Introducing the Quill™ device for modified sleeve circumcision with subcutaneous suture: a retrospective study of 70 cases

Preliminary study of a new magnetic compression technique for circumcision in dogs: An experimental animal model

Introduction

Traditional/ritual/medical circumcision can be associated with considerable intraoperative blood loss and a prolonged postoperative healing course. This study investigated the feasibility of the magnetic compression technique (MCT) for circumcision in beagle dogs.

Methods

A set of magnetic rings including a daughter magnetic ring (DMR) and a parent magnetic ring (PMR) were designed for circumcision. In eight beagle dogs as the animal model, the DMR was placed between the penis and the foreskin through the glans, and then the PMR was placed outside the penis. The DMR and PMR automatically attracted together to compress the foreskin. The necrosis of the prepuce of the anterior penis was observed daily. The operation time and time to magnetic ring shedding were recorded. Healing of the foreskin stump was visually observed.

Results

The magnetic rings were successfully installed in all eight dogs, and the operation process was without complication. The average operation time was 3.13 ± 0.92 min (range, 2-4.5 min). Postoperative X-rays showed good attraction of the magnetic rings. Daily post-operative observation showed progressive ischemic necrosis of the anterior foreskin and mild edema of the proximal foreskin. The dogs were generally in good condition and urinated freely. The magnetic rings fell off spontaneously 8-12 days after the operation, and the stump of the foreskin healed well.

Conclusion

The MCT may be a new approach for circumcision in a canine model, which suggests its potential for use in humans.

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.

Can circumcision be avoided in adult male with phimosis? Results of the PhimoStopTM prospective trial

Background

Circumcision as surgical treatment of adult phimosis is not devoid of complications. Efficacy of alternative non-surgical options is unclear. PhimoStop^TM is a therapeutic protocol which involves the use of appropriately shaped silicone tuboids of increasing size to obtain a non-forced dilation of the prepuce. The aim of the study was to evaluate the efficacy and durability of results of PhimoStop^TM device for the treatment of adult male phimosis.

Methods

A prospective trial was conducted between 2018 and 2020 on 85 consecutive adult male patients affected by phimosis and with an indication for circumcision. Patients were treated with PhimoStop^TM protocol and they were evaluated at baseline and after treatment through a subjective (patient self-reported information on various domains of his sexual function) and an objective assessment (evaluation of phimosis severity grade according to the Kikiros scale pre- and post-treatment, re-assessment of indication for circumcision post-treatment and validated questionnaires scores). Primary endpoint was to avoid the scheduled circumcision in 33% of the patients enrolled.

Results

Seventy-one patients (84%) completed the device usage phase as per study protocol. Median duration of tuboid application was 60 days. Thirty-seven patients (52.1%) had no indication for circumcision after treatment. Even considering patients lost to follow-up as failures, primary endpoint was reached in 43.5% of cases. There was a significant reduction of the grade of phimosis after treatment (P<0.001). Moreover IIEF-5 showed a statistically significant improvement after treatment (P<0.001). Thirty/37 patients who met the primary endpoint (81%) still have a successful resolution of their phimosis avoiding circumcision at a median follow-up of 24 months.

Conclusions

PhimoStop^TM device is effective for the treatment of adult male phimosis of Kikiros grade ≤2. The results seem to be durable in most patients at a median follow-up of 24 months. Randomized clinical trials are necessary in order to confirm our results and assess cost-efficacy.

Use of a disposable circumcision suture device versus conventional circumcision: a systematic review and meta-analysis

This systematic review assessed the safety and efficacy of the disposable circumcision suture device (DCSD) and conventional circumcision (CC) in the treatment of redundant prepuce and phimosis. Two independent reviewers conducted a literature search for randomized controlled trials (RCTs) using the DCSD and CC for the treatment of redundant prepuce or phimosis in China and abroad. Nine RCTs (1898 cases) were included. Compared with the CC group, the DCSD group had a shorter operative time (standardized mean difference [SMD] = -21.44; 95% confidence intervals [95% CIs] [-25.08, -17.79]; P < 0.00001), shorter wound healing time (SMD = -3.66; 95% CI [-5.46, -1.85]; P < 0.0001), less intraoperative blood loss (SMD = -9.64; 95% CI [-11.37, -7.90]; P < 0.00001), better cosmetic penile appearance (odds ratio [OR] =8.77; 95% CI [5.90, 13.02]; P < 0.00001), lower intraoperative pain score, lower 24-h postoperative pain score, lower incidence of infection, less incision edema, and fewer adverse events. There were no differences between the CC and DCSD groups in the incidences of dehiscence, or hematoma. The results of this meta-analysis indicate that the DCSD appears to be safer and more effective than CC. However, additional high-quality RCTs with larger study populations are needed.

Intracavernosal Prostaglandin Injection Prior to Circumcision Allows More Precise Removal of Foreskin

OBJECTIVES

The study aims to evaluate the outcomes of adult circumcision with the use of intracavernosal injection (ICI) of prostaglandin to induce an erection at time of operation.

METHODS

Twenty patients undergoing circumcision received ICI with prostaglandin prior to surgery. Demographics of all patients along with outcomes and complications at 2-week and 3-month follow-up were recorded.

RESULTS

No complications were evident at 2-week and 3-month follow-up. All 20 patients were satisfied with cosmetic result.

CONCLUSIONS

Circumcisions performed with ICI is a novel technique that allows accurate removal of foreskin and can be safely applied to current surgical technique for improved cosmetic results.