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By Darrel Gregory,

Shang ring, CircCurer (ZSR) or Glue circumcision for adults

Glue circumcision gives better result.

Many patients are asking about different methods of circumcision. Adult circumcision can be performed by using:

  1. Shang ring device
  2. ZSR or CircCurer (LangHe) staples suture device
  3. Glue
  4. Stitches

Pros and cons of different methods of adult circumcision:

 Shang ring Circumcision:

Adult circumcision with Shang ring is quick procedure however wound healing takes longer than circumcision with stitches. (J Urol 2012)

A systematic review and meta-analysis of circumcision with Shang ring vs circumcision with stitches was reported in Urology 2015. As compared with the circumcision with stitches, Shang circumcision is associated with shorter operative time, lower operation pain, higher satisfaction with penile appearances, less blood loss during operation, lower complications, and lower bleeding rate. Shang circumcision appears to be a safer and more effective choice in comparison with circumcision with stitches for adult male patients.

One long term study showed scar width is 3.7+/- 1.6 mm (clinical med journal 2014). Healing showed significant wound edge gap after removal of Shang ring and this wound healed by secondary intention with scaring in some cases.

Circumcision with ZSR or CircCurer (LangHe) staples suture device:

Adult male circumcision with a circular stapler versus circumcision with stitches: A prospective randomised clinical trial involving 879 patients. In this study, the safety and efficacy of a new male circumcision technique involving the use of a circular stapler was reported. The operative time, blood loss, pain and complications were significantly lower in the stapler group. However, the treatment costs in the circumcision with stapler were much higher than those in the circumcision with stitches.

388/441 (88.0%) who underwent stapler circumcision required removal of residual staple nails. Stapler circumcision is a time-efficient and safe male circumcision technique, although it requires further improvement (Ref: Brazilian J of Med and Bio Research (2015) 48: 577-582)

This systematic review compared the safety and efficacy of the disposable circumcision suture device with circumcision with stitches in the treatment of long foreskin and tight foreskin. A meta-analysis of 9 trials using the both methods for the treatment of long foreskin or phimosis in China and abroad was studied. As compared with the Circumcision with stitches, the circumcision with staples device had a shorter operative time, shorter wound healing time, less blood loss, better cosmetic outcomes, lower pain, lower incidence of infection, less incision swelling, and fewer complications.

There were no differences between theses two groups in the incidences of wound dehiscence, or bleeding under the skin. The results of this study indicates that the Circumcision with staples device appears to be safer and more effective than CC. However, additional high‐quality trials with larger study populations are needed. (Asian J of Andrology (2017) 19, 362–367)

Circumcision with stitches or Glue:

Traditionally, circumcision wounds are closed by absorbable stitches. The use of tissue glue (iso amyl 2-cyanoacrylate) has been compared with traditional suturing for the approximation of circumcision wounds. In this study, both the methods were found to be comparable with significantly less time consumed in glue group. The purpose of the present study has been to prove that cyanoacrylate as a better option to circumcision with stitches in terms of cosmetic result, time consumed and incidence of infection.

Tissue glue group had less wound infection, bleeding and was cosmetically superior. The mean operative time was 14.2 min with tissue glue compared to 24.4 minutes for sutures. This difference was found as highly significant.

Conclusions: This study showed that the use of tissue glue in comparison to stitches has the following advantages: 1. Cosmetically better 2. Less operation time. All other criteria measured were nearly the same.  (Indian J Urol. 2011 27: 475–478.)

By looking at the medical literature our results with circumcision with glue were superior to all other methods and these results are endorsed by many patient’s feedback at Thornhill Circumcision Clinic

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By Darrel Gregory,

The prepuce or foreskin as it is commonly known can sometimes be too tight to retract over the glans penis – this is called Phimosis.

Phimosis is normal in toddlers and babies and all boys are born with a tight foreskin, as the boys grow the foreskin stretches, although in some cases, this does not happen.

If it occurs in older boys it may be because a skin condition has scared the tissue.  Most can live with the condition, but may need surgical intervention should the symptoms worsen.

Steroids can sometimes help the condition for short to medium term.  Circumcision can be an option for the more severe cases.

BALANITIS XEROTICA OBLITERANS (BXO)

Balanitis Xerotica Obliterans (BXO) is an inflammatory condition of the foreskin or the glans. It may be caused by trauma, irritants or an infection. Infective balanitis is commonly caused by bacteria or fungi (yeasts) which thrive in the warm, moist, dark conditions under the foreskin. Poor hygiene or retained soap, retained smegma or inadequate drying may cause an irritant balanitis.

WHAT IS BALANITIS XEROTICA OBLITERANS (BXO) FORESKIN?

BXO is a thin white crinkly patch that appears on the foreskin. It can be troublesome if this is not treated. This is also known lichen sclerosis atrophicus or white spot disease.

WHO GETS THE BXO

BXO is a disease that can affect uncircumcised males of all ages ranging from young boys to adolescent and adults. This is the commonest cause of tightening of the foreskin (BXO phimosis)

WHAT CAUSES THE BXO?

The exact cause of BXO is unknown. Sometimes it is associated with diseases in which the body’s immune system attacks normal tissues. Despite the tendency to affect genital skin, BXO is not an infection and is not contagious, so sexual partners cannot pick it up. Rarely, BXO can occur in relatives.

WHAT ARE THE SYMPTOMS OF BXO?

Many patients have none, but the most common symptom of BXO is itching. As a rule the patches on the foreskin itch and can also be sore if the skin breaks down or cracks. In the genital area, the scar-like process can tighten the skin, and this can interfere with sexual intercourse in affected men. BXO can make the foreskin tight and difficult to retract, and can even partly block the flow of urine.

If you have this problem,  then you can call us confidentially to find out availability.

 

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By Darrel Gregory,

Luton – audit results

The widespread acceptance of adult local anaesthesia circumcision in the community remains debatable. We report outcomes (Glue and Stiches) from a dedicated GP clinic over two year period. Patient demographics, indications and postoperative complications were recorded prospectively.

Of 373 circumcisions (glue n=269 and stitches n=103), 230 patients had therapeutic indications including 63 (17%) balanitis xerotica obliterans and 11 (2.9%) had minor complications (infection n=6, bleeding n=2 and redo n=3) with no significant difference between the two groups.

Circumcision performed in adults remains a safe surgical option under local anesthesia in dedicated GP surgeries. Glue circumcision gives excellent result for adult circumcision.

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