal cautery, Gomco, and Plastibell for circumcision in neonates and infants: a prospective randomized trial

Background Circumcision is the most common surgical procedure performed for a male newborn. This trial aimed to compare between three commonly used techniques for male circumcision in our institute. Patients and methods From January 2014 to January 2015, 150 babies were randomized into three groups according to the circumcision technique: babies circumcised using the bone-cutter forceps with thermal cautery (group I), Gomco clamp (group II), and the Plastibell device (group III). Intraoperative details, postoperative pain and complications, cosmetic outcome, and parent satisfaction were recorded. Results Operative time was significantly shorter for group I (P Conclusion The thermal cautery with bone-cutter technique proved superiority in hemostasis, operative time, and parent satisfaction, with less pain in the postoperative period. All three techniques had comparable final cosmetic outcome.

Is the plastibell of any haemostatic value after 24 h?

Background:The Plastibell is the most popular circumcision method among mothers in our city. Haemorrhage is its major problem. At our centre, we have recorded many circumcision problems resulting from prolonged retention of the Plastibell ring and this study, therefore, sought to explore the ways of reducing complications resulting from prolonged retention of the ring.Patients and Methods:This was a prospective study, in which a total of sixty consecutive male neonates were recruited with all undergoing circumcision using the Plastibell device. Thirty patients were assigned to the subject group, in whom the Plastibell ring was removed by the investigator at 24 h while the other thirty constituted the control group whose Plastibell rings were allowed to fall off on their own. The patients selected were aged between 7 and 28 days.Results:Overall, 4 (6.6%) of the sixty neonatal circumcisions in this study were complicated by haemorrhage. There was minor bleeding in 3 (10%) of the thirty subjects and 1 (3.3%) of the thirty controls. There was no statistically significant difference between the groups (P = 0.3006). One patient each from the subject and control groups bled following slipped ligature a few hours after Plastibell circumcision. The other two patients in the subject group bled following the removal of the Plastibell ring at 24 h. All the bleeding episodes were effectively controlled within 5 min by firm digital pressure only administered through a piece of dry, sterile gauze.Conclusion:Post-circumcision haemorrhage was not significantly different between circumcised babies whose Plastibell rings were removed at 24 h and those in whom it was left to fall off on its own.

Intraperitoneal Bladder Perforation and Life-threatening Renal Failure in a Neonate Following Circumcision With the Plastibell Device

We present the case of an infant who suffered intraperitoneal bladder perforation secondary to routine neonatal circumcision with the Plastibell device. On day-of-life 5, the patient presented with abdominal distention, vomiting, diarrhea, and severe acute renal failure. After removal of a distal meatal obstruction caused by the Plastibell device and open repair of the bladder defect, the patient had an uneventful recovery with rapid return of renal function. Despite the relative safety of the Plastibell, this case underscores the importance of careful device placement, parental education, keen clinical judgment, and prompt intervention when indicated.

PLASTIBELL CIRCUMCISION

Design: Prospective Study. Setting: Different hospitals as a day care surgery.Period: March 2005 up to March 2012. Patients and Methods: Plastibell circumcision in infantsand children’s up to the age of 7 years was conducted using Plastibell device in different hospitalsas a day care surgery. Results: In Plastibell method, local edema was minor complication thendelayed separation of the ring, infection, mild bleeding after plastibell separation, respectivelyand no major complication was noted. Conclusion: Plastibell device circumcision preventsthe most serious complications like bleeding, infection etc. It is fast and ensures excellentcosmoses and it takes short operating time.

English

Design: Prospective Study. Setting: Different hospitals as a day care surgery.Period: March 2005 up to March 2012. Patients and Methods: Plastibell circumcision in infantsand children’s up to the age of 7 years was conducted using Plastibell device in different hospitalsas a day care surgery. Results: In Plastibell method, local edema was minor complication thendelayed separation of the ring, infection, mild bleeding after plastibell separation, respectivelyand no major complication was noted. Conclusion: Plastibell device circumcision preventsthe most serious complications like bleeding, infection etc. It is fast and ensures excellentcosmoses and it takes short operating time.

Circumcision with plastibell device

Background: In Muslims and Jews circumcision is common. Most of the time it is on religious ground. Circumcision involving plastibell device is less frequently employed. The aim of this study was to know the effectiveness of plastibell circumcision in children of younger than 2 years. Methods: It was a prospective study conducted from January 2014 to march 2015 at KBN Teaching Hospital and in private hospital. All the babies with age ranging from few days to two years who underwent circumcision using plastibell device, as a day case procedure were included in the study. Patients were followed up for one month in order to note the complications and final outcome of circumcision. Results: Circumcision using plastibell device was performed in 170 babies. 80 were neonates and 90 babies were above one month and below two year. Significantly fewer complications were noted in neonate compare to older babies. Conclusions: Circumcision using plastibell device is safe and easy method especially in younger age group with lesser complication rate.