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

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.

Foreskin problems

Understanding Foreskin Problems: Causes, Signs, and Treatment

The foreskin, a protective fold of skin covering the penis in uncircumcised individuals, requires proper care to prevent potential issues later in life. Here's a comprehensive guide to foreskin problems, their causes, signs, treatment, and preventive measures.

What is the Foreskin?

The foreskin is a layered fold of skin that shields the end of the penis in uncircumcised individuals. While it requires no special care in early childhood, attention to hygiene becomes crucial as one grows older to prevent problems like swelling, infection, tightness, irritation, and dryness.

Causes of Foreskin Problems:

In young children, the foreskin is naturally attached to the penis head by the synechia membrane, which dissolves over time. Forcing it back prematurely can lead to issues. Phimosis, where the foreskin is too tight, is another cause, usually resolving between ages two and six. STIs, infections, BXO (lichen sclerosis ) or injuries can trigger problems in teenagers and adults.

Signs of Foreskin Problems:

Look out for pain during urination, itchiness, inability to retract the foreskin, pain during intercourse, redness, soreness, swelling, dryness, or split and bleeding skin. Consult our specialist Urologist if you experience these symptoms.

Treatment for Foreskin Problems:

Treatment varies based on the issue. Dryness may be managed with creams or ointments like steroid cream, while infections like balanitis can be treated with medications. In some cases, procedures may be required, such as moving back the foreskin in children with phimosis or circumcision in adults with persistent issues. Our approach with circumcision with glue is the best option.

Prevention of Foreskin Problems:

Proper care is crucial. Change underwear regularly, opt for loose underwear, avoid heavily scented hygiene products, clean the foreskin daily with warm water, and use protection during sex to reduce STI risks.

Specialists for Foreskin Problems:

A urologist, or a pediatric urologist for children, is the specialist to consult for foreskin problems. We provide these services in the London Circumcision Centre.

When to Consider Circumcision:

Circumcision is only considered when foreskin problems are severe and impact daily life, causing persistent pain or frequent urination issues. Phimosis with a scared or cracked foreskin will require circumcision.

When to Seek Medical Advice:

Call us if you experience difficulty urinating, a burning sensation, increasing pain, or inability to return the foreskin to its original position.

Understanding and addressing foreskin problems early is essential for maintaining male reproductive health. Regular hygiene practices and prompt medical attention can make a significant difference in preventing and managing foreskin-related issues.