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circumcision with ＂no-flip Shang Ring＂ and ＂Dorsal Slit＂ methods for adult males： a single-centered, prospective, clinical study

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Asian Journal of Andrology 2016年第5期18卷 798-802页

作者： Jun-Hao Lei Liang-Ren Liu Qiang Wei Wen-Ben Xue Tu-Run Song Shi-Bing Yan Lu Yang Ping Han Yu-Chun Zhu Department of Urology West China Hospital Sichuan University Chengdu China Department of Urology Dujiangyan Medical Center/The Affiliated Hospital of ChengduUniversity Dujiangyan China

This paper was aimed to compare the clinical effectiveness and safety of adult male circumcision using the Shang RingTM （SR） with the no-flip technique compared with Dorsal Slit （DS） surgical method, A single-centered, prospective study was conducted at the West China Hospital, where patients were circumcised using the no-flip SR （n = 408） or the DS （n = 94） procedure. The adverse events （AEs） and satisfaction were recorded for both groups, and ring-removal time and percentage of delayed removals were recorded for the SR group. Finally, complete follow-up data were collected for 76.1% of patients （SR： n = 306; DS： n = 76）. The average ring-removal time for the SR group was 17.62 ± 6.30 days. The operation time （P 〈 0.001）, pain scores during the procedure （P 〈 0.001） and at 24 h postoperatively （P 〈 0.001）, bleeding （P = 0.001）, infection （P = 0.034）, and satisfaction with penile appearance （P 〈 0.001） in the SR group were superior to those in the DS group. After two postoperative weeks, the percentage of patients with edema in the SR group （P = 0.029） was higher but no differences were found at 4 weeks （P = 0, 185） between the two groups. In conclusions, the no-flip SR method was found to be superior to the DS method for its short operation time （〈5 min）, involving less pain, bleeding, infection, and resulting in a satisfactory appearance. However, the time for recovery from edema took longer, and patients may wear device for 2-3 weeks after the procedure.

关键词： Chinese Shang Ring circumcision Dorsal Slit phimosis redundant prepuce

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Simplifying the ShangRing technique for circumcision in boys and men: use of the no-flip technique with randomization to removal at 7 days versus spontaneous detachment

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Asian Journal of Andrology 2019年第4期21卷 324-331页

作者： Mark A Barone Philip S Li Richard K Lee Daniel Ouma Millicent Oundo Mukhaye Barasa Jairus Oketch Patrick Otiende Nixon Nyangweso Mary Maina Nicholas Kiswi Betty Chirchir Marc Goldstein Quentin D Awori EngenderHealth Washington DC 20004 USA Center for Male Reproductive Medicine and Surgery Department of Urology Weill Cornell Medical College New York Presbyterian Hospital New York NY 10065 USA Engender Health Nairobi 00100 Kenya Bon Sante Consulting Nairobi 00100 Kenya Homa Bay County Teaching and Referral Hospital Homa Bay 40300 Kenya Vipingo Health Centre Vipingo 80119 Kenya

To assess safety of the no-flip ShangRing male circumcision technique and to determine clinical course and safety of spontaneous detachme nt (i.e., allowing the device to fall off), we con ducted a case series of no-flip ShangRing circumcision combined with a randomized controlled trial of removal 7 days postcircumcision versus spontaneous detachment at two health facilities in Kenya. The primary outcome was the safety of the no-flip technique based on moderate and severe adverse events (AEs) during the procedure and through 42-day follow-up. A main sec on dary outcome was clinical course and safety of spontan eous detachment. Two hundred and thirty males 10 years and older underwent no?flip circumcision;114 randomized to 7-day removal and 116 to spontaneous detachment. All circumcisions were successfully completed. Overall 5.3%(6/114) of participants in the 7-day group and 1.7%(2/116) in the spontan eous group had an AE;with no d iff ere nces when compared to the 3% AE rate in historical data from African studies using the original flip technique (P = 0.07 and P = 0.79, respectively). Overall 72.4%(84/116) of participants in the spontaneous group wore the ShangRing until it detached. Among the remaining (27.6%;32/116), the ring was removed, primarily at the participants1 request, due to pain or discomfort. There was no d iff ere nee in AE rates (P = 0.169), visit day declared healed (P= 0.324), or satisfaction (P= 0.371) between randomization groups. The median time to detachment was 14.0 (IQR: 7-21, range: 5-35) days. The no?flip technique and spontaneous detachment are safe, effective, and acceptable to boys and men 10 years and older. Phimosis and penile adhesions do not limit successful ShangRing circumcision with the no-flip technique.

关键词： HIV prevention male circumcision device no-flip technique ShangRing voluntary medical male circumcision

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Disposable circumcision suture device： clinical effect and patient satisfaction

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Asian Journal of Andrology 2014年第3期16卷 453-456页

作者： Bo-Dong Lv Shi-Geng Zhang Xuan-Wen Zhu Jie Zhang Gang Chen Min-Fu Chen Hong-Liang Shen Zai-Jun Pei Zhao-Dian Chen The First Affiliated Hospital of Zhejiang University Zhejiang Hangzhou Departments of Urology The Second Affiliated Hospital of Zhejiang Chinese Medical University Hangzhou Department of Urology People's Hospital of Anji County Huzhou Department of Urology Traditional Chinese Medical Hospital of Deqing County Huzhou Department of Urology Traditional Chinese Medical Hospital of Tongxiang County Jiaxing China

In our experience patients undergoing circumcision are mostly concerned about pain and penile appearances. We conducted a prospective randomized trial to assess the benefits of a new disposable circumcision suture device （DCSD）. A total of 942 patients were equally divided into three groups （conventional circumcision, Shang ring and disposable suture device group）. Patients in the DCSD group were anesthetized with compound 5% lidocaine cream, the others with a 2% lidocaine penile block. Operation time, intra-operative blood loss, incision healing time, intra-operative and post-operative pain, the penile appearance and overall satisfaction degree were measured. Operation time and intra-operative blood loss were significantly lower in the Shang ring and suture device groups compared to the conventional group （P 〈 0.001）. Intra-operative pain was less in the suture device group compared With the other two groups （P 〈 0.001）; whereas post-operative pain was higher in the conventional group compared to the other two groups （P 〈 0.001）. Patients in the suture device （80.57%） and Shang ring （73,57%） groups were more satisfied with penile appearances compared with the conventional circumcision group （20.06%, P 〈 0.05）. Patients in suture device group also healed markedly faster than the conventional group （P 〈 0.01）. The overall satisfaction rate was better in the suture device group （78.66%） compared with the conventional （47.13%） and Shang ring （50.00%） groups （P 〈 0.05）. The combination of DCSD and lidocaine cream resulted in shorter operation and incision healing times, reduced intra-operative and post-operative pain and improved patient satisfaction with the cosmetic appearances.

关键词： circumcision disposable circumcision suture device patient satisfaction penis appearance pre-operative and post-operative pain Shang ring ~

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Ischemic glans penis after circumcision

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Asian Journal of Andrology 2004年第2期6卷 161-163页

作者： Yuan-ShengTzeng Shou-HungTang EnMeng Teng-FuLin Guang-HuanSun DivisionofUrology DepartmentofSurgery DepartmentofUndersea＆HyperbaricMedicine Tri-ServiceGeneralHospitalNationalDefenseMedicalCenterTaipeiChina

A 33-year-old male receiving dorsal penile nerve block (DPNB) for circumcision exhibited a postoperative ischemic change over the glans penis. The event occurred nearly 24 hours after the procedure. The patient was treated with intravenous pentoxifyllin and hyperbaric oxygenation. Total reverse of the ischemia was observed. The complications associated with circumcision and DPNB were reviewed and discussed.

关键词： circumcision glans penis hyperbaric oxygenation

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Glans ischemia after circumcision in children:Two case reports

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World Journal of Clinical Pediatrics 2021年第4期10卷 79-83页

作者： Daniela Codrich Alessandro Boscarelli Alessia Cerrina Maria-Grazia Scarpa Marianna Iaquinto Damiana Olenik Edoardo Guida Jurgen Schleef Department of Pediatric Surgery and Urology Institute for maternal and child health-IRCCS Burlo GarofoloTrieste 34137Italy

circumcision refers to the removal of the skin covering the tip of the penis and is one of the most common surgical procedures performed in *** though circumcision is a well-standardized operation,several minor and major complications may be experienced by paediatric *** ischemia(GI)has been widely reported in the paediatric literature as a complication following ***,etiopathogenesis of GI is not well defined and management guidelines are *** SUMMARY We describe our experience with this rare and scary complication using subcutaneous enoxaparin alone or in association with a topical *** Hypothetical causes and different management strategies are discussed.

关键词： circumcision Children Complications Glans penis Ischemia Case report

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The“ARM”principle and practice:Preventing postoperative complications of circumcision

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Chinese Journal of Plastic and Reconstructive Surgery 2022年第3期4卷 119-122页

作者： Chen Cheng Yiwen Zhou Quan Zhang Yang Liu Kaixiang Cheng Department of Plastic and Reconstructive Surgery Shanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai 200011China Department of Plastic Surgery Shanghai Basilica ClinicShanghai 200030China

Background: As one of the most commonly performed surgical procedures, circumcision may lead to complications. However, studies on preventing postoperative complications are scarce and still insufficient to draw any conclusions. This retrospective study aimed to summarize the surgical principles and consideration for preventing complications after ***: We reviewed 28 patients(aged 3–45 years;median age, 24 years) with prepuce hyperplasia or phimosis treated with our modified circumcision technique. In our modified technique, an accurate incision design is made through the stretch test, the stenosis is released, and veins and lymphatic tissues in the fascia are maintained. These surgical details for preventing complications were abbreviated to “ARM.”Results: None of the patients had complications at the 6-month follow-up postoperatively. Only mild prepuce edema was observed, which returned to the normal condition spontaneously within 2–3 weeks. The diameter of the distal penis increased by 0.4 ± 0.1 cm 6 months after the ***: The “ARM” principle may help surgeons to prevent postoperative complications of *** the fascia during the procedure can increase the diameter of the surgical region.

关键词： circumcision Complication Stenosis Lymphatic circulation

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Comparison of a modified Mogen clamp and classic dorsal slit circumcision under local anesthesia:A clinical study

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Current Urology 2022年第3期16卷 175-179页

作者： Yavuz Güler Department of Urology Private Safa HospitalIstanbul34000Turkey

Background:Currently,although various methods are used,there is no gold standard method for ***,we developed a modified circumcision clamp inspired by the Mogen clamp suitable for circumcisions performed under local anesthesia in our *** evaluate its success and complications,we compared our modified Mogen clamp with a dorsal slit *** and methods:From 2013 to 2017,we retrospectively evaluated 1309 patients who had undergone circumcision;of these,832 used the modified Mogen clamp method(Group 1)and 477 used the dorsal slit method(Group 2).The patients'age,surgery duration,minor hemorrhage(not requiring suture or repeated surgical exploration after circumcision but with buffer or clotting solution used),major hemorrhage(hemorrhage requiring suture or exploration),redundant prepuce skin remnants,revision numbers,and family satisfaction values were evaluated and compared between the 2 ***:Patients were assessed at least 3 times:1 day,1 week,and 1 month after *** mean ages in Groups 1 and 2 were 16.5±22.8 versus 15.5±18.8 months,*** surgical procedure durations were 9.2±1.7 and 15.4±2.5 minutes in Groups 1 and 2,respectively(pcircumcision procedure with the modified Mogen clamp can be performed more rapidly than with the dorsal slit,and the cosmetic results are better as the incision line is more *** postoperative complications were similar,with problems related to redundant skin occurring more frequently with clamp circumcision.

关键词： circumcision Mogen clamp Dorsal slit

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circumcision of Infants and Children: Short-Term Trauma and Long-Term Psychosexual Harm

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Advances in Sexual Medicine 2015年第2期5卷 22-38页

作者： Gregory J. Boyle Australian Institute of Psychology Fortitude Valley Queensland Australia

Non-therapeutic infant male circumcision is a permanent surgical alteration to the penis that may cause significant physical, sexual and psychological harm. Physical harms include unintended adverse effects of the surgery itself (e.g., complications such as bleeding, infection, excessive removal of foreskin leaving insufficient shaft skin to accommodate erections, etc.), as well as the inherent loss of healthy, functional tissue. Sexual harms that necessarily follow from circumcision include the loss of all sensation in the foreskin itself, and the loss of all sexual functions that involve the physical manipulation of the foreskin. Additional sexual harms that may follow circumcision include reduced sexual sensation in the remaining penile structures, difficulty with masturbation, increased chafing in both the circumcised man and his sexual partner, as well as reduced overall psychosexual/psychological tension relief and subjective satisfaction. Psychological harms include short-term trauma as well as the potential for long-term emotional disturbances, including sadness, frustration, distress, and anger—akin to post-traumatic stress disorder (PTSD). In this paper, the extent and severity of these various harms are considered and it is argued that they are more serious and more widespread than is commonly believed.

关键词： circumcision Sexual Reduction Surgery circumcision-Related Deaths Male Genital Mutilation

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circumcision: History, Philosophy and Facts

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Open Journal of Urology 2015年第8期5卷 114-117页

作者： M. Amin El-Gohary Burjeel Hospital Abu Dhabi UAE

Introduction: circumcision (from Latin “circumcidere” meaning to cut around) is one of the most ancient and common surgical procedures?worldwide. Every male who undergoes this procedure has to experience severe pain and vulnerable to serious complications including, but not limited to, infection, hemorrhage, accidental injury, ethical concerns, as well as death. Methods: A retrospective review of the factual, therapeutic, and rational aspects of circumcision from its believed conception to the present. Conclusion: Though the origins of this procedure are still sketchy, it is an age-old belief that, dating to the early civilizations, circumcision could be synonymous as a penance in context to humanity’s sexual awakening.

关键词： circumcision History

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Infant male circumcision: An evidence-based policy statement

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Open Journal of Preventive Medicine 2012年第1期2卷 79-92页

作者： Brian J. Morris Alex D. Wodak Adrian Mindel Leslie Schrieber Karen A. Duggan Anthony Dilley Robin J. Willcourt Michael Lowy David A. Cooper Eugenie R. Lumbers C. Terry Russell Stephen R. Leeder School of Medical Sciences and Bosch Institute The University of Sydney Sydney Australia

Here we review the international evidence for benefits and risks of infant male circumcision (MC) and use this to develop an evidence-based policy statement for a developed nation setting, focusing on Australia. Evidence from good quality studies that include meta-analyses and randomized controlled trials showed that MC provides strong protection against: urinary tract infections and, in infancy, renal parenchymal disease;phimosis;paraphimosis;balanoposthitis;foreskin tearing;some heterosexually transmitted infections including HPV, HSV-2, trichomonas, HIV, and genital ulcer disease;thrush;inferior hygiene;penile cancer and possibly prostate cancer. In women, circumcision of the male partner protects against HPV, HSV-2, cervical cancer, bacterial vaginosis, and possibly Chlamydia. MC has no adverse effect on sexual function, sensitivity, penile sensation or satisfaction and may enhance the male sexual experience. Adverse effects are uncommon (<1%), and virtually all are minor and easily treated. For maximum benefits, safety, convenience and cost savings, MC should be performed in infancy and with local anesthesia. A risk-benefit analysis shows benefits exceed risks by a large margin. Over their lifetime up to half of uncircumcised males will suffer a medical condition as a result of retaining their foreskin. The ethics of infant MC and childhood vaccination are comparable. Our analysis finds MC is beneficial, safe and cost-effective, and should optimally be performed in infancy. In the interests of public health and individual wellbeing, adequate parental education, and steps to facilitate access and affordability should be encouraged in developed countries.

关键词： Male circumcision Public Health Infant Infections Sexually Transmitted Infections Cervical Cancer

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