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By john@ergodigital.com,

Non-therapeutic male circumcision in children with a novel disposable ring – Circumplast improves the outcome as compared to the standard Plastibell device at a community clinic.

This cohort study evaluates the early postoperative complications in Circumplast and Plastibell techniques, in a community clinic, for non-therapeutic male circumcision.

Material & Methods

We reviewed the outcome of non-therapeutic male circumcision in children (n=1387) over a 1 year period (May 2014 to April 2015) in a community clinic, performed under local anaesthesia, by trained doctors with the backup of a trained paediatric surgeon. The technique was selected by doctors’ preference. Data was collected prospectively and early postoperative complications were compared between Circumplast & Plastibell circumcisions. Follow-up consultations were arranged if required.

Results

  • The mean age was 18 ± 1.9 months (median 5.1) in Circumplast circumcision (CC) and 9.4 ± 0.6 months (median 1.5) in Plastibell circumcision (PC).
  • Incidence of complications is significantly lower in CC (6.3% n=13/208) versus PC (13% n=154/1179).
  • Delayed ring separation/migration is significantly lower in CC (3.2% n=7/208) versus PC (8.7% n=102/1179).
  • Post-operative bleeding (0.5% vs 0.6% n= 1 vs 7), preputial adhesions (1.4% vs 2.4% n= 3 vs 28), and miscellaneous complications (0.5% vs 1% n= 1 vs 13) were lower but not statistically significant (p>0.5) in CC versus PC respectively.
  • Postoperative use of antibiotics was higher in CC versus PC (6.7% vs 3.8% n=14 vs 45) but not statistically significant.
  • In children under 6 months, the overall outcome in both groups is significantly better in comparison to 6 – 110 months old.
  • Mean follow-up consultations were 19 days (range 1 to 373) in CC and 20 days (range 1 to 305) in PC.

Conclusions

Non-therapeutic male circumcision by the Circumplast device has a significantly lower risk of early postoperative complications in a community clinic, especially migration / impaction of the ring when compared to the standard Plastibell device.

Comment by the clinic:

This is our latest audit from Thornhill Circumcision Centre. This audit was presented by one of our doctors in the meeting of paediatric urologists at Harrogate, Yorkshire, UK on 23 June 2016 at the congress”

Slide Show of the Presentation

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By john@ergodigital.com,

What is involved in a child circumcision?

  • Circumcision (ring method) is the cutting off of the extra fold of skin that normally covers the head of the penis with the application of a plastic ring. After circumcision, the tip of the penis is always exposed.
  • We use the Circumplast circumcision device of Australian origin, which has the special advantage that the ring cannot migrate proximally. Such migration has, over many years, been reported as a potential problem with the nominally similar Plastibell device. The Circumplast device also protects the glans (tip of penis) and leaves less inner skin, which gives a neater look of tight circumcision.
  • We have also experienced of stich and glue circumcision in children, Gomco clamp circumcision, Alisklamp circumcision (Turkish Clamp) and Plastibell circumcision.

Assessment of Baby or Boy

Each child is assessed and a consultation is necessary before the operation. If there is a problem or contra-indication for circumcision a Specialist Paediatric Urologist referral is advised.

Indication

Parents may wish to have their boy circumcised for religious, social or cultural reasons. Sometimes circumcision is recommended for medical reasons such as Balanitis Xerotica obliterans (BXO) foreskin.

Procedure

We perform circumcision on male children using a local anaesthetic which provides safe and effective pain-relief. We employ the Circumplast or Plastibell technique (a ring method). A plastic ring is tied around the end of the penis at the foreskin. Top of foreskin is removed. The ring stays on the end of the penis and prevents bleeding after the surgery. The surgery takes approximately 10-15 minutes.

Infant or Boy Circumcision

We normally use the Circumplast circumcision device of Australian origin, which has the special advantage that the ring cannot migrate proximally. Such migration has, over many years, been reported as a potential problem with the nominally similar Plastibell device in cases where that design has been used for tight styles of circumcision.

The Circumplast device also protects the glans (tip of penis) and leaves less inner skin, which gives a neater look of tight circumcision.

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By john@ergodigital.com,

How an Experienced Doctor Makes all the Difference

img_30_03The Thornhill Circumcision Centre are experts in different methods of circumcision such as sleeve, sutureless (Glue), free hand, forceps guided method, stitches, dorsal slit, revision, redo circumcision, preputioplasty and frenuloplasty (release/division of a short tight frenulum which causes the head of the penis to tilt down during erections also called “frenulum breve.”). The surgeon can discuss the characteristics of high and low cut, tight and loose cut types of circumcision.

Procedure

A local anaesthetic is injected into the base of the penis and all around the shaft of the penis with a single injection, but 2-3 jabs. This provides safe and effective pain-relief during the operation. This is used as the sole form of anaesthesia around the wound and the patient is not put to sleep during the procedure.

This minimises post-operative pain as well for 1 hour. The entire foreskin is removed using an incision just behind the head of the penis. This leaves the head of the penis completely exposed permanently.

Alternative to Circumcision

There are alternatives to full circumcision, such as excision of frenulum, V-Y plasty operation called preputioplasty, frenuloplasty, partial circumcision or medical treatments.

These are personal preferences and can be discussed further with our specialist surgeon.

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