Adult circumcision with Shang Ring Versus Glue

“The Shang Ring circumcision is safe and effective, does not require suturing or electrocautery, and is simple enough to enable the procedure to be performed by non-physician healthcare providers”

— Masson P, Li PS, Barone Ma, Goldstein M: The ShangRing device for simplified adult circumcision. Nat Rev Urol 2010;7:638–642

“Conventional adult male circumcision can be easily performed by an experienced urologist and the complications are rare”

— Yue Cheng, MD Chief, Professor of Urology and Andrology

“The total postoperative complication rate in the circumcision with Shang ring  was 8.16% (55 of 674)”

— Cheng Y, et al : Analysis and prevention of postoperative complications after Shang Ring adult male circumcision. Chinese J Clin 2012;6:e4474–e4476

“The overall postoperative complication rate in shang ring circumcision was 7.11%”

— Peng YF, Yang BH, Jia C, Jiang J: [Standardized male circumcision with Shang Ring reduces postoperative complications: a report of 351 cases]. Zhonghua Nan Ke Xue 2010;16: 963–966.

Chinese Shang Ring Male Circumcision: A Review by Urol Int DOI: 10.1159/000464449 (2017)

Please see the report as below: https://www.karger.com/Article/Pdf/464449

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“Glue Circumcision: Overall minor complication rate of adult circumcision with glue is 2.8% (5/181) at our circumcision clinic.”

— Audit report 1 May 2016 to 30 April 2017 by Dr Khan

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Adult circumcision with glue and stitches under local anaesthesia in our Thornhill clinic over 2 years ( Presented as a poster at London Healthcare Conference 2017)

Thornhill Clinic, 1-3 Thornhill Road, Luton, Bedfordshire, England

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 372 circumcisions (glue n=269 and stitches n=103), 230 (62 %) patients had medical 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 anaesthesia in dedicated GP surgeries. This could help ease pressure on local urology departments.

Frenulectomy of penis

Minor Tears at the Penile Frenulum Can Cause Pain and Bleeding During Sex.

What should you do if your penis frenulum is torn?

The penile frenulum, often referred to as the "banjo string," plays a crucial role in male anatomy by connecting the foreskin to the head of the penis. When this small piece of skin is too short, it can lead to a condition known as frenulum breve, causing discomfort during erection and sexual activities.

Adults feel pain during sex due to several reasons.  Some men have recurrent pain during sex. This may be due to a short or tight frenulum or a tear to the frenulum.   However, pain can occur due to other reasons as well. 

What is Frenulum Breve?

 Frenulum breve occurs when the penile frenulum is too tight. This small band of skin can cause pain, tears, bleeding, and scarring during sexual activities, making it a concern for many adolescents and men. In some cases, frenulum breve is associated with a skin condition called Balanitis Xerotica Obliterans (BXO), which can result in more severe scarring.

 Understanding the Stages of the penile frenulum

1. Tight/Short Frenulum without Tear or Scar:

   - Mild cases with no visible issues.

   - Lubricants during sex can help prevent problems.

2. Torn Frenulum with Healing:

   - Tear and healing occur, but no lasting scar.

   - Considerable discomfort during this stage.

3. Visible Frenulum Scarring with or without BXO:

   - Scar tissue becomes visible.

   - Associated with a skin condition (BXO) in some cases.

4. Complete Scarring of BXO Beyond the Frenulum:

   - Severe scarring extends beyond the frenulum.

   - Can result in significant complications.

Treatment Options

1. Observation:

   - For mild cases, no specific treatment.

   - Using a lubricant during sex can help avoid problems.

2. Steroids Cream:

   - In the early stages of scarring, applying a steroid cream can be effective.

3. Penile Frenuloplasty or frenulectomy:

   - A procedure to release the tight frenulum.

   - Dissolvable stitches used for healing.

   - Loose bandage applied for a day or two.

4. Circumcision:

   - Removal of the foreskin, suitable for more severe cases.

Frenuloplasty or frenulectomy of the penis or release or division of frenulum breve can be cured the pain during sex. Frenulectomy, is simply a foreskin-releasing procedure. An incision is made on the frenulum or excised the ridge underneath the surface, thus allowing full retraction. This will allow you to retain your foreskin but at the same time be able to keep the area underneath clean. 

Frenulectomy and circumcision can be done at the same time. Sometimes, adults preferred frenulum removal during the circumcision. 

Frenulectomy is the first-line treatment in these cases in which pain or tear to the frenulum is the main complaint. 

The benefit is that he retains his foreskin. Frenuloplasty helps to get rid of most of the bending of the penis.

What Happens During Frenuloplasty or Frenulectomy

- Done under local or general anaesthesia.

- The frenulum is cut and stitched in a way that lengthens it.

- Wound is sealed with glue

- Dissolvable stitches are used, and a bandage is applied temporarily.

Risks and After-Effects:

- Expect swelling and bruising, which can last a few weeks.

- Minimal bleeding, usually manageable with pressure.

- Infection is a rare complication treated with antibiotics.

- Changes in sensation over the penis head may occur.

- Some tenderness at the scar site.

- 5-10% chance of foreskin tightness recurrence.

Taking Care After the Procedure:

- Swelling and bruising may persist for a few days.

- Stitches dissolve in 3-4 weeks.

- Painkillers can help with discomfort.

- Keep the area dry. Avoid baths for 10 days.

- No swimming or intense exercise for two weeks.

- Maintain wound hygiene after urination.

- Apply Vaseline to the penis tip.

- Wear tight underwear for a couple of days.

- Start withdrawing the foreskin daily after 4 days.

- Sexual abstinence for 4-6 weeks.

Dr. Khan and Our Consultant Urologists, who are fully trained and most experienced in frenuloplasty or frenulectomy (removal of frenulum), will give you professional advice on whether this frenulum removal suits you.  

Newborn and baby boys circumcision by circumplast (modern Ring)

A review of first 1000 circumcisions in boys with a novel disposable ring in a community clinic.

Thornhill Circumcision Clinic, Luton and Leyton Clinic, London

PURPOSE

We evaluated postoperative complications in first 1000 circumcisions with a novel disposable ring, Circumplast, in a community clinic (London and Luton Clinic) for non-therapeutic male circumcision.

MATERIAL AND METHODS

We reviewed the outcome of first 1000 circumcisions performed with Circumplast device in children from May 2014 to October 2016 in a community clinic. Data were collected prospectively and all circumcisions were performed under local anaesthesia, by trained doctors with the backup of a trained paediatric surgeon. Early and late complications were assessed. Complications were further looked for under and over 3 months old. Follow-up consultation/visit were arranged if required.

RESULTS

The mean age of the patients was 11 ± 0.6 months (median 2, range 2 days to 11 years). The overall incidence of minor complications was 10% (n=101).

There is no major complication.

The outcome was significantly better in children under 3 months (7%, 39/554) over than 3 months (14%, 62/446) (p<0.05). Delay in ring separation is significantly lower in children under 3 months (0.3% to 2.9%) (p<0.05). Postoperative use of antibiotics for suspected infection was also significantly lower in children under 3 months (3% vs 7.4% n=17 vs 33) (P<0.05).

Post-operative bleeding (1%), preputial adhesions (1%), buried penis (0.6%), redo operations (0.7%), and urinary retention (0.01%) were recorded, but there was no significant difference in children under 3 months (P>0.05). Mean follow-up consultations were 16 days (range 1 to 373).

CONCLUSIONS

Non-therapeutic baby boys circumcision by the Circumplast device can be safely performed in a community clinic. This novel device decreases the risks of complication especially in children under 3 months of age.

Fisher Exact test, two tailed p value, <0.05 is significant, was done by Graphpad software

BXO phimosis- current practice

Our approach to the treatment of Balanitis Xerotica Oliterans (BXO) is aimed at eliminating occlusive contact of skin to urine, minimising urinary and sexual morbidity, abolishing the risk of progression to penile squamous cell carcinoma (PSCC) (by curing the inflammatory and scarring disease), with preservation of the foreskin if possible  If the condition is diagnosed early and interventions instituted promptly, disease progression and morbidity can be halted, and normality can be restored. Our medical treatment protocol involves avoidance of contact with urine by assiduously emptying the urethra after micturition (by shaking, squeezing, dabbing, and using barrier preparations), regular use of soap substitutes and barrier emollient creams and application of ultrapotent topical corticosteroids for a fixed, monitored period of time (usually clobetasol propionate). In addition, the short trimming of pubic hair is recommended in order to eliminate penile abrasion, irritation and inflammation. We avoid using topical calcineurin inhibitors due to the theoretical link with progression to SCC, but accept that this is controversial in BXO The mainstay of surgical management is circumcision.

If the above medical treatment regiment fails then circumcision is offered. Some patients may require further urethromeatal surgery. The success rates with medical therapy previously reported in the literature by us and others are in the range of 50-60%, whereas circumcision is thought to lead to cure in >75% of patients. Our results confirm the above; in isolated BXO, 50% of patients were treated successfully with medical therapy and foreskin preservation. The validity of the above treatment protocol is vindicated further by the outcomes of this study, with 91.7% having achieved resolution of symptoms, and the remaining either receiving ongoing medical therapy (4.8%) or waiting to undergo circumcision (3.5%). Side effects were minimal and mainly related to surgery.

Ref:

Journal of the European Academy of Dermatology and Venereology, Version of Record online: 16 AUG 2017