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ZSR circumcision

A white, inflammatory scaring condition called BXO can also develop in congenital tight foreskin in adults.

The Association Between Phimosis and Balanitis Xerotica Obliterans (BXO) 

Phimosis, a condition characterised by the tightening of the foreskin, leading to difficulty in retracting it over the head of the penis, can appear at birth (congenital) or later in adult life (acquired). This blog also discussed the correlation between acquired tight foreskin and balanitis xerotica obliterans (BXO), also known as lichen sclerosus et atrophicus, a chronic inflammatory condition primarily affecting the genital area. 

Correlation Analysis of Phimosis and BXO: Notably, the association between acquired phimosis and BXO is more pronounced than congenital phimosis. BXO is identified as the primary causative factor for acquired phimosis in both adults and children. The inflammatory nature of BXO triggers scarring and constriction of the foreskin, consequently resulting in diseased and acquired phimosis. While the relationship between congenital phimosis and BXO is less explicit, BXO can also be present in cases of congenital phimosis. 

Significance and Treatment Modalities: The heightened risk of BXO linked to acquired phimosis underscores the critical importance of timely diagnosis and effective management. Early intervention for BXO is paramount in averting complications such as extensive scarring and urethral stricture. 

Treatment approaches vary based on severity and aetiology. In milder instances of acquired phimosis, topical corticosteroids and non-surgical interventions may be required. Surgical intervention, particularly circumcision, may be warranted in severe cases of phimosis or BXO, particularly when they pose significant discomfort, impede hygiene, or disrupt sexual function. 

Recent Study on BXO and Phimosis: A contemporary study sought to enhance our understanding of the correlation between BXO and phimosis. Histological analysis of tissue samples from 120 subjects who underwent circumcision for phimosis was conducted. Findings revealed a substantial presence of BXO, with 45.1% of subjects with congenital phimosis and 62.3% with acquired phimosis manifesting BXO. This data strongly indicates a robust association between BXO and acquired phimosis. 

Key message: The study distinctly underscores a robust correlation between BXO and acquired phimosis. Notably, the type of phimosis (congenital or acquired) emerged as the pivotal factor linked to BXO development in this investigation. Nevertheless, further research is warranted to validate and fortify these observations. 

Consultation with our Urological Specialist: Individuals faced with challenges retracting the foreskin are advised to seek consultation with our consultant urologists for precise diagnosis and tailored treatment options. 

Note: This blog is intended solely to serve an informative function and should not be taken as medical professional advice. For specific concerns, it is imperative to use the expertise of our consultant urologists.

Which disposable stapler device is better for adult circumcision: CircCurer or ZSR

Stapler Options for Adult Circumcision: CircCurer vs. ZSR Circumcision Stapler Devices

I. Introduction

In the UK, new stapler options for adult circumcision have been introduced.

We look at the performance, postoperative healing, complications, and stapler removal rate of two disposable circumcision stapler devices used in adult male circumcision: CircCurer and ZSR.

II. Comparison of CircCurer and ZSR Circumcision Stapler devices

   A. Operative Efficiency and Safety

      1. Performance in operative time

      2. Complication rates

      3. Infection and bleeding rates

Operative Efficiency and Safety: Both stapler devices demonstrated similar performance in operative time (around 7 minutes) and complication rates. Patients experienced minimal infections and hematomas in both groups, underscoring the safety of these devices. Pain scores were comparable between the CircCurer and ZSR stapler circumcision groups.

   B. Postoperative Considerations

      1. Healing outcomes

      2. Swelling rates

      3. Stapler’s removal rates

Postoperative Considerations: While both devices resulted in successful circumcision, some subtle differences emerged regarding post-surgical experiences. The CircCurer group showed a slightly higher swelling rate (oedema) than ZSR. However, a significant difference arose with staple removal. The ZSR group had a substantially higher incidence of staples spontaneously falling out (62.9%) than the CircCurer group (38%).

III. Patient Satisfaction and Considerations

   A. Patient satisfaction levels

   B. Healing time comparison

   C. Staple removal considerations

Despite the difference in staple retention, patients in both groups reported remarkably high satisfaction levels at the two-month follow-up, instilling confidence in the effectiveness of these devices. However, it's essential to consider some additional factors when choosing a stapler device for adult circumcision:

Healing Time: At two months, patients of both groups reported satisfaction with the outcome. This means that stapler circumcision takes longer to heal compared to traditional methods of circumcision.

Staple Removal: The study highlighted that ZSR exhibited a higher rate of staple fallout, necessitating an additional follow-up procedure for removal in the CircCure method, sometimes requiring local anaesthesia. More patients (40-60%) in the CircCurer group must return for a follow-up procedure to remove the staplers

IV. Making an Informed Decision

   A. Empowering doctors to make informed choices.

   B. Factors for patient consideration

   C. Highlighting distinctions in stapler devices

This information provides valuable insights for doctors and patients considering stapler circumcision for adults. While both CircCurer and ZSR proved effective and safe for the procedure, the higher rate of staple fallout with ZSR is a noteworthy distinction. Understanding these differences empowers doctors and patients to actively participate in decision-making, selecting the most suitable device based on individual needs and preferences.

V. Conclusion

   A. Summary of benefits of both devices

   B. Noteworthy distinctions

   C. Impact of healing time and staple removal on decision-making

In conclusion, both devices offer similar benefits, including short surgery times, low complication rates, and high patient satisfaction. However, the ZSR device showed a significantly higher rate of metal clips falling out spontaneously and less need for a follow-up procedure for staple removal. Healing time is much longer in stapler circumcision compared to traditional methods.

VI. References

    • Efficacy and safety of two disposable circumcision suture devices for circumcision in adults: a prospective comparative multicentre study, International Journal of Impotence Research June 2024, Italy, and Spain DOI:10.1038/s41443-024-00933-3

    • Circumcision devices versus standard surgical techniques in adolescent and adult male circumcisions: a Cochrane review. BJU Int. 2022 Jul; 130(1): 26–34. doi: 10.1111/bju.15604

    • Adult male circumcision with a circular stapler versus conventional circumcision: A prospective randomized clinical trial Braz J Med Biol Res. 2015 Jun; 48(6): 577–582. doi: 10.1590/1414-431X20154530

    • A Comparative Study on the Clinical Efficacy of Two Different Disposable Circumcision Suture Devices in Adult Males, Urol J 2017 Aug 29;14: 5013-17

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