A Retrospective Taiwanese-Population-Based Clinical Study on Determining the Efficacy and Safety of Disposable Circumcision Anastomat.

Traditional approaches for male circumcision are tedious and could lead to complications such as peri-/postoperative pain, bleeding, and infection. Thus, for the first time, we investigated the surgical outcomes of recently the discovered Disposable Circumcision Anastomat Type A (Dongguan ZSR Biomedical Technology Company Ltd., China), a disposable circumcision suture device (DCSD), in terms of the operation time, surgical complexity, safety, satisfaction, and aesthetic outcomes and most importantly the prognostic factors for postoperative infection. A total of 394 individuals were circumcised, with a mean age, body mass index (BMI), stretched penile length (SPL), and penile circumference of 30.1 ± 7.05 years, 25.47 ± 4.73, 10.12 ± 1.61, and 7 ± 0.73 cm, respectively. Associated comorbidities included diabetes mellitus (6.09%), hypertension (2.03%), gout (1.02%), end-stage renal disease (ESRD, 0.25%), and HIV (0.25%). The mean operation time, average postoperative bleeding, and wound infection rate was 31.4 ± 9.96 min, 2.54%, and 9.39%, respectively. The mean VAS postoperative pain scores at D0 and D1 were 4.4 ± 2.4 and 1.9 ± 1.6, respectively. Moreover, 1.27% of subjects required reoperation, and a 2.03% rate of instrument malfunction was noted. The significant factors associated with the post-operative infection group were age (p = 0.0313), BW (p = 0.0081), BMI (p = 0.0026), penile circumference (p = 0.0343), and DM (p ≤ 0.001). Multivariate analyses revealed only DM as a statistically significant factor (p < 0.001). Our box−whisker plot revealed no significant difference between the HbA1c level of infection (Hb1Ac = 7.77 ± 1.39) and non-infection groups (Hb1Ac = 6.92 ± 1.84). However, a trend of higher glycemic index in the infection group was observed. Conclusively, DSCD could be an effective and safe alternative to performing circumcision. However, in the population with advanced aging, phimosis, elevated BMI, and DM (HbA1C > 9%), users should be highly cautious due to the increased risk of infection, dehiscence, and hematoma.

[Knot-free suture and frenulum positioning combined with application positioning using a disposable circumcision suture device in circumcision].

OBJECTIVE: To explore the effect of knot-free suture and frenulum positioning combined with application positioning (KFS-FP + AP) in circumcision using a disposable circumcision suture device. METHODS: We retrospectively analyzed the clinical data on 160 cases of circumcision for phimosis or redundant prepuce by KFS-FP + AP (the observation group, n = 80) or by routine circumcision (the control group, n = 80) with a disposable circumcision suture device from February 2021 to December 2021. We recorded the operation time, incidence of frenulum breve, incidence of frenulum dislocation, and Visual Analog Scale (VAS) scores at 6 hours after surgery, and compared them between the two groups of patients. RESULTS: The operation time was longer in the observation than in the control group (8.00 ï¼»8.00, 9.00ï¼½ min vs 5.00 ï¼»5.00, 5.00ï¼½ min), and the incidence rates of frenulum breve (0 vs 8.75%, P < 0.05) and frenulum dislocation (0 vs 7.5%, P < 0.05) significantly lower in the former than in the latter group. There were no statistically significant difference in the VAS scores between the observation and the control groups (2.60 ï¼»2.00, 3.00ï¼½ vs 2.55 ï¼»2.00, 3.00ï¼½, P > 0.05). CONCLUSION: KFS-FP + AP with a disposable circumcision suture device is a safe and effective method of circumcision, with high satisfaction of the patients and worthy of clinical promotion.

A Modified Pressure Dressing to Avoid Severe Bleeding After Circumcision With a Disposable Circumcision Suture Device and a Discussion on the Mechanism of Bleeding With the Disposable Circumcision Suture Device.

INTRODUCTION: A novel type of a disposable circumcision suture device (DCSD) has been proved to be effective and safe; however, a few cases of severe bleeding took place after circumcisions. AIM: To evaluate the effectiveness of a modified double-layer pressure dressing to avoid severe bleeding after circumcision with the DCSD, in our department in a prospective randomized controlled study, and discuss the mechanism of bleeding with DCSD. METHODS: Patients with redundant foreskin or phimosis were included between September 2018 and November 2019 and divided into 2 groups: In group A, the conventional pressure dressing was performed; in group B, an modified double-layer pressure dressing was performed. MAIN OUTCOME MEASURE: The main outcomes and complications (surgical time, incidence of glans ischemia, severe bleeding rate, infection rate, pain level, total cost, and overall satisfaction) were collected and analyzed. RESULTS: A total of 624 patients were recruited for this study. There was no difference in the average age and body mass index between 2 groups. No patient suffered obvious glans ischemia. In group B, lower pain level, lower incidences of severe bleeding, and better satisfaction were recorded. CONCLUSION: The mechanism of bleeding with the DCSD was discussed in this study, and the modified pressure dressing was proved effective, safe, and easy to perform. W Jiang, J-li Fu, W-l Guo, et al. A Modified Pressure Dressing to Avoid Severe Bleeding After Circumcision With a Disposable Circumcision Suture Device and a Discussion on the Mechanism of Bleeding With the Disposable Circumcision Suture Device. Sex Med 2021;9:100288.

[Abnormally short frenulum induced by circumcision with the disposable circumcision suture device: Causes and improvement of the surgical method].

OBJECTIVE: To investigate the causes of abnormally short frenulum induced by circumcision with disposable circumcision suture device and the improvement of the surgical method. METHODS: We retrospectively analyzed the clinical data on 320 cases of phimosis or redundant prepuce treated from January 2020 to September 2020, including 160 children (group A) and 160 adults (group B), each further divided into an observation group (n = 80, groups A1 and B1) and a control group (n = 80, groups A2 and B2). The patients in groups A1 and B1 underwent circumcision by suture positioning at the frenulum with the disposable circumcision suture device, and those in groups A2 and B2 received conventional circumcision with the disposable circumcision suture device. We compared the operation time, incidence rate of abnormally short frenulum and Visual Analogue Scale (VAS) score at 6 hours after surgery among the four groups of patients. RESULTS: Statistically significant differences were observed between groups A1 and A2 in the operation time (12.00 ï¼»11.00, 13.00ï¼½ vs 8.50 ï¼»8.50, 9.00ï¼½ min, P < 0.05) and the incidence rate of abnormally short frenulum (0 vs 10%, P < 0.05) but not in the VAS score (3.00 ï¼»3.00, 4.00ï¼½ vs 3.00 ï¼»3.00, 3.75ï¼½, P > 0.05). Statistically significant differences were also found between groups B1 and B2 in the operation time (12.00 ï¼»11.00, 12.00ï¼½ vs 6.25 ï¼»6.00, 7.00ï¼½ min, P < 0.05) and the incidence rate of abnormally short frenulum (0 vs 7.5%, P < 0.05) but not in the VAS score (2.00 ï¼»2.00, 3.00ï¼½ vs 2.00 ï¼»2.00, 3.00ï¼½, P > 0.05). CONCLUSIONS: Abnormally short frenulum induced by circumcision with the disposable circumcision suture device is mainly attributed to ligation and fixation of the prepuce with the fixation band. Circumcision with the disposable circumcision suture device by suture positioning at the frenulum is a safe and effective method worthy of clinical promotion.

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

OBJECTIVE: To assess the clinical efficacy of disposable circumcision suture device (DCSD) in children receiving circumcision. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Comparative efficacy and safety of different circumcisions for patients with redundant prepuce or phimosis: A network meta-analysis.

BACKGROUND: Phimosis and redundant prepuce are defined as the inability of the foreskin to be retracted behind the glans penis in uncircumcised males. To synthesize the evidence and provide the hierarchies of different circumcisions for phimosis and redundant prepuce, we performed an overall network meta-analysis (NMA) based on their comparative efficacy and safety. MATERIAL AND METHODS: Electronic databases including PubMed, Embase, Wan Fang, VIP, CNKI and CBM database were researched from randomized controlled trials (RCTs) for redundant prepuce or phimosis. We conducted the direct and indirect comparisons by aggregate data drug information system (ADDIS) software. Moreover, consistency models were applied to assess the differences among the male circumcision practices, and the ranks based on probabilities of intervention for the different endpoints were performed. Node-splitting analysis was used to test inconsistency. RESULTS: Eighteen RCTs were included with 6179 participants. Compared with the conventional circumcision(CC), two new styles of circumcisions, the disposable circumcision suture device(DCSD) and Shang Ring circumcision(SRC), provided significantly shorter operation time[DCSD: standardized mean difference (SMD) = -20.60, 95% credible interval(CI) (-23.38, -17.82); SRC: SMD = -19.16, 95%CI (-21.86, -16.52)], shorter wound healing time [DCSD:SMD = -4.19, 95%CI (-8.24,-0.04); SRC: SMD = 4.55, 95%CI (1.62, 7.57); ] and better postoperative penile appearance [DCSD: odds ratios odds ratios (OR) = 11.42, 95%CI (3.60, 37.68); SRC: OR = 3.85,95%CI (1.29, 12.79)]. Additionally, DCSD showed a lower adverse events rate than other two treatments. However, no significant difference was shown in all surgeries for 24 h postoperative pain score. Node-splitting analysis showed that no significant inconsistency was existed (P > 0.05). CONCLUSIONS: Based on the results of NMA, DCSD may be a most effective and safest choice for phimosis and redundant prepuce. DCSD has the advantages of a shorter operation time, better postoperative penile appearance, fewer complication and shorter wound healing time. However, with the limitations of our study, additional multi-center RCTs are needed to evaluate the outcomes.

[Frenulum identification positioning with a disposable suture device in circumcision to prevent postoperative penile frenulum malposition].

OBJECTIVE: To investigate the effect of the frenulum identification positioning method with a disposable suture device in circumcision for the prevention of postoperative penile frenulum malposition. METHODS: Totally 212 patients with phimosis or redundant prepuce underwent circumcision from March 2015 to September 2016, including 109 cases of conventional circumcision (the control group) and 103 cases treated by frenulum identification positioning with a disposable suture device (the observation group). We observed the postoperative position of the penile frenulum and median raphe and compared the deviation angles of the frenulum between the two groups of patients. RESULTS: The median of penile frenulum deviation angle (interquartile range) was 0 (3.56) in the observation group, significantly smaller than 12.41 (19.59) in the control (P <0.001, P = 0.000). And the rate of frenulum deviation was remarkably lower in the former (8.74% ï¼»9/103ï¼½) than in the latter group (66.06% ï¼»72/109ï¼½) (P <0.01). CONCLUSIONS: Circumcision using the frenulum identification positioning method with a disposable suture device can effectively avoid postoperative penile frenulum malposition. With the advantages of safety and easy operation, it deserves clinical application and popularization.

Use of a disposable circumcision suture device versus conventional circumcision: A systematic review and meta-analysis / 亚洲男科学杂志(英文版)

This systematic review assessed the safety and efficacy of the disposable circumcision suture device (DCSD) and conventional circumcision (CC) in the treatment of redundant prepuce and phimosis. Two independent reviewers conducted a literature search for randomized controlled trials (RCTs) using the DCSD and CC for the treatment of redundant prepuce or phimosis in China and abroad. Nine RCTs (1898 cases) were included. Compared with the CC group, the DCSD group had a shorter operative time (standardized mean difference [SMD] = -21.44; 95% confidence intervals [95% CIs] [-25.08, -17.79]; P < 0.00001), shorter wound healing time (SMD = -3.66; 95% CI [-5.46, -1.85]; P < 0.0001), less intraoperative blood loss (SMD = -9.64; 95% CI [-11.37, -7.90]; P < 0.00001), better cosmetic penile appearance (odds ratio [OR] =8.77; 95% CI [5.90, 13.02]; P < 0.00001), lower intraoperative pain score, lower 24-h postoperative pain score, lower incidence of infection, less incision edema, and fewer adverse events. There were no differences between the CC and DCSD groups in the incidences of dehiscence, or hematoma. The results of this meta-analysis indicate that the DCSD appears to be safer and more effective than CC. However, additional high-quality RCTs with larger study populations are needed.

Frenulum identification positioning with a disposable suture device in circumcision to prevent postoperative penile frenulum malposition / 中华男科学杂志

Objective@#To investigate the effect of the frenulum identification positioning method with a disposable suture device in circumcision for the prevention of postoperative penile frenulum malposition.@*METHODS@#Totally 212 patients with phimosis or redundant prepuce underwent circumcision from March 2015 to September 2016, including 109 cases of conventional circumcision (the control group) and 103 cases treated by frenulum identification positioning with a disposable suture device (the observation group). We observed the postoperative position of the penile frenulum and median raphe and compared the deviation angles of the frenulum between the two groups of patients.@*RESULTS@#The median of penile frenulum deviation angle (interquartile range) was 0 (3.56) in the observation group, significantly smaller than 12.41 (19.59) in the control (P <0.001, P = 0.000). And the rate of frenulum deviation was remarkably lower in the former (8.74% ［9/103］) than in the latter group (66.06% ［72/109］) (P <0.01).@*CONCLUSIONS@#Circumcision using the frenulum identification positioning method with a disposable suture device can effectively avoid postoperative penile frenulum malposition. With the advantages of safety and easy operation, it deserves clinical application and popularization.

[Shang Ring versus disposable circumcision suture device in the treatment of phimosis or redundant prepuce].

OBJECTIVE: To compare the clinical efficiency of Shang Ring with that of the disposable circumcision suture device (DCSD) in the treatment of phimosis or redundant prepuce. METHODS: From June 2013 to March 2015, we treated 320 patients with phimosis or redundant prepuce using Shang Ring (n=158) or DCSD (n=162). We compared the operation time, intra-operative blood loss, incision healing time, postoperative complications, postoperative satisfaction, and treatment cost between the two groups of patients. RESULTS: Comparison between the Shang Ring and DCSD groups showed that the operation time was (5.6±1.3) vs (5.4±1.2) min, intra-operative blood loss (1.2±0.8) vs (1.3±0.9) ml, postoperative delayed hemorrhage 3.16% (5/158) vs 4.32% (7/162), incision healing time (16.1±7.2) vs (7.5±2.3) d, wound infection 15.82% (25/158) vs 7.41% (12/162), 1-month postoperative incision edema 29.11% (46/158) vs 9.26% (15/162), overall postoperative satisfaction rate 63.92% (101/158) vs 90.12% (146/162), and treatment cost (1121.2±15.6) vs (2142.6±10.8) RMB ¥. There were statistically significant differences between the two groups in the latter five parameters (P<0.05 ), but not in the first three (P>0.05 ). CONCLUSIONS: The DSCD has an obvious superiority over Shang Ring for its relatively lower complication rate, shorter incision healing time, and better cosmetic appearance.

Compared the Efficacy of Circumcision Suture Surgery and Surgery Foreskin Cerclage Ring / 现代医院

Objective The curative effect comparison of circumcision suture surgery and surgery foreskin cerclage ring.Methods Selection in our department from July 2013 to October 2016 were selected from children with phimosis or re-dundant prepuce in children with a total of 562 cases as the research object , randomly divided into control group (182 cases) and observation group (380 cases).The observation group using disposable circumcision suture treatment , the control group using prepuce ring resection in the treatment of patients , observe the operation effect , two postoperative pain and complica-tions.Results The observation group operation success rate ( 100%) was significantly higher than the control group (94.09%), observation group operation time , intraoperative bleeding volume , postoperative 24h pain scores were signifi-cantly less than the control group , the adverse reaction rate of observation group ( 6.32%) was significantly lower than the control group (11.54%),the differences between groups were significantly P<0.05.Conclusion Ircumcision surgery su-ture is better than that of ring foreskin cerclage surgery , more safe and reliable .

Shang Ring versus disposable circumcision suture device in the treatment of phimosis or redundant prepuce / 中华男科学杂志

<p><b>Objective</b>To compare the clinical efficiency of Shang Ring with that of the disposable circumcision suture device (DCSD) in the treatment of phimosis or redundant prepuce.</p><p><b>METHODS</b>From June 2013 to March 2015, we treated 320 patients with phimosis or redundant prepuce using Shang Ring (n=158) or DCSD (n=162). We compared the operation time, intra-operative blood loss, incision healing time, postoperative complications, postoperative satisfaction, and treatment cost between the two groups of patients.</p><p><b>RESULTS</b>Comparison between the Shang Ring and DCSD groups showed that the operation time was (5.6±1.3) vs (5.4±1.2) min, intra-operative blood loss (1.2±0.8) vs (1.3±0.9) ml, postoperative delayed hemorrhage 3.16% (5/158) vs 4.32% (7/162), incision healing time (16.1±7.2) vs (7.5±2.3) d, wound infection 15.82% (25/158) vs 7.41% (12/162), 1-month postoperative incision edema 29.11% (46/158) vs 9.26% (15/162), overall postoperative satisfaction rate 63.92% (101/158) vs 90.12% (146/162), and treatment cost (1121.2±15.6) vs (2142.6±10.8) RMB ¥. There were statistically significant differences between the two groups in the latter five parameters (P<0.05 ), but not in the first three (P>0.05 ).</p><p><b>CONCLUSIONS</b>The DSCD has an obvious superiority over Shang Ring for its relatively lower complication rate, shorter incision healing time, and better cosmetic appearance.</p>

Applications of disposable circumcision stapler with lidocaine cream combined with lidocaine injection anesthesia in circumcision / 中华泌尿外科杂志

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 eases) ,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), wound healing time had no significant difference (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.

Effect of compound prescription cortex phellodendri chinensis fluid on postoperative wound anastomosis nail loss in patients with circumcision by disposable circumcision suture device / 中国生化药物杂志

Objective To discuss cause and treatment measures of the postoperative failed to fully automatic nail in patients with circumcision by disposable circumcision suture device, so as to improve the quality of the circumcision.Methods 182 cases received circumcision by disposable circumcision suture device were randomly selected from September 2014 to March 2015 in the hospital and divided into control group ( n =86 ) and treatment group (n=96).All the patients received oral antibiotics for three days conventionally.Patients in control group were dressing with 0.1%iodine after treatment, dressing change every two or three days, while the treatment group soaking with 30 mL to 40 mL compound prescription cortex phellodendri chinensis fluid for 15 min two times per day.The postoperative wound anastomosis nail loss effect in two groups were compared.Results The time of complete nail loss in patients soaking with compound prescription cortex phellodendri chinensis fluid was significantly shorter than that in patients dressing with 0.1% iodine (P<0.05), but there was no significantly difference of the first time to lose nail between two groups.The rate of complete nail loss in treatment group was 94 cases (97.9%), which was significantly higher than 68 cases (79.1%) in control group (χ2 =16.47,P<0.05). The adverse reactions were mild of two groups.Conclusion The compound prescription cortex phellodendri chinensis fluid has exact effect on postoperative wound anastomosis nail loss and recovery in patients’ with circumcision by disposable circumcision suture device.