Comparison of the clinical efficacy of "one-cut" circumcision and traditional circumcision / 现代泌尿外科杂志

【Objective】 To introduce the key techniques of "one-cut" circumcision, and to compare its clinical efficacy with traditional circumcision. 【Methods】 A retrospective analysis was conducted on 120 cases of circumcision in our center during Jul.2020 and Jul.2022, including 60 cases in the "one-cut" group and 60 cases in the traditional circumcision group. The operation time, postoperative edema time, satisfaction with cosmetics and improvement of sexual life were compared between the two groups. 【Results】 Compared with the tradition group, the "one-cut" group had shorter operation time [(19.2±7.4) min vs. (23.1±1.7) min, P<0.001] , shorter postoperative edema time [(5.5±3.2) d vs. (9.6±5.5) d, P<0.001] , and higher satisfaction with cosmetics [(3.6±0.5) vs. (3.1±0.8), P<0.001)] , but there was no difference in improvement of sexual life between the two groups (P=0.08). 【Conclusion】 "One-cut" circumcision is easy to operate, with short operation time, fast postoperative recovery, neat incision and satisfactory appearance, which is worth popularizing.

Clinical analysis of children with pathological phimosis treated by circumcision / 中华泌尿外科杂志

Objective:To investigate the clinical characteristics of pathological phimosis and analyze the correlation between pathological phimosis and balanitis xerotica obliterans(BXO) in children.Methods:The clinical data of 45 children who underwent circumcision and histopathologic evaluation in our hospital from July 2018 to August 2022 were retrospectively analyzed. According to the results of the pathological examination, lichen sclerosis et atrophicus cases were classified as the BXO group, and other cases were classified as the non-BXO group. The two groups' age, history, and symptoms were recorded and compared. The management of meatal stenosis and the effect of topical steroids were described.Results:There were 33 patients in the BXO group, aged (7.42±2.46)years old, of which 91% (30/33) were 5-11 years old. There were 12 patients in the non-BXO group, aged (10.42±2.88) years old. The difference of age between the two groups was statistically significant ( P< 0.05). But there was no significant difference between the BXO group and non-BXO group in the history of balanoposthitis(28 cases vs. 7 cases), history of foreskin dilated(15 cases vs. 3 cases), frequent urination (18 cases vs. 10 cases), urgent urination(12 cases vs. 4 cases), urination pain(17 cases vs. 3 cases), dysuria(21 cases vs. 5 cases), pruritus(25 cases vs. 7 cases), penile pain(7 cases vs. 1 case), ballooning(7 cases vs. 6 cases), and spraying (14 cases vs. 2 cases)( P > 0.05). All 8 cases of meatal stenosis were in the BXO group. Three cases underwent meatal dilatation and indwelling catheter was left for 5-10 days, and topical steroid was used on the third day after surgery. The remaining cases were treated with topical steroids after a pathological diagnosis of BXO. Among the 4 cases with partial urethral meatus involvement, 3 had good results after treatment, and 1 had no significant improvement and underwent meatal dilatation twice later. In 1 case, meatal stenosis was found two weeks after surgery, but no meatal abnormality was found during operation. All patients recovered smoothly during a median follow-up of 12.2 (5.4, 21.8) months. Conclusions:BXO is the main cause of pathologic phimosis in boys, and the diagnosis is based on histopathology. The main complication of BXO is meatal stenosis, which should be detected as early as possible and treated in time.

Application of foam dressing combined with adhesive penile hood after circumcision in children / 中国实用护理杂志

Objective:To investigate the effect of applying foam dressing combined with self-made adhesive penile hood fixation in children after circumcision.Methods:A total of 101 cases of children who received circumcision from January to December 2020 in the urology department of the People′s Hospital of Xuancheng City were selected. The patients were randomly divided into experimental group (50 cases) and control group (51 cases). In the experimental group, the incision was wound with foam dressing combined with the self-made adhesive penile hood fixation method, while in the control group, the incision was wound with the conventional sterile gauze dressing combined with the simple plastic basket fixation method.The postoperative incision bleeding, prepuce edema, incision pain, incidence of complications and the satisfaction of the children′s family members on postoperative dressing and fixation were compared between the two groups.Results:The incidence of prepuce edema in the experimental group was 88.00% (44/50), 12.00% (6/50), 0, which in the control group was 43.14% (22/51), 45.10% (23/51), 11.76% (6/51), and the difference between the two groups was statistically significant ( Z= -4.80, P<0.05). In the experimental group, pain score at 24 hours after operation and at the time of dressing change were 3.50 ± 1.04, 2.48 ± 0.54, respectively, which were lower than that of the control group 5.31 ± 1.36 and 7.12 ± 0.97, and the difference between the two groups was statistically significant ( t=7.53, 29.66, all P<0.05). The incidence of postoperative infection and urinary retention in the experimental group were 0 and 2.00% (1/50), respectively, which were lower than 7.84% (4/51) and 7.84% (4/51) in the control group, and the difference between the two groups was statistically significant (Fisher′s exact probability method, P<0.05). The degree of family satisfaction in the experimental group was 96.00% (48/50), which was higher than that in the control group (78.43%, 40/51), and the difference between the two groups was statistically significant ( χ2=6.95, P<0.05). Conclusions:The application of foam dressing combined with pasting penile hood after circumcision can reduce the degree of foreskin edema, pain and the incidence of complications, and improve the satisfaction of the children′s family members.

The role of women in promoting voluntary medical male circumcision uptake: Literature review

Voluntary medical male circumcision (VMMC) is a global strategy for reducing female-to-male sexual transmission of HIV. Women whose partners are circumcised benefit from a reduced risk of contracting other sexually transmitted diseases; making their role in VMMC critical. The objective of our study was to identify and synthesize existing evidence related to women's role in promoting VMMC from a regional perspective. The review and selection process were guided by the Problem; Intervention; Comparison and Outcome (PICO) model, which facilitated the exclusion of irrelevant studies. The search strategy search terms for the PICO components with synonyms, related terms and specialist terms were harvested from the Medical Subject Headings (MeSH)© and Embase©. The inclusion criteria were published studies in English and relevant to women's role in VMMC for the prevention of HIV between 2007 and 2020. Four key categories emerged from the literature as follows: role of women, VMMC uptake, barriers and facilitators of VMMC. The majority of the studies concur on the importance of involving women in VMMC uptake as they have the power to negotiate with their male partners through communication and can persuade men to be circumcised, making it a joint decision. The benefits of VMMC in improving sexual pleasure and attractiveness of the penis seemed to positively convince women to influence and educate men to improve the uptake of VMMC. Women are motivated to convince men to undergo male circumcision (MC) because of the benefits associated with them such as reduction of HIV transmission and cervical cancer. There are, however, limited studies focusing on women's involvement in VMMC; hence, more research to explore this area is recommended.

The GUD technique: glandar urethral disassembly. An alternative for distal hypospadias repair

ABSTRACT Introduction We present an alternative procedure for distal hypospadias consisting of urethral mobilization and partial glandar disassembly, namely GUD (glandar urethral disassembly) technique. Materials and Methods A subcoronal circumcision exposes distal dysplastic urethra. We incise the Buck´s fascia on both sides of urethra releasing it partially from the corpora. We keep a thin bridge of urethral plate to the glans and disassembly almost completely the glans from the corpora, except for the bridge. The glans is incised creating two wide wings that are extremely mobile. The urethra is mobilized, advanced and sutured to the tip of the glans. The glans wings embrace the distal urethra producing a conical glans. Discussion The concept of urethral mobilization has been reported and popularized by Koff in the literature to correct distal hypospadias. One of the limitations of this procedure is the risk of urethral retraction due to extensive proximal dissection. We got inspiration from Mitchell and Bagli' s work of penile disassembly in epispadias to develop the GUD concept. We adopt minimal urethral mobilization mainly in glandar/proximal penile shaft and complete deconstruction of the glans, detaching the corpora from the glans and rotating the wide glans wings to embrace the urethra. Therefore we avoid suture urethroplasty and refurbish the glans to a better conical shape. Conclusion We are convinced that this operation can be regarded as a genuine alternative to distal hypospadias (coronal and subcoronal) but should not be addressed to midshaft forms.

Tunica vaginalis flap – is it a better surgical choice for urethro-cutaneous fistula following circumcision?

Objective: To study the effectiveness of tunica vaginalis flap in repair of post circumcision urethro- cutaneous fistula. Materials and Methods: The current study reviewed all patients having surgical repair of post-circumcision urethrocutaneous fistula from December 2014 to April 2019 at our institution. Results: Ten cases presenting at age 5 to 22 years were operated. Most [60%] of the circumcisions were performed by a doctor at peripheral hospitals and others were done by traditional circumcisers. All cases had a single fistula and the size was more than 5mm in all cases. Three-layered fistula closure was done in all cases using the tunica vaginalis flap as the second layer for closure. There was no recurrence in any case. Conclusion: Use of Tunica vaginalis flap for repair of post circumcision urethro-cutaneous fistula is a highly effective technique regardless of size and site of the fistula. It is a simple procedure without any postoperative complications and without any recurrence

Acercamiento sociocultural a la mutilación genital femenina / Sociocultural approach to the feminine genital mutilation

RESUMEN La mutilación genital femenina se inscribe dentro de las prácticas tradicionales perjudiciales, reconocidas como forma de violencia contra las mujeres y las niñas. Tema extremadamente complejo, delicado y politizado, difícil de entender a través de definiciones normativas, clasificaciones y delimitaciones geográficas. Su desconocimiento, por parte de los profesionales de la salud, puede contribuir a un manejo inadecuado de las pacientes. El trabajo tiene como objetivo argumentar sobre aspectos socioculturales de la Mutilación Genital Femenina, esenciales para su manejo integral por el profesional de la salud. Se recomienda el enfoque, llamado "las cinco P": prevalencia, prevención, protección, persecución y provisión de servicios. Además, se deben evitar las actitudes de reproche o victimización hacia la paciente, así como no promover la medicalización de la práctica.

ABSTRACT The feminine genital mutilation is registered among the harmful traditional practices recognized as form of violence against the women and the girls. Complex topic, the fact that was politicized, difficult to understand through normative definitions, classifications and geographical delimitation. Its ignorance, on the part of the professionals of the health, can contribute to an inadequate handling of the patients, as part of their integral attention. The work takes as an objective to argue on sociocultural aspects of the Feminine Genital Mutilation, essential for its integral handling for the health professional. The approach, called "five P" is recommended: predominance, prevention, protection, pursuit and provision of services. Moreover, the reproach attitudes must be avoided or victimization towards the patient, expression of a euro-central and paternalistic look towards the different, unexpected or unknown; as well as not to promote the medicalization of the practice.

Safe Male Circumcision for HIV Prevention among Adolescents with Deafness in Uganda: Awareness Prevalence and Implications for Policy and Programming

Background: Safe Male Circumcision (SMC)[1] has been widely recommended by WHO as part of a comprehensive HIV prevention strategy. However, literature pertaining to SMC amongst adolescents with a disability, and the deaf community in particular, is almost non-existent. This study sought to establish SMC prevalence, knowledge, attitude and post circumcision behaviour among adolescents with deafness in Uganda.Methods: The study was cross-sectional, used a mixed-methods approach and recruited 447 participants. 363 questionnaires were administered to adolescents of age 15 - 24 years (192 males and 171 females) from three study sites. We assessed socio-demographic variables, circumcision status, post circumcision behaviour, attitude and knowledge levels towards SMC. Qualitative data was also collected from 84 participants (m=46, f=38) using focus group discussions and key informant interviews. Quantitative data were analysed using Stata software while qualitative was thematically analysed.Results: A total of 60.9% male adolescents with deafness self-reported to be circumcised. Both male and female participants reported SMC information to be highly inaccessible (84%). Only 27.8% study participants knew about the partial protective effect of SMC against HIV, 51.8% were uncertain, while 26% thought that SMC provided full protection. Both male and female respondents had a positive attitude towards SMC (68.3%) and females were more knowledgeable (50.3%) about the partial preventive effect of SMC against HIV transmission and timeframe for the resumption of sexual activity compared to males (30.2%). Linkages were noted between SMC, social networks and key sociodemographic characteristics like ethnicity, religion and education level.Conclusion: Despite a 60.9% prevalence and general positive attitude towards SMC, study findings showed limited service access and substantial knowledge gaps in SMC efficacy, also related to high-risk behaviour after circumcision. This can largely be explained by limited targeting by HIV prevention programmes among this (deaf) category of adolescents, related barriers associated with vulnerability arising from their disability (deafness) and developmental stage (adolescence). Key actors in HIV prevention efforts should demonstrate cognizance of heightened risk among vulnerable adolescent categories through more inclusive interventions to address prevailing knowledge and service gaps. [1] This study was conducted between 2015-2016 when the commonly used term was Safe Male Circumcision (SMC) and not Voluntary Medical Male Circumcision (VMMC) as its popularly being packaged now. This manuscript has stuck to the originally used SMC acronym.

Comparison of two analgesic block techniques for circumcision: dorsal penile nerve block and caudal block

Background: Circumcision is most common and oldest surgery but also could be frightening for children because of postoperative pain. Authors aim to evaluate postoperative pain conditions of patients by using the visual pain scale (VPS).Methods: Between 2016 and 2018, 168 children undergone circumcision. The patients were splitted into three groups depend on their anesthetic care; the dorsal penile block (DPNB), caudal block (CB) and combine block.Results: The mean age were 95.3±20.9 (65-186) months. There was no significant difference between the CB and combine block in VPS at 1st, 3rd hours and second days (p=0.19, p=0.39 and p=0.9 respectively). The VPS significantly higher in the DPNB arm when compared with caudal and combine block arm at 1st and 3rd hours (p<0.01 and p<0.01 respectively) but there was no significant difference between the DPNB and caudal block at second days (p=0.9). There was no significant difference between groups for analgesic requirements (p=0.07). Incidences of nausea and vomiting were seen rarely especially in the DPNB arm and the difference was not statistically significant among the groups (p=0.9).Conclusions: CB and DPNB are effective techniques for pain relief following penile surgery. CB has superior to DPNB at 1st and 3rd hours but no difference at follow up. Both techniques are appropriate methods for postoperative pain relief.

Postoperative aesthetic and healing features of postectomy using three different surgical techniques: a randomized, prospective, and interdisciplinary analysis / Aspectos estético e cicatricial pós-operatórios da postectomia por três diferentes técnicas cirúrgicas: análise randomizada, prospectiva e interdisciplinar

ABSTRACT Objective: to compare the postoperative esthetic and healing aspects of postectomy performed by different surgical techniques, based on the evaluation of different specialty expert professionals. Methods: prospective and randomized clinical trial enrolling 149 preschool children with a medical indication for circumcision, divided into three groups: postectomy with the hemostatic device Plastibell® (PB group), conventional technique (CV group) and conventional with subcuticular stitches (SC group). Pictures were taken from patients at pre-defined angles on the 30th and 60th postoperative days. Photos were evaluated by three specialists (dermatologist, pediatrician and plastic surgeon), who assigned scores from 1 to 5 regarding the esthetic and healing features at each moment. Grades 4 or 5 from all specialists characterized "best result". Data were analysed to compare the used surgical techniques, the judgments from specialties and postoperative complications. Results: most of the patients obtained the "best result" regarding healing (70%) and esthetics (56%). The final overall result showed the PB group as the best for healing (p=0.028) and the SC group as the best for esthetics (p=0.002). For the dermatologist, on the 60th postoperative day, the CV group presented the worst aesthetic result, whereas for the pediatrician and the plastic surgeon, the PB group presented the best healing result and the SC group had the best esthetic result. There was no difference between the groups regarding the presence of complications. Conclusion: the most common surgical techniques used to perform postectomy in children were differently assessed regarding healing and esthetic features by distinct medical professionals. The analysis of these two parameters among experts from related areas diverged among them and over time.

RESUMO Objetivo: analisar os aspectos estético e cicatricial pós-operatórios (PO) de pacientes submetidos a postectomia por diferentes técnicas cirúrgicas a partir da avaliação de profissionais experientes de áreas afins. Método: ensaio clínico prospectivo e randomizado, incluindo 149 meninos em idade pré-escolar com indicação médica de postectomia, divididos em três grupos: postectomia com dispositivo hemostático Plastibell® (grupo PB), técnica convencional (grupo CV) e convencional com pontos subcuticulares (grupo SC). Os pacientes foram fotografados em ângulos predefinidos no 30º e 60º dias de PO e as fotos avaliadas por três especialistas (dermatologista, pediatra e cirurgião plástico) que atribuíram notas entre 1 e 5, quanto aos aspectos estético e cicatricial em cada momento. Notas 4 ou 5 de todos os especialistas caracterizaram o "melhor resultado". Os dados foram submetidos à análise estatística para comparar as técnicas cirúrgicas, as avaliações dos especialistas e as complicações pós-operatórias. Resultados: a maioria dos pacientes obteve "melhor resultado" cicatricial (70%) e estético (56%). O resultado geral final apontou o grupo PB como superior quanto à cicatrização (p=0,028) e o grupo SC quanto ao aspecto estético (p=0,002). Para o dermatologista, na segunda avaliação, o grupo CV apresentou o pior resultado estético, enquanto para o pediatra e o cirurgião plástico, o grupo PB apresentou o melhor resultado cicatricial e o grupo SC o melhor resultado estético. Não houve diferença entre os grupos quanto à presença de complicações. Conclusão: as técnicas cirúrgicas mais empregadas para realizar postectomia em crianças foram avaliadas quanto aos resultados cicatricial e estético de distintas maneiras. A análise desses dois parâmetros entre especialistas de áreas afins divergiu entre eles e ao longo do tempo.

Evaluation of the Role of Circumcision in Reducing Symptomatic Urinary Tract Infection Following Vale Ablation

Aim: The aim of this single center short-term prospective study is to determine the effects of circumcision in reducing the risksof symptomatic urinary tract infection (UTI) in post posterior urethral valve (PUV) ablated patients and to compare them withtheir non-circumcised counterparts.Objective: The specific objective of this study in the group includes: a. To identify patients with PUV who develop UTI with subsequentrenal damage. b. Proportion of children with symptomatic UTI in each group. c. Relative risks of presenting with symptomatic UTIafter PUV ablution and. d. To analyze statistically when circumcision really reduces the incidence of UTI in valve ablated patients.Materials and Methods: A single institutional prospective study of patients who were admitted with PUV between April 2016and September 2017 Institutional Ethics Committee Clearance and informed consent of the parents were taken. Boys withcongenital anomalies along with hypospadias and epispadias or any other condition rendering circumcision impossible wereexcluded from the study.Results: We identified 38 patients in all of whom 23 underwent circumcision at the time of valve ablation. The mean age ofthese patients was 41.22 days on a mean follow-up period of 1 year. Only one patient (4.35%) in the circumcised group hadtwo episodes of UTI, whereas three patients (20%) who had not undergone circumcision had five episodes of UTI.Conclusion: Circumcision along with PUV ablation does protect these patients from post-ablation symptomatic UTI and thusis protective against ongoing renal damage.

Limited Dorsal Slit Preputialplasty for Management of Phimosis in Children

Objective: To evaluate the functional and cosmetic result of limited dorsal slit preputialplastyfor surgical management of phimosis in children. Methods: This is a prospective cohortstudy (Jan 2010 to Dec 2019) of 246 children (age >5 y) who were unable to retract theforeskin and were symptomatic. Results: No intraoperative complications wereencountered. Preputial edema was the most common (n=45, 18.2%) immediatepostoperative occurrence. At one year follow-up, a total cosmetic score of 6 (consideredoptimal) was seen in 203 (91%) patients. A score of 5 was observed in 13 (5.9%) and theremaining 7 (3.1%) had a score of less than 4. All pubertal children, except one, could retractprepuce freely without discomfort. Conclusion: This preputialplasty provides satisfactorycosmetic and functional result in phimosis, and is an acceptable alternative to circumcision

Miasis genital como complicación de circuncisión debido a fimosis: reporte de caso / Genital myiasis as complication of circumcision due to phimosis: case report

Resumen La circuncisión es un procedimiento quirúrgico de baja complejidad; el riesgo de complicaciones oscila entre el 0,2 a 5%, siendo la miasis un hecho poco frecuente. Para su tratamiento, principalmente se extraen las larvas, y se administran antiparasitarios y antibióticos para prevenir la infección secundaria. El objetivo del artículo es reportar el caso de un adulto masculino, quien presentó miasis genital posterior a una circuncisión y biopsia. En la mayoría de los casos, la miasis es accidental en humanos, y su verdadera incidencia es difícil de establecer debido al subregistro. La mala higiene, el bajo nivel socioeconómico y el hacinamiento son factores de riesgo importantes para adquirirla, además de la excesiva exposición del hospedero potencial a las moscas. Es fundamental realizar un correcto tratamiento de heridas y un seguimiento estricto del paciente que recibe manejo quirúrgico. MÉD.UIS.2019;32(2):41-6

Abstract Circumcision is a non complex surgical procedure, but is not a harmless option. Risk of complications may fluctuate between 0,2% and 5%, being myiasis a low often situation, for its treatment mainly the larvae are extracted, antiparasitics and antibiotics are administered to prevent secondary infection. The objective of the article is to report the case of a male adult, who presented genital myiasis after a circumcision and biopsy. In most of cases myiasis is accidental in humans and its true incidence is very hard to establish due to underreporting. Poor hygiene, low socio-economic level and overcrowding, are risk factors to obtain it, besides an excessive exposure to flies. A right wounds treatment and a strict monitoring of patient in surgical management is essential. MÉD.UIS.2019;32(2):41-6

Management Of Phimosis With Use Of Betamethasone And Prepucial Dilatation -A Prospective Study

Introduction: Physiological phimosis, a common complaint in the surgery outpatient department presenting as non–retractile foreskin is due to adhesions between the inner layer of the prepuce with glans penis or due to tight tip of the prepuce. These patients are managed with circumcision, preputial dilatation and topical application of steroid. In this study, we compare different outcomes measures in children treated with dilatation along with Betamethasone ointment. Methods: This prospective study was conducted in the department of General surgery outpatient department in 2018. We followed up 50 patients who underwent application of betamethasone ointment followed by dilatation and application of betamethasone impregnated antibiotic cream twice daily over a period of six weeks. We recorded basic demographic features, parent anxiety, parental compliance, parent satisfaction, complete response and persistence of phimosis at the end of the treatment. Results: The median age of the patients was 36 with range (23–48) months. At the end of six weeks, with regard to all outcome measures namely parent compliance, parent satisfaction, symptom resolution. Moreover, phimosis persisted in 3 (6%) of the patients treated with dilatation and betnovate ointment. Conclusions: This study shows that Dilatation and local application of betnovate ointment is a better alternative to circumcision.

Application effect of preoperative intranasal dexmedetomidine in pediatric anesthesia / 中国基层医药

Objective To observe the clinical effects of preoperative intranasal dexmedetomidine in pediatric anesthesia.Methods From April 2014 to April 2017,40 pediatric patients who accepted elective circumcision,ASA Ⅰ,aged 2 to 10 years in Wenjiang Branch of Sichan Provincial People's Hospital were divided into two groups,with 20 cases in each group.The test group received intranasal dexmedetomidine 1 μg/kg,and the control group received intranasal equal volume of saline 30 min before surgery.HR,SpO2,BP were monitored and recorded before intranasal (T0),5min after intranasal (T1),10min after intranasal (T2),20min after intranasal (T3),30min after intranasal (T4).The sedation score was assessed after 30 min of administration.The restless score was observed after waking.Results ANOVA analysis showed that there were significant differences in SBP (F =14.54,P ＜ 0.05) and DBP (F =22.69,P ＜ 0.05) between the two groups,and the SBP (F =13.77,P ＜ 0.05),DBP (F =10.48,P ＜ 0.05),HR(F =5.13,P ＜ 0.05) had interaction effects.Compared with those of the control group,the heart rate and the diastolic pressure of the test group were decreased at T2 ～ T4 (all P ＜ 0.05).The sedation score of the test group was superior than that of the control group(t =-9.131,P ＜0.05),and the postoperative agitation score was lower than that of the control group (t =3.387,P ＜ 0.05).Conclusion Intranasal dexmedetomidine can provide satisfactory sedative effects without affecting the vital signs of children and significantly reducing the postoperative agitation.

Simplifying the ShangRing technique for circumcision in boys and men: Use of the no-flip technique with randomization to removal at 7 days versus spontaneous detachment / 亚洲男科学杂志(英文版)

To assess safety of the no-flip ShangRing male circumcision technique and to determine clinical course and safety of spontaneous detachment (i.e., allowing the device to fall off), we conducted a case series of no-flip ShangRing circumcision combined with a randomized controlled trial of removal 7 days postcircumcision versus spontaneous detachment at two health facilities in Kenya. The primary outcome was the safety of the no-flip technique based on moderate and severe adverse events (AEs) during the procedure and through 42-day follow-up. A main secondary outcome was clinical course and safety of spontaneous detachment. Two hundred and thirty males 10 years and older underwent no-flip circumcision; 114 randomized to 7-day removal and 116 to spontaneous detachment. All circumcisions were successfully completed. Overall 5.3% (6/114) of participants in the 7-day group and 1.7% (2/116) in the spontaneous group had an AE; with no differences when compared to the 3% AE rate in historical data from African studies using the original flip technique (P = 0.07 and P = 0.79, respectively). Overall 72.4% (84/116) of participants in the spontaneous group wore the ShangRing until it detached. Among the remaining (27.6%; 32/116), the ring was removed, primarily at the participants' request, due to pain or discomfort. There was no difference in AE rates (P = 0.169), visit day declared healed (P = 0.324), or satisfaction (P = 0.371) between randomization groups. The median time to detachment was 14.0 (IQR: 7-21, range: 5-35) days. The no-flip technique and spontaneous detachment are safe, effective, and acceptable to boys and men 10 years and older. Phimosis and penile adhesions do not limit successful ShangRing circumcision with the no-flip technique.

Experience in circumcision of children aged 3-6 years under the intervention of modern holistic medical model / 国际外科学杂志

Objective@#Under the intervention of modern holistic medical model, the subjective feelings and objective effects of parents and children in circumcision were studied in children aged 3-6 years.@*Methods@#A prospective study was conducted to select 2012 children aged 3 to 6 years who underwent circumcision at the First Affiliated Hospital of Kunming Medical University from August 2013 to May 2017. The patients were divided into control group and experimental group by completely randomized grouping, there were 1 006 cases in each group. The children in the control group were treated with a single biomedical model, which was completed according to the conventional flow-type operation. The children in the experimental group adopted the modern holistic medical model, and the full modern holistic medical model intervention was performed before, during and after the operation. The medical treatment process highlighted the overall humanistic care for the children. The age of the control group was (4.19±1.75) years old, and the age of the children in the experimental group was (4.26±1.68) years old. The operation time, the degree of surgical pain [with the pain visual analogue scale (VAS)], the postoperative complications (including postoperative hemorrhage, penile edema, infection, wound rupture), wound healing time, surgery satisfaction rate and fear level of children were compared between the two groups. Measurement data were expressed as mean±standard deviation (Mean±SD), t-test was used for comparison between groups; Chi-square test was used to compare the count data.@*Results@#In the control group, the operation time was (9.26±1.87) min, the surgical pain VAS was (2.59±0.72), postoperative bleeding was 38 (3.8%), severe penile edema was 78 (7.8%), and infection was 12 (1.2%), wound rupture was 32 cases (3.2%), the wound healing time was (20.4±2.56) d, and the surgical satisfaction rate was 67.4%. In the experimental group, the operation time of was (6.15±1.23) min, the surgical pain VAS was (1.71±0.54), postoperative bleeding was 6 cases (0.6%), severe penile edema was 12 cases (1.2%), and infection was 8 cases (0.8%), wound rupture was 2 cases (0.2%), the healing time was (15.2±3.16) d, and the operation satisfaction rate was 98.8%. The operation time, surgical pain VAS, postoperative bleeding, severe penile edema, wound splitting rate, healing time and surgical satisfaction rate were statistically significant (P<0.05), and there was no statistical difference in wound infection rate between the two groups (P>0.05). The fear level of children in the experimental group was superior to the control group at levels 0, 1, 2 and 3, the difference was statistically significant (P<0.05).@*Conclusions@#Under the intervention of modern holistic medical model, the child′s operation process is smooth, the children and parents have good subjective feelings, no obvious fear, good compliance, high satisfaction, good objective clinical effect, and positively improve the relationship between doctors and patients. The society has won a good reputation and deserves to be promoted clinically.

Experience in circumcision of children aged 3-6 years under the intervention of modern holistic medical model / 国际外科学杂志

Objective Under the intervention of modern holistic medical model,the subjective feelings and objective effects of parents and children in circumcision were studied in children aged 3-6 years.Methods A prospective study was conducted to select 2012 children aged 3 to 6 years who underwent circumcision at the First Affiliated Hospital of Kunming Medical University from August 2013 to May 2017.The patients were divided into control group and experimental group by completely randomized grouping,there were 1 006 cases in each group.The children in the control group were treated with a single biomedical model,which was completed according to the conventional flow-type operation.The children in the experimental group adopted the modern holistic medical model,and the full modern holistic medical model intervention was performed before,during and after the operation.The medical treatment process highlighted the overall humanistic care for the children.The age of the control group was (4.19 ± 1.75) years old,and the age of the children in the experimental group was (4.26 ±1.68) years old.The operation time,the degree of surgical pain [with the pain visual analogue scale (VAS)],the postoperative complications (including postoperative hemorrhage,penile edema,infection,wound rupture),wound healing time,surgery satisfaction rate and fear level of children were compared between the two groups.Measurement data were expressed as mean ± standard deviation (Mean ± SD),t-test was used for comparison between groups;Chi-square test was used to compare the count data.Results In the control group,the operation time was (9.26 ± 1.87) min,the surgical pain VAS was (2.59 ±0.72),postoperative bleeding was 38 (3.8％),severe penile edema was 78 (7.8％),and infection was 12 (1.2％),wound rupture was 32 cases (3.2％),the wound healing time was (20.4 ± 2.56) d,and the surgical satisfaction rate was 67.4％.In the experimental group,the operation time of was (6.15 ± 1.23) min,the surgical pain VAS was (1.71 ± 0.54),postoperative bleeding was 6 cases (0.6％),severe penile edema was 12 cases (1.2％),and infection was 8 cases (0.8％),wound rupture was 2 cases (0.2％),the healing time was (15.2 ± 3.16) d,and the operation satisfaction rate was 98.8％.The operation time,surgical pain VAS,postoperative bleeding,severe penile edema,wound splitting rate,healing time and surgical satisfaction rate were statistically significant (P ＜ 0.05),and there was no statistical difference in wound infection rate between the two groups (P ＞ 0.05).The fear level of children in the experimental group was superior to the control group at levels 0,1,2 and 3,the difference was statistically significant (P ＜ 0.05).Conclusions Under the intervention of modern holistic medical model,the child's operation process is smooth,the children and parents have good subjective feelings,no obvious fear,good compliance,high satisfaction,good objective clinical effect,and positively improve the relationship between doctors and patients.The society has won a good reputation and deserves to be promoted clinically.

Use Of Bipolar Cauterization In Circumcision

Male circumcision is done very frequently in all Pediatric surgery set up. Though several open and device based techniques of circumcision have been described in literature but no single procedure is taken as gold standard in terms of prevention of complications. In India, generally population are from tribal regions and due to non availability of resources dorsal slit technique is preferred and accepted but had complications like injury to urethra/glans, skin laceration, bleeding and infection. Bipolar cauterization holds its merits and demerits. In our experience the use of bipolar technique is safe, mostly complication free and gives good cosmetic outcome.