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.

Can Men with Diabetes Undergo Circumcision?

Circumcision in Diabetic Men

Yes, men with diabetes can safely undergo circumcision. Operation for freoskin may be a beneficial treatment option for foreskin conditions in diabetic men. This blog will cover several aspects of circumcision for diabetic men, including reasons for the procedure, necessary health metrics, where to get it done, and who performs the surgery,

1. Reasons for circumcision in diabetic men

2. Normal HbA1c results of diabetes required for the procedure

3. Locations where men can get circumcision 

4. Types of anaesthesia needed for circumcision 

5. Specialist doctors for performing the circumcision 

6. Risks of circumcision in diabetes 

7. Aftercare for circumcision with diabetes 

Reasons for Circumcision in Diabetic Men:

Men with diabetes are more susceptible to developing balanitis, inflammation, BXO, and infection of the foreskin. Fungal infection or other factors often cause these conditions. Despite antifungal and antibiotic treatments, recurring infections can lead to scarring due to BXO and phimosis. Circumcision becomes the most effective option for managing these conditions in diabetic men, especially when phimosis is severe and less responsive to non-surgical treatments.

Importance of Diabetic Control:

Reasonable diabetic control is crucial for optimal healing and reducing the risk of complications. Even if diabetes is not perfectly controlled, circumcision may still be an option, but HbA1c must be less than 7.6%.

Where to Find Adult Circumcision for Diabetic Men:

At the London Circumcision Centre, specialist consultants who are NHS urologists perform circumcisions for diabetic men.

Anesthesia for Circumcision:

Most circumcisions with glue or stitches can be done under local anaesthesia. However, some patients with needle phobia may require general anaesthesia.

Benefits of Local Anesthesia:

Local anaesthesia is a safer alternative for diabetic patients about to undergo circumcision, especially when considering other health conditions that make general anaesthesia risky.

Minimising Infection Risk:

Antibiotics are typically administered after circumcision, and waterproof glue is applied to reduce the risk of infection in diabetic patients. Diabetic patients are also advised to keep diabetes under control afterwards and are given antibiotic cream to use for ten days. Showers or washing are recommended after three days postoperatively.

Specialist doctor:

We are experienced specialist doctor who does circumcision in diabetes patients at London Circumcision Centre

Disclaimer:

This blog post is for informational purposes only and should not be a substitute for professional medical advice. It is essential to consult with a specialist to discuss your situation and determine if circumcision is the right choice for you.

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

Adult circumcision with CircCurer (LangHe) staple device (ZSR Circumcision)

First Private Clinic in London, UK, that Offers  Circumcision with this Novel CircCurer (LangHe) staples Device

Many patients are asking Dr Khan to circumcise with ZSR or stapler devices. Adult circumcision can be performed by  CircCurer (LangHe) or ZSR staples suture device. Dr Khan has simulation training in CircCurer (LangHe) staples suture device. 

Dr Khan offers circumcision with this new CircCurer (LangHe) staple device at The London Circumcision Clinic, Leyton, London. 

Adult circumcision with CircCurer stapler is a quick procedure. When it was compared with conventional circumcision with stitches, stapler circumcision is associated with shorter surgical time, higher patient satisfaction with penile looks, lower operative pain, less operative blood loss, and lower wound bleeding post-operatively. However, wound healing takes longer than traditional circumcision in adults.

 Anaesthesia

A local anaesthetic is used for the circumcision with staplers and injected into the base of the penis and all around the shaft of the penis. This provides safe and effective pain relief during the circumcision. This also minimises post-operative pain for a few hours.

Men's Circumcision Cost with CircCurer in the UK (16-YEAR-OLD AND ABOVE)

Circumcision with stapler Device £780 includes consultation on the same day and one free follow-up visit.

Informed Consent

We provide the patient with all the information about the stapler circumcision ahead of time. Stapler Circumcision is an irreversible procedure and makes the head of the penis exposed permanently. Informed consent is taken before the procedure.

Full or Partial Circumcision

Full circumcision means moderately cutting the inner and outer foreskin to expose the full of head of the penis. Partial circumcision leaves loose skin, which partially covers the glans (head of penis). Partial circumcision may not work in all adults. 

Full circumcision might give a false impression of loose/partial circumcision when the penis is in a flaccid state, especially in patients with a buried penis. Partial circumcision is possible, but it has a few complications in the long term. These can be discussed with Dr Khan at the Adult Circumcision Clinic  in London, UK

 Procedure Technique

The following are methods for adult and boys over 16-year-old for circumcision: 

• After local anaesthesia, the foreskin was retracted, and assess the suitability.

• If there is scarring due to BXO, stapler circumcision is not advisable to perform.

• Apply the bell of the instrument inside the foreskin

• Secure the right position of the stapling device

• Cut the skin and staples applied at the same time

• Apply the bandage around the wound at the end of the circumcision

Recovery for Adult Circumcision with staplers 

Circumcision with a stapler heals quicker than one with stitches. Swimming and weight lifting should be avoided for 2-3 weeks. Full recovery following circumcision generally requires 4-6 weeks.  Over-sensitivity of the glans may take a few months to resolve.

Adult Circumcision Healing Tips

To reduce the effect of night erections, pull on the staplers during the first few days after the adult circumcision, empty your bladder before retiring and a few times during the night. Sleep on your side or back. It may be helpful to draw your knees up a bit into a more foetal position. Wear tight underwear after the circumcision to prevent unnecessary movement. Follow the aftercare advice and keep the wound dry for five days. 

Please take vitamin C regularly for ten days to promote healing. If the staplers are completely off, apply vitamin E cream, Mederma gel, or bio-oil to the scar after 15 days. This will improve the scaring. Please contact us at The London Circumcision Centre for further advice.

Medical evidence 

Five recent studies involving 2026 men were included in comparing the stapler and conventional circumcisions with stitches.  The statistically significant incidence of circumcision with staplers was intra-operative blood loss, operating time, the mean pain score on the operation day, the mean pain scores on post-operation days and wound healing time. The majority of the patients (88.0%) required the removal of residual staples postoperatively after four weeks. 

References: 

1. Brazilian Journal of Medical and Biological Research (2015) 48: 577-582

2. Asian Journal of Andrology (2017) 19, 362–367

3. Scientific Report (2016) 6, 25514 

Risk of Adult Circumcision

The risks of circumcisions are explained to the patients. Risks are failed staple procedure requiring traditional circumcision, bleeding, bruises, haematoma formation, infection, retaining of staplers for more than four weeks, unintentional damage to the glans, removal of too much or too little skin, lymphoedema, aesthetically displeasing results and a change of sensation during sexual activity.

The patient should also be informed that, during the postoperative period, erections can cause pain, bleeding and discomfort. There are slight chances of disruption of the staples or scarring of wounds, which might require a redo or revision circumcision. 

Postoperative Care

You might experience discomfort for a few days after the circumcision, but painkillers help to decrease the pain. Passing urine is not usually affected by the circumcision. There will be swelling and bruising of the shaft of the penis for 2 to 3 weeks after the stapler circumcision. This will then subside gradually and should not be a cause for alarm. Bleeding after circumcision can be stopped by applying pressure or a bandage.

A dressing (bandage) is applied around the wound line to prevent the wound from sticking to your underclothes. A bandage with self-adhesive stretch gauze will stay for three days (Cobain). The wound will be at least 2-3 weeks before healing is completed, and you may return to work when you are comfortable enough.

Most people require at least 2-3 days off work. You should gently wash the wound daily after one week if the wound is dry and shower regularly.  It would be best to stop going to the gym or lifting heavy weights for 2 weeks. You should avoid any sexual activity for 4-6 weeks after the circumcision to avoid the breakdown of the wound.

Follow up visit

 Some of the staplers come off themselves. However, some staples remain over the wound after 3 weeks. All patients require arranging an appointment after 3-4 weeks so that we can remove the residual staples. 

PS: This information is for suggestions only. It is not a substitute for professional medical advice. Please call Dr. Khan at +447527314081 for free telephone advice without any obligation.

 © London Circumcision Centre, 2024. Unauthorised use and duplication of this blog without express and written permission from this blog’s author and owner is strictly prohibited.