Adult male circumcision with a circular stapler versus conventional circumcision: A prospective randomized clinical trial

Abstract

Male circumcision is the most frequently performed procedure by urologists. Safety and efficacy of the circumcision procedure requires continual improvement. In the present study, we investigated the safety and efficacy of a new male circumcision technique involving the use of a circular stapler. In total, 879 consecutive adult male patients were randomly divided into 2 groups: 441 underwent stapler circumcision, and 438 underwent conventional circumcision. The operative time, pain score, blood loss volume, healing time, treatment costs, and postoperative complications were compared between the two groups. The operative time and blood loss volume were significantly lower in the stapler group than in the conventional group (6.8 ± 3.1 vs 24.2 ± 3.2 min and 1.8 ± 1.8 vs 9.4 ± 1.5 mL, respectively; P<0.01 for both). The intraoperative and postoperative pain scores were significantly lower in the stapler group than in the conventional group (0.8 ± 0.5 vs 2.4 ± 0.8 and 4.0 ±0.9 vs 5.8 ± 1.0, respectively; P<0.01 for both). Additionally, the stapler group had significantly fewer complications than the conventional group (2.7% vs 7.8%, respectively; P<0.01). However, the treatment costs in the stapler group were much higher than those in the conventional group (US$356.60 ± 8.20 vs US$126.50 ± 7.00, respectively; P<0.01). Most patients (388/441, 88.0%) who underwent stapler circumcision required removal of residual staple nails. Overall, the present study has shown that stapler circumcision is a time-efficient and safe male circumcision technique, although it requires further improvement.

The characteristics of circular disposable devices and in situ devices for optimizing male circumcision: a network meta-analysis

“…Fifteen trials were retrieved for a detailed evaluation and five were excluded: two non-randomized controlled trials, one trial that compared two application methods of one device, and two trials that used immature 15 and harmful devices 22 . Ten randomized controlled trials (RCTs) were identified (4649 men) 12 18 20 21 23 24 25 26 27 28 and included in our meta-analysis ( Fig. 1 ); moderate methodological quality is shown in Fig.…”

“…Of all the RCTs, six were conducted in China 20 21 24 25 27 28 , and the remaining four were conducted in South Africa 12 , Uganda 23 , Rwanda 18 , and Kenya and Zambia 26 . Nine RCTs were two-arm trials: circular stapler versus CC (three studies), Shang Ring versus CC (four studies), Unicirc versus CC (one study), and PrePex versus CC (one study).…”

“…They are associated with a shorter operative time (OT), a lower intraoperative pain score, a higher satisfaction with penile appearance, less intraoperative blood loss (IB), a lower rate of adverse event, and a lower incidence of wound bleeding (WB) 13 18 19 . Circular disposable devices (CDD), such as the Circular Stapler 20 and Unicirc 12 , are based on a principle different from that of ISD and may be superior to CC 21 . However, credible evidence is insufficient to confirm whether ISD or CDD can optimize MC, and comprehensive comparisons of their advantages and disadvantages are lacking.…”

Comparison between circumferential local anesthesia and dorsal penile nerve block in circumcision procedure

“…A T-test was used to compare age and BMI between two groups. We used the nonparametric Mann-Whitney test to compare pain scores 12 . Statistical significance was defined as a p-value of < 0.05.…”

A Prospective Randomized Controlled Study of Comparison of Complications Between Sleeve Technique Versus Conventional Dorsal Slit Technique for Circumcision in Children

“…Thus both the surgical techniques took almost similar healing time as per this study. In Jin et al study, for Dorsal slit technique, the mean of Healing time is 14.4±2.1 days and for sleeve technique, the mean of Healing time is 12.5±1.8 days 15. In Huo et al study, for Dorsal slit technique, the mean of Healing time is 16.3±3.1 days and for sleeve technique, the mean of Healing time is 12.0±2.9 days.…”