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

Men’s circumcision

Understanding Men's Circumcision: Medical Perspectives

Introduction:

Circumcision, a surgical procedure involving the removal of the foreskin covering the penis, is a practice that spans both medical necessity and cultural traditions. This article seeks to comprehensively examine the medical dimensions of male circumcision, shedding light on the conditions that may warrant the procedure and the corresponding therapeutic interventions.

Medical Reasons for Circumcision in Men:

1. Tight Foreskin (Phimosis):

- Phimosis, characterised by a foreskin too tight to retract, can result in discomfort during erections or urination.

- Before opting for circumcision, alternative treatments like topical steroids are considered.

2. Recurrent Balanitis:

- Inflammation and infection of the foreskin and penis head may necessitate circumcision as a viable treatment option.

3. Paraphimosis:

- In cases where the foreskin cannot be restored to its original position, causing swelling and pain, circumcision becomes a preventive measure against serious complications.

4. Balanitis Xerotica Obliterans:

- This condition, inducing scarring and inflammation of the foreskin (BXO) and penis head, may find resolution through circumcision.

5. Cancer of the Penis:

- Although penile cancer is rare, circumcision could be recommended as part of the treatment protocol, often coupled with surgery, radiotherapy, or chemotherapy.

Other Treatment Options:

- Exploring less invasive approaches, such as topical steroids for phimosis or corticosteroid ointments for balanitis, precedes the consideration of circumcision.

HIV Prevention:

- Evidence from African trials suggests that circumcised men may have a reduced risk of HIV acquisition. However, the procedure's effectiveness against other sexually transmitted infections remains inconclusive.

The Procedure :

- Circumcision, generally a straightforward outpatient surgery, offers options for either general or local anaesthesia.

- Employing a scalpel or surgical scissors, the foreskin is excised, and the remaining edges are meticulously stitched together.

Recovery:

- Postoperative care involves adherence to instructions, including refraining from sexual activity for at least four weeks.

- Initial discomfort, swelling, and mild pain are anticipated, but persistent issues may signal infection, warranting prompt treatment.

Risks:

- Complications post-circumcision for medical reasons are infrequent in the UK, with bleeding and infection representing the most common concerns.

- Potential complications encompass reduced sensation, tenderness around the scar, and, in some instances, additional surgical interventions are necessary.

Conclusion:

Men's circumcision, whether motivated by medical necessity or cultural considerations, necessitates a thorough evaluation of potential advantages and risks. Engaging in meaningful discussions with our Consultant Urologist and exploring alternative treatments are indispensable to the decision-making process.

Adult Circumcision in London

Our Adult Circumcision in London services are provided to individuals aged 16 and above, addressing medical and nonmedical reasons. Medically, the procedure is recommended for conditions like tight foreskin, recurrent infections and cracked foreskin. Nonmedical reasons may include religious, personal, or cultural considerations. Anaesthesia options include local penile block with circumcision methods such as glue, stitches, or stapler techniques.

Indications

Circumcision is advised for medical conditions such as tight foreskin, tight when erection, recurrent infections, and scarring conditions like Balanitis Xerotica Obliterans (BXO). Circumcision also addresses issues like a tight or short frenulum and is performed for hygiene, cultural, or religious reasons.

Circumcision Pros and Cons

While medically recommended, debates surround the consequences of circumcision. Health benefits include a reduced risk of urinary tract infections, sexually transmitted diseases (STIs), and penile and cervical cancer. However, potential risks involve bleeding, infection, poor cosmetic results, and changes in sexual sensation. Trials in Africa suggest preventive benefits against STIs and HIV among men.

Anaesthesia

Local anaesthesia is administered with 2-3 pricks around the base and shaft of the penis, ensuring a pain-free experience during the operation. This method also minimises post-operative pain for a few hours.

Cost in the UK

Our transparent pricing includes a £150 consultation fee if the procedure is done at the same time and various circumcision options:

- Full circumcision with stitches £580

- Full circumcision with Glue £660

- Revision or Redo circumcision £980

Informed Consent

Informed consent is a priority. Patients receive comprehensive information about the irreversible nature of circumcision and its potential impact on sexual anatomy.

Full or Partial Circumcision

Both full and partial circumcision options are available. Full circumcision involves moderate removal of the inner and outer foreskin to expose the head of the penis, while partial circumcision leaves some loose skin.

Procedure Techniques

Various methods of circumcision are employed based on individual needs:

1. Dorsal slit method: Mainly for phimosis and paraphimosis.

2. Sleeve method: Freehand cutting.

3. Forceps-guided method: Use of forceps to cut the skin.

4. Freehand method: Cutting with scissors.

5. Shang ring: A disposable clamp.

6. Glue vs stitches: Glue or stitches are applied to skin edges, while glue involves using a medical glue to seal the skin. Each method has advantages, with glue known for better outcomes, less pain, less complication and precise closures.

7. Stapler circumcision: stapler techniques involve using a specialised device to cut and seal the skin simultaneously. The stapler techniques are known for being quick but may require the removal of staplers in some cases.

Recovery

Circumcision with glue promotes quicker healing than stitches. Swimming and weightlifting should be avoided for 2-3 weeks. Full recovery typically takes 4-6 weeks, with oversensitivity of the glans possibly lasting a few months.

Healing Tips

To minimize the impact of nocturnal erections on stitches, glue or staplers, empty your bladder before sleep and sleep on your side. Wear tight underwear, follow aftercare advice, and keep the wound dry for 3 days. Regular vitamin C intake for ten days and application of vitamin E or bio-oil after 15 days can promote healing and scar improvement.

Risks

Patients are informed about potential risks, including bleeding, bruises, hematoma formation, infection, accidental damage to the glans, aesthetically unpleasing results, and changes in sensation during intercourse and masturbation.

Post-operative Care

Expect discomfort for a few days, manageable with simple painkillers. Urination is usually painless and unaffected. Swelling and bruising subside within 7-10 days. Dressings remain for three days, and light clothing is advisable for 2-3 days. Return to work when comfortable, but refrain from sexual activity for 4-6 weeks.

Note: This information is a guide and not a substitute for professional medical advice. For further assistance, contact our doctor at +447527314081 for free telephone advice.

When will circumcision be needed for tight foreskin (phimosis) in adults or older men?

Male circumcision is rarely discussed, leading to insufficient information about foreskin conditions. This causes many conditions to go unnoticed, worsening one's health. One such condition is phimosis, where the foreskin is too tight to retract. Sometimes, it can fold back when the penis is relaxed but not when erect. This tightness causes minor damage during erections and sexual activity, leading to scarring. In adults, phimosis can be associated with infections like balanitis or sexually transmitted diseases.

Facts:

- Physiological phimosis in children often improves with age. The foreskin attachment breaks down, releasing a white material called smegma pearls. Most boys have a fully retractable foreskin by ages 10-12.

- Pathological phimosis is a medical condition caused by disease or scarring (BXO). It's important to distinguish it from a natural tight foreskin (physiological phimosis) as treatments differ.

Paraphimosis occurs when the foreskin gets stuck behind the penis head due to a tight ring. It requires immediate treatment, such as pulling the foreskin forward or preputioplasty to preserve it.

Causes:

- Skin conditions like BXO, Lichen planus, or Eczema.

- Infections: Circumcised men have lower rates of sexually transmitted infections, including syphilis, chancroid, and genital herpes (HSV-2).

- Scarring: BXO can cause severe scarring and phimosis.

- Potential cancer: There's a long-known link between un-circumcised men and penile cancer, especially in cases of phimosis history.

Non-surgical treatment:

Treatment for phimosis depends on age and severity. Options include:

- Steroid creams or ointments.

- Stretching exercises in early stages.

- Antifungal or antibiotic medications.

However, stretching scarred foreskin may cause more tearing and scarring. Scientific evidence is lacking for its effectiveness. Phimosis creams have had limited success in recent reports. Mild phimosis symptoms in adults can be managed by using condoms and lubricants during sexual activity.

Mild tight foreskin caused by fungal infection can be treated with antifungal medications and steroid cream. Adults with high blood glucose levels (diabetes mellitus) and phimosis may require circumcision due to recurring fungal infection or possible BXO. Tight foreskin (phimosis) in diabetic patients often requires circumcision and biopsy of the foreskin.

Surgical treatments:

- Frenuloplasty: A procedure that releases the frenulum, a small fold of tissue. It allows the foreskin to detach from the penis head.

- Preputioplasty: A procedure that expands the foreskin by an incision in front, enabling full retraction.

- Partial circumcision: Leaving part of the foreskin covering the penis head. It has long-term complications.

- Full circumcision: The standard surgical option with glue or stitches for tight foreskin, particularly for BXO phimosis, traumatic injury, or penile cancer.

If sexual activity is painful or uncomfortable due to phimosis, urgent treatment is needed. Home treatment includes daily cleansing, controlled stretching exercises, and clearing smegma. Infections with tight foreskin (balanitis) require antibiotic or antifungal treatment. It's essential to get examined for sexually transmitted diseases by a GUM clinic or a doctor.

In summary, there are various alternatives to full circumcision, such as medications, creams, frenuloplasty, preputioplasty, or a combination. These options should be discussed with a specialist or urologist. Full circumcision without any medical problems should be seriously considered as it is irreversible surgery.

PS: This information is for guidance only. This is not a replacement for professional medical advice. Please call Dr Khan for video consultation £150 advice at +447527314081 without any obligation.