Redundant Prepuce Research Articles

Clinical curative effect analysis of disposable circumcision suture device Versus Shang Ring circumcision and Traditional circumcision

Objective To compare the efficacy and safety of disposable circumcision suture device (DCSD), ShangRing circumcision and traditional circumcision in the treatment of patients with redundant prepuce or phimosis. Methods All the 620 patients with redundant prepuce or phimosis were randomly divided into three groups: the DCSD group(n=280) and the ShangRing group(n=210) and the traditional circumcision group(n=130). Factors concerning efficacy and safety were compared. Results DCSD showed obvious advantages of the ShangRing and the traditional circumcision in operating time(6.1±0.8), (8.5±1.7), (30.1±0.5)min, intraoperatve blood soss (1.0±0.0), (1.0±0.0), (5.0±1.0)mL, wound healing time (14.5±1.5), (18.5±2.0), (13.5±1.5)d, postoperative pain score (1.94±1.08), (3.89±0.98), (4.20±0.58). The incidence of postoperative hematoma was 2.29%, 2.25%, 1.52%, and post operation edema rate was 8.04%, 25.89%, 30.89%.There was significant difference in above results (P<0.05). Conclusions DCSD has advantages of shorter operation and incision healing time, reduced postoperative pain score, and high appearance satisfaction.It should be widely used in clinical practice. Key words: Foreskin; Phimosis; Circumcision, Male

Application of disposable oval circumcision anastomat in pediatric urology

Objective: To summarize the application experience of Ai Tong (Chinese Shang Ring) disposable oval circumcision anastomat in pediatric urology. Methods: A retrospective study of 1 481 cases of pediatric urology using a disposable oval circumcision anastomat at Xuzhou Children's Hospital from October 2014 to December 2017 was performed. The average age at the time of surgery was 5.2 (2-14 years) years. Among them, there were 1 226 cases of phimosis, 32 cases of scar phimosis in chronic infection, 23 cases of phimosis or redundant prepuce with urethral duplication, 29 cases of foreskin trauma, 35 cases of phimosis or redundant prepuce with urethral cyst, 3 cases of phimosis or redundant prepuce with urethral stricture, 108 cases of phimosis or redundant prepuce with webbed penis, 6 cases of phimosis with penile downward bending, 4 cases of phimosis with short frenulum preputii, and 15 cases of relatively normal foreskin development, I° and II° hypospadias with unapparent penile downward bending, and megalourethra with complete foreskin hypospadias. Results: All operations were completed successfully. The postoperative circumcision time was less than 5 days on 2 cases(0.1%), and was longer than 25 days on 9 cases(0.6%). The average postoperative circumcision time was 13.2 days. During a follow-up period of 3 months, except for 2 cases (0.1%) of frenulum preputii edema, all other cases had a satisfactory foreskin appearance. They had no obvious foreskin scar hyperplasia, the foreskin cutting edge was neat, the foreskin ligament was intact, the foreskin was left and right symmetrical, and the foreskin was preserved in the absence of erection to cover the coronary sulcus to 1/3 of the glans. All children with hypospadias had no urethral stricture and urethral fistula, and the penis was satisfactory. Conclusions: Ai Tong (Chinese Shang Ring) disposable oval circumcision anastomat is satisfactory in the treatment of various diseases of pediatric urology. With a low incidence of postoperative complications, it may be easy to carry out this procedure at grass-roots hospital.

AB100. Anatomical basis and clinical effect of selective dorsal neurectomy for patients with lifelong premature ejaculation: a randomized controlled trial

BackgroundAlthough American Urological Association and European Association of Urology guidelines do not consider surgical treatment for premature ejaculation (PE), the use of SDN has increased for many years in Asian countries. The aim of this study is to evaluate anatomical basis and clinical effect of selective dorsal neurectomy (SDN) in patients with PE in mainland China.MethodsPatients were assigned to two groups: group 1, comprising 46 patients with redundant foreskin, and group 2, comprising 96 patients with redundant foreskin and PE. Group 2 patients were further randomly classified into group 2a undergoing SDN and circumcision (n=48) and group 2b undergoing only circumcision (n=48). The number of dorsal penile nerves was compared between groups 1 and 2. Pre- and postoperative intravaginal ejaculation latency time (IELT), 5-item version of the International Index of Erectile Function (IIEF-5), PE diagnostic tool (PEDT), and postoperative complications were compared between groups 2a and 2b.ResultsGroup 2 patients had more dorsal penile nerves of 1–2-mm (P=0.007) and ≥2-mm (P<0.001) diameters than group 1 patients. Group 2a had a longer postoperative IELT than preoperative IELT (P<0.001), and postoperative PEDT was lower than preoperative PEDT (P<0.001). More patients in group 2a had ejaculation controllability after surgery than before surgery (P<0.001). No difference was found between pre- and postoperative IIEF-5. For group 2b patients, there were no statistical differences between pre- and postoperative effects on any of the criteria (P>0.05). No statistical difference was found between groups 2a and 2b in postoperative complications (P>0.05).ConclusionsPatients with lifelong PE have more and thicker dorsal penile nerves than those without lifelong PE, and SDN is effective in improving lifelong PE by IELT prolongation and ejaculation controllability with few postoperative complications. SDN is a promising treatment for lifelong PE patients who had poor response to medicine or refused oral medication.

Penile Median Raphe Anomalies as an Indicator of Megameatus Intact Prepuce Anomaly in Children Undergoing Routine Circumcision

ObjectiveTo arouse the suspicious for early diagnosis and hence, proper management of megameatus with an intact prepuce (MIP), as there is no external clue for detection of such cases, which usually come to light for the first time in a boy who is about to retract his prepuce or during neonatal circumcision. Materials and MethodsExamination of neonates and infants coming to circumcision clinic to detect congenital genitourinary anomalies. Evaluation of 12,518 neonates and infants coming for ritual circumcision from 2006-2017, who were examined thoroughly to detect any incidental congenital genitourinary anomalies. Fifteen of them were diagnosed to have a MIP anomaly. They were investigated to perceive any associated median raphe (MR) anomalies. Sensitivity, positive predictive value, specificity, and negative predictive value of MR anomalies in cases of MIP were estimated and compared with other children who had a normally positioned meatus. ResultsOverall incidence of MIP in this group of babies was 0.12%. Twelve of 15 cases (80%) with MIP had 19 forms of MR anomalies; mainly raphe deviation in 6 cases, hyperpigmented raphe in 6, prominent raphe in 4, and bifurcation in 3 cases. Three cases had a redundant long prepuce, and 1 had paraphimosis after preputial retraction, otherwise no other genitourinary anomalies could be detected in those cases. ConclusionMR anomalies, mainly deviation and hyperpigmented prominent raphe, are significant indictors for the presence of an invisible MIP anomaly. Abnormally redundant long prepuce may be seen in such cases, but this is not common.

Clinical effectiveness of disposable circumcision suture in children: a prospective randomized controlled trial

To assess the clinical efficacy of disposable circumcision suture device (DCSD) in children receiving circumcision. Children with phimosis and redundant prepuce undergoing circumcision in our hospital were prospectively enrolled in this study hospital and randomized into DCSD group and conventional circumcision (CC) group. A total of 236 boys were enrolled, including 132 in DCSD group and 104 in CC group. The use of local anesthesia, operation time, intraoperative blood loss, intraoperative and postoperative pain scores, penile appearance satisfaction rates, postoperative complications, healing time of the incision, and the overall satisfaction rate were compared between the two groups. Compared with CC group, DCSD group had a significantly higher proportion of local anesthesia (P < 0.01), shorter operative time (P < 0.001), less intraoperative blood loss (P < 0.001), lower intraoperative and postoperative pain scores (P < 0.001), higher penile appearance satisfaction rates (P=0.03), less postoperative complications (P=0.04), shorter healing time (P < 0.001), and a higher overall satisfaction rate (P < 0.005). The use of DCSD can shorten the operative time and is associated with good tolerance of local anesthesia, less pain, quick recovery, and higher penile appearance satisfaction rates in children receiving circumcision.

Clinical effect of two-person of and one-person operations of disposable circumcision stitching instrument

Objective To compare the clinical effect of two-person operations of disposable circumcision stitching instrument and one-man operations of disposable circumcision stitching instrument. Methods Clinical data of 340 patients with redundant prepuce or phimosis from March 2015 to August 2017 were randomly divided into control group which patients with two-person operation of disposable circumcision stitching instrument and study group which patients with one-man operation of disposable circumcision stitching instrument were reviewed prospectively.There were 188 patients in the study group, including 22 patients with phimosis and 166 patients with redundant prepuce; Among the 152 patients in the control group, there were 17 cases with phimosis and 135 cases with redundant prepuce.Two groups with operation time, intraoperative blood loss, postoperative skin staple missing, 2 hours postoperative pain, postoperative edema, the swelling subsided time, postoperative complications, postoperative patient satisfaction, and so on. Measurement data were represented as ±s, and comparison between groups was analyzed using t test; count data were represented as percentage and comparison between groups was analyzed chi-square. Results All operations were finished successfully for the patients by two-person or one-man of operations of disposable circumcision stitching instrument.In terms of operation, the operation time of the observation group and the control group was (7.76±0.45) minutes and (7.86±0.91) minutes respectively, and the difference was not statistically significant(P>0.05). Intraoperative hemorrhage of observation group and control group were (1.77 ± 0.22) ml and (1.72± 0.26) ml, and the difference was not statistically significant(P>0.05). There was no statistically significant difference between the observation group and the control group (P>0.05)in the postoperative 2 hours pain score and skin staple missing.In the postoperative complications, the deviation rate of the prepuce was 1.11%, significantly lower than the control group 5.92%, and the difference was statistically significant (P<0.05). There was no statistically significant difference between the observation group and the control group in terms of edema on the third postoperative day, short postoperative anastomosis, patient satisfaction, and postoperative infection. Conclusion The way of one-man operation of disposable circumcision stitching instrumente not only saves labor costs, but also has a good postoperative clinical effect, meanwhile, it has high efficiency and strong operability, and is worthy of promotion for clinical first-line urologists. Key words: Circumcision, male; Surgical staplers; Phimosis; Redundant prepuce

Diagnosis and treatment of epispadias with complete prepuce

Objective To summarize the diagnosis and treatment of epispadias with complete prepuce. Methods Between January 2007 and April 2017, clinical records were reviewed for 5 patients diagnosed as epispadias with complete prepuce. The patients were 34 to 66 months old (mean age 44.3 months) , who presented with short beaked penis and nonretractile prepuce. A dorsal midline gap between corpora cavernosa could be felt on palpation. There was dorsal chordee with broad spade like glans. The preputial opening was stenosed and dorsally placed urethral opening after retraction of the prepuce. Two patients were incontinent before surgery. Epispadias were coronal type in 2 cases and penile type in 3 cases. All 5 cases were repaired by Thiersch-Duplay procedure. Results The mean follow-up time was 44.5 months (ranged 3 to 98 months). The stricture occurred in 1 patient 1 month after operation, and after dilation and indwelling catheter for a month, the problem resolved. One needed a secondary preputial plasty due to redundant ventral foreskin 8 years after operation. In 3 of 5 cases, parental satisfaction was not achieved mainly due to short length. Only 1 case was incontinent after surgery and the other four achieved urinary continence. Voiding cystourethrogram (VCUG) and ultrasonography (USG) were done in 2 patients who were incontinent before surgery. One case presented right vesicoureteral reflux of Grade Ⅱ and the other was normal. The urodynamic results of 2 patients were normal. Conclusions Epispadias with complete prepuce is extremely rare and its preoperative diagnosis remains difficult. A definitive diagnosis is based upon history, physical examination and imaging tests. Fewer complications and better continence rates were achieved in the boys with epispadias and intact prepuce. Penile length is an important factor affecting surgical outcome. Key words: Epispadias; Incontinent; Prognosis

Safety and Efficacy of Circumcision Stapler in the Treatment for Children with Phimosis and Redundant Prepuce

Objective: To observe the clinical effect and safety of circumcision stapler in children with phimosis and redundant prepuce. Methods: From July 2013 to July 2017, 40 children were prospectively randomized and assigned to experiment group (circumcision stapler n = 20) or control group (conventional circumcision, n = 20). Outcomes were operation time, intraoperative blood loss and postoperative complications. Results: There was significant difference between the two groups for operation time (5.35 min vs 30.30 min, P < 0.05) and intraoperative blood loss (2.56 ml vs 10.40 ml, P < 0.05) respectively. Conclusion: Circumcision staplers are superior to conventional circumcision for the advantages of shorter operation time and fewer blood losses.

Clinical effects of circumcision device combine with elastic thread in posthetomy: analysis of 1362 cases

Objective To observe the clinical effects of the circumcision device combine with elastic thread for redundant prepuce and phimosis in posthetomy. Methods Clinical data of 1362 patients of redundant prepuce and phimosis underwent circumcision device combine with elastic thread were analyzed. The operative time, recovery time and main complication with the Shang Ring have been compared. Results All operations were successfully completed. Circumcision device combine with elastic thread group avoid ring-removal pain, the healing time and wound edema incidence was significantly reduced, as well as the pain after the operation. Conclusions Circumcision device combine with elastic thread has great advantages and wide introduction value. Key words: Circumcision, Male

Evaluation of clinical curative effects of disposable stitching instrument in redundant prepuce patients.

The present study aimed to investigate the clinical curative effect of disposable stitching instrument operation in patients with redundant prepuce or phimosis. A total of 102 cases of patients with circumcision were randomly selected (from June 2013 to December 2014) from the department of plastic and aesthetic surgery of our hospital and were randomly divided into control and observation groups (n=51). Patients in the control group were treated by traditional circumcision operation, while patients in the observation group were treated by novel disposable circumcision stitching instrument. Operation time, bleeding volume, incision healing time, postoperative complications and incision aesthetic satisfaction in the groups were observed. As a result, intraoperative bleeding volume of patients in the observation group was significantly less in comparison to the control group. Operation time and incision healing time of patients in the observation group was shorter than that of the control group. Additionally, the incidence of postoperative complications of patients in the observation group was noted to be lower than that of the control group. On the other hand, the incision aesthetic satisfaction of patients in the observation group was higher than that of the control group. Blood vessel counting and nerve fiber counting of tissue specimen in the observation group were more than those of the control group. Postoperative VAS scores of patients in the observation group were significantly lower than that of the control group. Each rating scale scores of EPQ of patients in the observation group improved significantly compared with that of the control group. In conclusion, the present findings show that disposable circumcision stitching instrument operation is more advantageous in comparison to the traditional procedure along with minimal compilations and better post surgery health condition of patients.

Disposable circumcision suture devices versus Shang ring circumcision for management of redundant prepuce or phimosis: A systematic review and meta-analysis

ObjectiveTo evaluate the clinic efficacy and safety of the disposable circumcision suture device (DCSD) and Shang ring circumcision (SRC) in the treatment of redundant prepuce or phimosis with a meta-analysis. Material and methodsElectronic databases including PubMed, Embase, Wan Fang, VIP, CNKI and CBM database were researched from inception to August 30, 2016 for relevant RCTs and prospective studies, the reference lists of the included studies were also searched manually. The risk ratios (RR) or mean difference (MD) with 95% confidence intervals (CI) as the effect sizes were calculated by the Revman 5.3 and stata12.0 software. ResultsTwelve RCTs or prospective studies were included with 3345 patients among which 1661 cases received DCSD treatment and 1684 SRC. Compared to the Shang ring circumcision treatment, the disposable circumcision suture device provided a significantly shorter operation time [MD=−0.94, 95%CI (−1.76, −0.12), P=0.02], lower pain scores [MD=−1.89, 95%CI (−2.72, −1.07), P<0.001], no stitch removal pain, better postoperative penile appearance [RR=1.10, 95%CI (1.04, 1.17), P=0.001], fewer complications [RR=0.42, 95%CI (0.32, 0.56), P<0.001] and shorter wound healing time [MD=−8.92, 95%CI (−10.79, −7.05), P<0.001]. Meanwhile, there is more intraoperative blood loss [MD=0.12, 95%CI (0.02, 0.22), P=0.02], and more treatment cost [MD=877.57, 95%CI (737.94, 1017.20); P<0.001]. ConclusionsBased on the results of our meta-analysis, DCSD is more effective and safer than SRC. Thus, it has the advantages of shorter operation time, lower pain scores, better postoperative penile appearance, fewer complication and shorter wound healing time. However, the results need additional high-quality multicenter RCTs to evaluate in the future.

Comparative effect of dorsal slit circumcision and disposable circumcision suture device

Objective To compare the safety and effectiveness of disposable circumcision suture device (DCSD) with conventional circumcision in surgical treatment of phimosis and redundant prepuce. Methods One hundred and sixty one patients with phimosis or redundant prepuce were randomly assigned to be treated by circumcision using disposable circumcision suture device (DCSD group, n=89) or conventional circumcision (CC group, n=72), respectively. Results The operation time was (3.8±0.5)min in DCSD group and (31.6±2.7)min in CC group (F=71.21, P=0.000), blood loss was 1.0(0.9, 1.2)ml in DCSD group and 6.2(5.7, 7.0)ml in CC group (Z=-10.90, P=0.000). There were no significant differences in intraoperative pain score (1.4±0.6 vs. 2.9±0.8, F=2.08, P=0.151) and wound healing time [(14.0±1.3) vs. (16.8±2.1) d, F=0.10, P=0.754] between two groups. There was no need to change the dressing for patients in DSCD group 3 days after the operation, while patients in CC group changed dressing 3 times after the operation. No significant differences in postoperative complication rate [10%(9/89) vs. 4%(3/72), χ2=2.04, P=0.153] and satisfaction rate with the penile appearance [98%(87/89) vs. 94%(68/72), χ2=0.47, P=0.494] were found between two groups. Conclusion DCSD exhibits superiority over CC for shorter operation time and less blood loss in circumcision. Key words: Circumcision, male; Phimosis; Surgical stapling

Bleeding after circumcision is more likely in children with lichen sclerosus (balanitis xerotica obliterans)

Over 27,000 circumcisions were performed in England in 2012-13. The complication rate is generally perceived to be low, although published figures vary widely. Balanitis xerotica obliterans, more correctly termed Lichen Sclerosus et atrophicus (LS), is one of the commonest indications for medical circumcision. To test the hypothesis that children undergoing circumcision for LS have a higher rate of postoperative bleeding than those undergoing the procedure for other reasons, we retrospectively reviewed records for patients undergoing circumcision. The disease and procedure coding system was used to identify patients who underwent circumcision (ICD10 code N303) between 2000-2010. Cases with a diagnosis unrelated to circumcision and children circumcised during hypospadias repair were excluded. Bleeding which required return to theatre for surgical arrest was considered significant. Cases were identified by review of medical records if there was: a second procedure during the same admission, or readmission coded for circumcision within 2 weeks. Only cases with histologically confirmed LS were included in the LS cohort. GraphPad online calculator was used for statistical analysis (two tailed Fisher's exact test. 2385 boys with a median age of 4 years (range 0-16) were included in the study. Indication for circumcision included religious (1305, 54.7%), phimosis or redundant prepuce (512, 21.5%), suspected LS (366, 15.4%) and balanoposthitis (202, 8.5%). LS was histologically confirmed in 262 (10.9%) boys. Fourteen (0.6%) patients returned to theatre for surgical arrest of bleeding following circumcision; 6 had LS and 8 did not (Table 1). The bleeding rate was higher in those with LS (2.3%) than in those without (0.3%), P=0.0003 with a relative risk of 6.08. Post-operative complications are distressing, especially if further surgery is required. Published figures for complications following circumcision vary widely making counseling regarding risk difficult. Since LS includes an inflammatory element and circumcision in widespread LS can be challenging, the observation of more post-operative bleeding in patients with histologically confirmed LS during a previous audit prompted the hypothesis that this may be a significant finding. Thus we reviewed all patients requiring return to theatre within 2 weeks of circumcision, finding that whilst the overall bleeding rate was low, circumcision for LS significantly increased the risk. Although factors such as the severity of LS and surgical technique were not assessed, this is still a notable finding which should be reflected during pre-operative counseling.

Clinical application of disposable circumcision suture device (DCSD) versus ShangRing circumcision in male circumcision

Objectives To compare the efficacy and safety of disposable circumcision suture device (DCSD) and ShangRing circumcision in the tratment of patients with redundant prepuce or phimosis. Methods 180 patients with redundant prepuce or phimosis were randomly divided into two groups: the DCSD group (n=93) and the ShangRing group (n=87). Factors concerning efficacy and safety were compared. Results DCSD showed obvious advantages over the ShangRing in operating time [(6.36±1.09)min vs. (7.23±1.10) min], postoperative 24h pain score (1.94±1.08) vs.(2.89±0.98), postoperative 7d pain score (2.08±0.89) vs. (3.74±1.01), wound healing time [(18.44±3.58)d vs. (21.66±3.65)d], the incidence of wound dehiscence (2.2% vs. 11.5%), and overall satisfactory rate (86.0% vs. 73.6%). There was significant difference in above results (P 0.05). Conclusions DCSD has advantages of shorter operation and incision healing time, reduced postoperative pain score, and high appearance satisfaction. It should be widely used in clinical practice. Key words: Circumcision, Male; Surgical Staplers

Application of diclofenac sodium suppository anal preemptive analgesia combined with lidocaine hydrochloride in circumcision

Objectives To investigate analgesia effect and curative effect of diclofenac sodium suppository anal ahead in circumcision resection. Methods 200 patients with redundant prepuce were randomly divided into control group and the experimental group, patients in control group was given with 1% lidocaine 10mL for penile block anesthesia, patients in experimental group were given diclofenac sodium suppository anal before the surgery, and then given 1% hydrochloric acid lidocaine 10mL for penile block anesthesia. Efficacy of diclofenac sodium suppository anal super analgesia was evaluated. Results Compared with the control group, the pain of the patients in the experimental group was significantly lower than that of the 1~3h after anesthesia, and the difference was statistically significant (P<0.05). Conclusions Diclofenac sodium suppository anal can effectively reduce pain of circumcision anesthesia and postoperation. It is recommended that the diclofenac sodium suppository is used in clinical operation for reducing the patient's pain. Key words: Circumcision, Male; Lidocaine; Analgesia

Somatosensory evoked potentials assess the efficacy of circumcision for premature ejaculation.

To assess the efficacy and mechanism of circumcision in the treatment of premature ejaculation (PE) with redundant prepuce, we enrolled a total of 81 PE patients who received circumcision. The patients' ejaculatory ability and sexual performances were evaluated before and after circumcision by using questionnaires (Intravaginal ejaculation latency time (IELT), Chinese Index of PE with 5 questions (CIPE-5) and International Index of Erectile function- 5 (IIEF-5)). Furthermore, somatosensory evoked potentials (SEPs) including dorsal nerve (DNSEP) and glans penis (GPSEP) of the patients were also measured. The mean IELTs of preoperation and post operation were 1.10±0.55 and 2.48±2.03 min, respectively (P<0.001). In addition, the geometric mean IELT after operation was 2.16 min, compared with the baseline 1.07 min before the operation, the fold increase of the IELT was 2.02. Compared with the uncircumcised status, scores of CIPE-5 showed a significant increase after circumcision (P<0.001). The mean latencies (and amplitudes) of GPSEP and DNSEP were 38.1±4.0 ms (3.0±1.9 uV) and 40.5±3.4 ms (2.8±1.6 uV) before circumcision, respectively; and 42.8±3.3 ms (2.8±1.6 uV) and 40.5±4.1 ms (2.4±1.2 uV) in the follow-up end point after circumcision. Only the latencies of GPSEP showed significant prolongation before and after circumcision (P<0.001). The ejaculation time improvement after circumcision is so small, and equal to placebo response, therefore it could not be interpreted as a therapeutic method in men with PE.

Applications of disposable circumcision stapler with lidocaine cream combined with lidocaine injection anesthesia in circumcision

Objective To investigate the application efficacy of disposable circumcision stapler with compound lidocaine cream combined with lidocaine injection in the circumcision. Methods From September 2013 to November 2014, 120 cases (11 cases of redundant prepuce phimosis patients), were divided into disposable circumcision suture group (S group, 60 cases) and conventional circumcision (T group, 60 cases), two groups had no statistically significant difference at patient age and wrapping case (6 cases phimosis of S group, 5 cases phimosis of T group)(P>0.05. Patient's age ranged from 11 to 49 years. 30 patients in each group were treated with lidocaine cream combined with lidocaine injection, and another 30 patients were treated with a local anesthetic lidocaine injection. Comparisons were conducted among the four groups on the operation time, anesthesia, intraoperative and postoperative pain score, blood loss and postoperative complications, postoperative appearance satisfaction, wound healing time. Results For the disposable circumcision stapler with lidocaine cream combined with lidocaine injection group, disposable circumcision stapler with lidocaine injection group, sleeve circumcision with lidocaine cream combined with lidocaine injection group and sleeve circumcision with lidocaine injection group, the operation time was (5.3±1.5)min, (4.9±1.4)min, (31.6±3.4)min, (32.0±3.3)min respectively, blood loss was (0.6±0.4)ml, (0.8±0.5)ml, (6.9±2.4)ml, (7.5±2.1)ml respectively, narcotic pain score was 0.6±0.6, 3.2±3.9, 2.5±1.0, 0.5±0.6, intraoperative pain score was 0.8±0.9, 1.4±0.8, 2.2±1.1, 3.1±1.1, postoperative 24 h pain score was 1.6±0.9, 2.2±0.8, 2.6±1.3, 4.4±1.1, postoperative 48h pain score was 0.7±0.6, 0.8±0.9, 2.4±0.8, 2.8±0.7, wound healing time was (13.7±1.5)d, (13.5±1.7)d, (14.2±1.3)d, (14.1±1.6)d, the rate of postoperative complications was 6.6% (2/30), 10.0%(3/30), 26.6%(8/30), 33.4%(10/30), satisfaction rate of appearance was 93.4%(28/30), 96.7%(29/30), 70.4%(22/30), 80.0%(24/30). Compared with sleeve circumcision with lidocain injection group, disposable circumcision stapler with lidocaine cream combined with lidocaine injection had a shorter operation time, less pain, less bleeding, higher appearance satisfaction rate and lower incidence of complications (P 0.05). Conclusion Application of the disposable circumcision stapler with lidocaine cream combined with lidocaine injection on circumcision is safe and has got better clinical outcomes. Key words: Redundant prepuce; Disposable circumcision suture device; Compound lidocaine cream; Lidocaine injection

Circuncisión neonatal con anestesia local. Resultados de un protocolo estandarizado

IntroductionNeonatal circumcision is a common procedure in the US and other countries, with low rates of complications in trained hands. However, it has recently been incorporated into the clinical environment in Chile. Our goal was to establish a local standardised protocol for neonatal circumcision under local anaesthesia, and evaluate the results and possible complications. Patients and methodA standardised prospective protocol was used on patients who underwent neonatal circumcision. The inclusion criteria were: children <60days and <5kg. The surgical technique used was topical local anaesthesia and penile block, attrition of redundant prepuce and mucosa with Mogen® clamp, and section with scalpel. The protocol was used and evaluated from November 2005 to October 2014 by a paediatric surgeon and/or paediatric urologist trained in the technique. Complications and conditions until final discharge were analysed. ResultsThe protocol was applied to 108 patients over a 9year period. The mean age at procedure was 9days (1-52). One patient (0.9%) had immediate bleeding, requiring further surgery. All patients were discharged from further medical checks at 1 month, without any other complications. The reason for the procedure was by parental request in 100% of the cases, and always for sociocultural reasons. ConclusionNeonatal circumcision under local anaesthesia is a simple procedure, and has excellent results in selected patients, and with no major complications. With proper training, and adapting the initial protocol, it can be performed on an outpatient basis, without putting the neonates through the risks of general anaesthesia.

Acceptability of Male Circumcision among College Students in Medical Universities in Western China: A Cross-Sectional Study.

BackgroundMale circumcision (MC) has been shown to reduce the risk of female to male transmission of HIV. The goal of this survey was to explore MC’s acceptability and the factors associated with MC among college students in medical universities in western China.MethodsA cross-sectional study was carried out in three provinces in western China (Guangxi, Chongqing and Xinjiang) to assess the acceptability of MC as well as to discover factors associated with the acceptability among college students in medical universities. A total of 1,790 uncircumcised male students from three medical universities were enrolled in this study. In addition, 150 students who had undergone MC were also enrolled in the survey, and they participated in in-depth interviews.ResultsOf all the uncircumcised participants (n = 1,790), 55.2% (n = 988) were willing to accept MC. Among those who accepted MC, 67.3% thought that MC could improve their sexual partners’ hygiene, 46.3% believed that HIV and sexually transmitted diseases (STDs) could be partially prevented by MC. The multivariable logistic regression indicates that MC’s acceptability was associated with three factors: the redundant foreskin (OR = 10.171, 95% CI = 7.629–13.559), knowing the hazard of having a redundant foreskin (OR = 1.597, 95% CI = 1.097–2.323), and enhancing sexual pleasure (OR = 1.628, 95% CI = 1.312–2.021). The in-depth interviews for subjects who had undergone MC showed that the major reason for having MC was the redundant foreskin (87.3%), followed by the benefits and the fewer complications of having MC done. In addition, most of these participants (65.3%) said that the MC could enhance sexual satisfaction.ConclusionsMC’s acceptance among college students in medical universities is higher than it is among other populations in western China. An implementation of an MC programme among this population is feasible in the future.

Comparative study of the circumcision techniques curative effect between circumcision suture device and Shang Ring

Objective To compare the clinical effectiveness among disposable circumcisionsuture device and Shang Ring in treating redundant prepuce and phimosis. Methods The clinical data of 224 cases of circumcisions done by disposable circumcision suture device(n= 112)and Shang Ring(n= 112) were retrospective1y analyzed.Operation time,intra-operational bleeding and postoperative complications among two techniques were compared. Results Disposable circumcision suture operation and Shang ring circumcision without significant difference in the operation time and intra-operational bleeding.There result was(6.1±0.8)min vs(6.5±1.7)min and(2.0±0.0)mL vs(1.8±0.0)m L(P> 0.05).The incidence of postoperative complications with incision pain rate was 21.43% vs 50.89%,infection rate was 14.29% vs 6.25%,frenum area incision edema rate was 8.04% vs 25.89%,and the postoperative hematoma and healing time was(8.0±1.7)d vs(14.0±1.2)d,the differences were statistically significant(P<0.05). Conclusion Each of two techniques has its own advantages and disadvantages.The treatment decision making should be a detailed description to the patients,we propose that school -age children should choose Shang Ring built-in method and the others should use disposable circumcision suture device depending on the situation. Key words: Circumcision; Shang Ring; Circumcision suture device