A prospective, randomized controlled trial of circumcision in adult males using the CO2 laser: modified technique compared with the conventional dorsal-slit technique

Phimosis in Adults: Narrative Review of the New Available Devices and the Standard Treatments

BACKGROUND

Phimosis is the inability to completely retract the foreskin and expose the glans. The treatment of phimosis varies depending on the age of the patient and the severity of the disease; a great number of conservative or surgical treatments are currently available.

AIM

To provide the first review summarizing the available options for the treatment of adult phimosis.

METHODS

A PubMed, Cochrane and Embase search for peer-reviewed studies, published between January 2001 and December 2022 was performed using the search terms "phimosis AND treatment".

RESULTS

A total of 288 publications were initially identified through database searching. Thirty manuscripts were ultimately eligible for inclusion in this review. Conservative treatment is an option. and it includes topical steroid application and the new medical silicon tubes (Phimostop™) application for gentle prepuce dilation. Concerning the surgical approach, the gold-standard treatment is represented by circumcision in which tissue synthesis after prepuce removal can be also obtained with barbed sutures, fibrin glues or staples. Laser circumcision seems to be providing superior outcomes in terms of operative time and postoperative complication rate when compared to the traditional one. Several techniques of preputioplasty and use of in situ devices (which crush the foreskin and simultaneously create haemostasis) have been also described. These in situ devices seem feasible, safe and effective in treating phimosis while they also reduce the operative time when compared to traditional circumcision. Patient satisfaction rates, complications and impact on sexual function of the main surgical treatments are presented.

CONCLUSION

Many conservative and surgical treatments are available for the treatment of adult phimosis. The choice of the right treatment depends on the grade of phimosis, results, complications, and cost-effectiveness.

Does using a laser improve outcomes of conventional circumcision in adult and children populations? Results from a systematic review and meta-analysis

BACKGROUND

Male circumcision is a well-known old surgery, and several recently developed techniques have been scaled up, including the introduction of laser technology, as alternative approaches to overcome morbidity of conventional surgery scalpel/suture method OBJECTIVES: We aimed to perform a systematic review and meta-analysis of studies comparing laser circumcision versus conventional circumcision technique in terms of perioperative outcomes and efficacy (complications, unacceptable appearance, reoperation rate) both in children and adults.

MATERIALS AND METHODS

This review was performed following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Continuous variables were analyzed using the inverse variance of the mean difference with a random effect, 95% confidence interval (CI), and p-value. The incidence of complications, unacceptable appearance, and reoperation rate were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as odds ratio (OR), 95% CI, and p-value. Significance was set at p-value ≤0.05 and 95%CI.

RESULTS

Seven studies were included. In comparison to the conventional circumcision, laser circumcision shoved lower visual analogue score at 24-h, and 7 days after surgery, a lower rate of overall complication rate (OR 0.33, 95% CI 0.24-0.47, p < 0.001), scarring (OR 0.09, 95% CI 0.02, 0.41, p = 0.002), and unacceptable appearance (OR 0.09, 95% CI 0.05, 0.15, p < 0.001). We found no statistically significant difference in surgical time, and incidence of bleeding, infection, wound dehiscence, and reoperation rate.

DISCUSSION AND CONCLUSION

Our review infers that laser-assisted circumcision is certainly a safe and strong contender as the procedure of choice in both children and adult populations.

Dual laser circumcision: a novel technique to improve traditional surgery

Circumcision represents one of the oldest and routinely performed urological surgery. It implies the exeresis of the prepuce due to ethnic, religious and medical reasons. Different authors reported straightforward advantages of this procedure including increased penile hygiene, reduction of penile cancer risks and lower rates of urinary tract infections. Circumcision can be easily performed and reproduced according to different techniques. Nowadays, different types of lasers have been developed and this technology is gaining consensus in the urological community. Aim of this article is to describe our surgical technique for laser circumcision with the Lasemar Eufuton 1500, clarifying the surgical steps and the benefits of this technology.

Use of Holmium YAG laser in circumcision: a novel, less complicated and alternative procedure for adolescent

Background

To evaluate the efficacy and safety of Holmium YAG laser circumcision in adolescents.

Methods

Eighty-one patients underwent circumcision for medical reasons, and patients’ requests were collected retrospectively during February 2017 to February 2019. They were divided into two groups: Holmium YAG laser (group 1, n = 41) and conventional group (group 2, n = 40). The guillotine method with a Holmium YAG laser was applied for circumcisions, and all the procedures were performed by a single urologist who was well-experienced with circumcision practices.

Results

The average age of group 1 was 15.53 ± 7.35 years old, and the average age was 16.34 ± 9.22 years old in group 2. There was no significant difference in age and indications. The average operative time was significantly shorter in group 1 than in group 2 (24.40 ± 3.94 vs. 27.25 ± 4.35 min, p < 0.01). The estimated blood loss was less in group 1 compared to group 2. There were fewer complications in group 1 than in group 2 (3/41 vs. 10/40, p < 0.01) and patients also felt less pain in group 1 (p < 0.01). All patients tolerated this procedure without severe side effects.

Conclusions

The use of Holmium YAG laser in circumcision is a novel, less complicated, easy, and less painful alternative procedure for circumcision in young males.

Technology Meets Tradition: CO2 Laser Circumcision versus Conventional Surgical Technique

Purpose

We wished to present the clinical applications and to evaluate the benefits of the use of a carbon dioxide (CO₂) laser versus the conventional procedure for circumcision in adults, in terms of duration of surgery, surgical techniques, complications, pain and cosmetic appearance.

Patients and Methods

The medical records of 482 patients who had been circumcised were retrospectively evaluated. The patients were divided into two groups: 168 patients (Group A) were circumcised with traditional techniques; and 314 patients (Group B) were circumcised using a CO₂ laser. All the patients were circumcised under local anesthesia. Pain was evaluated using a verbal numerical rating scale for pain assessment. Postoperative wound swelling, bleeding, infection and pain were assessed at 4 hours, 24 hours and 7 days after surgery.

Results

There were no significant differences between the two groups in terms of bleeding and infections. The difference in operating times between the groups was significant (p<0.001). Wound disruptions occurred in one patient in Group A at 3 days and two patients in Group B at 1 week. Pain scores were low and there was less pain in Group B than in Group A during the first 4 hours (1.8 vs 3.7; p<0.002). Compared with the conventional method, the CO₂ laser technique was associated with much less pain at both 1 day (p<0.002) and 7 days (p<0.001) postoperatively. The cosmetic results were superior in Group B; a linear surgical scar developed in 94.9% of patients in Group B versus 61.3% in Group A (p<0.001).

Conclusion

Our results show that the use of a CO₂ laser was associated with a shorter operative time, less wound irritation and better cosmetic appearance compared with standard surgical techniques for circumcision.

Modified Circumcision Using the Disposable Circumcision Suture Device in Children: A Randomized Controlled Trial

OBJECTIVE

To evaluate and compare the surgical outcomes and complications of the modified circumcision using disposable circumcision suture device (device group) and the conventional dorsal slit circumcision (conventional group) in children.

METHODS

A total of 284 patients were randomized to either device group or conventional group. All patients were preoperatively assessed and evaluated at 4 weeks after surgery. The perioperative data and postoperative outcomes were compared between the 2 groups.

RESULTS

No statistical differences were observed in the average age and indications between the 2 groups preoperatively (P > .05). Compared with the conventional group, patients in the device group were shorter mean operative time, less blood loss, lower intraoperative and postoperative pain score, faster incision healing time and a higher satisfaction rate of penile cosmetic appearance (P < .01). Similarly, the incidences of complication were significantly lower in the device group than in the conventional group (4.3% vs 12.3%, P < .05).

CONCLUSIONS

The modified circumcision using disposable circumcision suture device is a simple, safe, faster, and effective procedure and may become the attractive alternative to the conventional technique for the children, with a relatively lower complication rate and better cosmetic results. With the improvement of disposable circumcision suture device, the modified circumcision using disposable circumcision suture device has the potential to be widely used in the world.