circumcision

To evaluate the efficacy of frenulum protection technique of the disposable circumcision suture device (DCSD) in adult males.

Atotal of 53 adult males were diagnosed with redundant prepuce and underwent circumcision with DCSD using frenulum protection technique. The main preoperative and postoperative measure of the length of penile frenulum was evaluated. Other data such as edema rate, intraoperative blood loss, operation time, postoperative pain, staple falling off time, incision infection rate, and evaluation of satisfaction rate with penis appearance were documented in the study.

There was no significant difference in preoperative and postoperative frenulum length for each patient. The mean length of the penile frenulum before and after surgery was 2.25 ± 0.36 cm and 2.23 ± 0.39 cm, respectively (p = .31). The rate of frenulum length preservation was 100%. All the patients had no excessive resection of the frenulum and no serious complication happened after surgery. The satisfaction rate of postoperative penis appearance from patients’ evaluation was 98.1% (52/53).

The frenulum protection technique was simple and operable, which could help the operator to accurately identify the most distal position of the frenulum and retain a sufficient length of frenulum during DCSD circumcision.

The study assessed whether effective pain management of the neonate could be achieved through topical approaches rather than acetaminophen in circumcision. Epinephrine and/or Lidocaine solutions with clinically proven safety were preferred for topical use. 

This study was conducted by separating 105 neonates into three groups, each of which consisted of 35 patients. The group I was followed up and assessed by performing pain management using only acetaminophen; in Group II topical liquid local anesthetic medication without Epinephrine. In Group III topical liquid local anesthetic medication with Epinephrine was used in pain management, including acetaminophen, to reduce oral medication if necessary. The pain was monitored using the Neonatal Infant Pain Scale.

In all three groups, it has been shown statistically that topical medication effectively relieves pain and reduces the need for oral medication. In the comparison of Group II and Group III, it was found that the presence of pain was lesser in the use of lidocaine containing epinephrine and less oral medication was required (p<0.001 & p<0.001). The frequency of topical application in Group II was statistically significantly lower compared to Group I (p<0.001). Topical administration containing Epinephrine was more effective compared to the group using only oral acetaminophen or liquid lidocaine without Epinephrine (p<0.001 & p<0.001). 

Painless procedures should be preferred in surgical procedures of neonates. If painful procedures need to be performed, effective pain management plans should be set up beforehand. Few oral medications can be used in the management of pain in neonates. In surgical procedures such as circumcision, intensive medication use is required, topical pain-relieving medications can be used to avoid or reduce the need for drugs that may have adverse effects.

This study aimed to examine the short and long-term complications of thermocautery-assisted circumci-sions with local anesthesia done in a sterile environment in operating room conditions, accompanied by literature.

The participants who consecutively underwent thermocautery-assisted circumcision with local anesthesia from June 2018 to May 2019 were included in the study. They were one month-17 years old, same ethnic origin, in same location. The age groups were compared in terms of complications.

The participant age and surgical duration means were 4.89 ± 2.08 (30 days-17 years) years old and 7.484 ± 1.524 (5-20 minutes) minutes, respectively. Complications were observed in fifty-three participants or 2.9% of the whole observation set. The participants under intervals of one six months and over 6 years of age had signif-icantly lower complication rates when compared to the other participants, and this comparison was statistically significant (P = 0.001).

The study results demonstrated that circumcision with thermocautery after local anesthesia is a vi-able, reliable, and effective method. It can be assumed that circumcisions in males especially may be effective in 1-6 months, and over 6 years of age. Parents choose this method because it is more appropriate and eliminates the risk of general anesthesia.

To evaluate the effectiveness of a modified disposable circumcision suture device (DCSD) with ap-plication of plastic sheet to avoid severe bleeding after circumcision and compare the surgical effects and other postoperative complications of two DCSDs.

A total of 943 excess foreskin patients from January 2018 to January 2020 who under-went circumcision using two different DCSDs were recruited. Preoperative characteristics (patient age, height and weight), main surgical outcomes (surgical time, intraoperative blood loss, incision healing time) and postoperative complications (postoperative hemorrhage and hematoma rate, edema rate, incision infection rate, residual staples rate) were collected and analyzed. Patients' "satisfaction" or "dissatisfaction" was also investigated.

Preoperative characteristics showed no significant statistical difference. The modified DCSD group has a lower intraoperative bleeding, postoperative hemorrhage or hematoma rate and residual staples rate compared with the conventional group. Incision healing time and incision infection rate between the two groups were similar. Nevertheless, conventional group has a shorter surgical time, a lower edema rate and a higher satisfaction rate.

The modified DCSD with application of plastic sheet can avoid severe bleeding after circumcision effectively and can be served as a new choice for circumcision

 Circumcision is a common surgery and causes severe pain and anxiety in children. Today, virtual reality is used as an easy and cost-effective non-pharmacological method to manage pain and anxiety with no side effects.

 This study aimed to investigate the effect of virtual reality on the reduction of pain and anxiety in children who underwent circumcision.

 This single-blind randomized clinical trial was performed on 40 children in 2019. The research instruments included the demographic survey, the Observational Scale of Behavioral Distress, and the Oucher pain scale which were completed in both groups 30 min before and after the circumcision (immediately after dressing the surgical wound). Anxiety immediately before circumcision. The children’s pain was assessed during anesthesia in both groups. A two-step intervention was performed on the experimental group. A preoperative virtual reality training video and a virtual reality animation were presented to distract the patients during the circumcision. All these steps except virtual reality were performed in the control group. Data were analyzed using SPSS software (version 16).

 Virtual reality as a distraction technique significantly reduced anxiety and pain at the onset of circumcision (p <0.001) and during anesthesia (p <0.001) as well as pain (P=0.005) and anxiety (p <0.001) at the end of the circumcision in the intervention group compared to the control group.

Implications for Practice:

 Clinical use of virtual reality can be used for the reduction of pain and anxiety in children during the circumcision process.

Circumcision is the most common surgery in male infants in Islamic countries. Therefore, Knowledge of its side effects and appropriate therapies is essential. In this case report, we describe a 12-days neonate with Glans Ischemia, two days after circumcision. We admitted the neonate and treated him with oral Pentoxifylline and antibiotic for three days. Thus Pentoxifylline can be implemented as a treatment in post-circumcision ischemia of the glans penis in neonates.

Male circumcision involves the partial or total removal of the prepuce (foreskin) from the penis,and it is the most common surgical procedure performed on infants in the USA. According to social conventiontheory, in demographic populations where male circumcision is more socially accepted, we would predict thatcircumcised men would be more likely to report satisfaction with their circumcision status. This exploratorystudy investigated the ways in which particular demographic sub-groups have differing attitudes and levels ofsatisfaction based on their circumcision status.

The participant data used in theseanalyses are from a study conducted to explore the effects of false beliefs concerning circumcision and intactpenises on circumcision satisfaction. After participant exclusion based on additional criteria, 902 male partici-pants from the United States, ranging in age from 18-75 (M = 34.0, SD = 10.0), remained. A series of demographicinformation by circumcision status between participants Analysis of Variances (ANOVA) were conducted on cir-cumcision status satisfaction.

Results indicated that circumcision status satisfaction varied as a func-tion of race/ethnicity, religion, relationship status, and sexual orientation. Statistically significant differencesin circumcision status satisfaction were found for all of the demographic variables.

Using socialconvention theory, these data suggest that circumcision satisfaction is related to endorsement of the dominantculture and its norms surrounding the masculine body. Further investigation is warranted regarding causal im-plications of how one’s demographic characteristics may affect one’s satisfaction with their circumcision status

This study investigates the frequency of isolated microorganisms and the antimicrobial resistant pattern of inner foreskin and smegma in prepubertal children.

This comparative cross-sectional study was conducted between March and November 2019, where 132 prepubertal boys, who were scheduled to receive religious circumcisions at our outpatient clinic, were examined. The patients were divided into the following groups based on the presence of smegma in their subpreputial space: Group I (with smegma, n=58) and Group II (without smegma, n=74). Sterile stuart transport swabs (Advanced Diagnostic Research, Mediko Kimya, Turkey) were taken from the smegma or the subpreputial space (glans surface and inner foreskin) using aseptic techniques and then the swab samples were immediately transported by sterile stuart transportation for microscopy, culture identification, and antibiographic resistance test-ing by conventional test methods and automated systems (VITEK II, Biomerieux, France) to the Microbiological Laboratory of our hospital.

48 bacteria isolated from 39 boys in Group I comprised 28 gram-positive species (58.3%) and 20 gram-negative species (41.7%). The most commonly isolated gram-negative bacterium was Proteus mirabilis (45%) while most positive was Staphylococcus hominis (42.9%). In Group II, 68 boys had 103 bacterial isolates in the glans comprising 81 gram-positive species (78.6%) and 22 gram-negative species (21.4%). The most com-monly isolated gram-negative bacterium was Proteus mirabilis (42.9%) while the most positive were Enterococcus faecalis (40.7%) and S. hominis (42.9%)

The subpreputial space of uncircumcised boys is colonized by various types of uropathogens resistant to multidrug drugs. Smegma does not pose additional risks to microbiological colonization in children.

Male circumcision (MC) is a minimal procedure to remove penile foreskin and is one of the oldest and most fre-quent surgical procedures in Iran, where the majority of the population identify themselves as Muslim. Despitenumerous health benefits, MC is an issue of debate among pediatricians, urologists, and other medical profes-sionals. Much of the debate stems from the lack of national guidelines and the incidence of minor or seriousclinical complications. This study performed a systematic review on the current literature on male circumcisionin Iran and summarized the major clinical complications reported by the studies.

  To  discuss  whether  concealed  penis  after  circumcision  lowers  perimeatal  urethral  and  glanular  sulcus  uropathogenic  bacterial  colonization  in  healthy  boys  with  no  urinary  tract  problems  and  prevents  attacks  of  febrile  urinary  tract  infections  in  non-healthy  boys  with  defined  urinary  tract  abnormalities.  

  This  case-control  study  was  conducted  in  Ibn-i  Sina  Hospital  and  retrospectively  collected  data  of   471 boys  were  analyzed.  All  patients  were  scanned  for  any  urinary  tract  abnormality  and  those  with  any  defined  abnormalities  were  classified  as  non-healthy  group. (123 patients)  Non-healthy  patients  were  divided  into  two  subgroups  as  concealed  (n:31)  and  non-concealed  (n:92)  penis  after  circumcision.  Healthy  patients  with  no  urinary  problems  were  divided  into  three  groups  as  circumcised  without  concealed  penis  (n:144),  with  concealed  penis  after  circumcision  (n:104)  and  uncircumcised  control  group  (n:100).  Bacterial  cultures  were  obtained  from  both  periurethral  meatal  and  glanular  sulcus  areas  by  adhering  strictly  to  the  rules  of  obtaining  bacterial  culture  to  avoid  false-positive  or  negative  culture  results.  Also  only  uropathogenic  bacterias  were  evaluated,  irrelevant  results  were  excluded.     

  Mean  age  was  similar  in  healthy  population.  Comparison  of  three  groups  showed  that  there  was  a  significant  difference  in  both  cultures.(P = .026 for periurethral meatal region, P = .039 for glanular sulcus region)  In  post  hoc  analysis,  non-concealed  group  had  a  lower  rate  of  culture  positivity  in  both  areas  compared  to  other  groups.    Mean  age  was  also  similar  in  non-healthy  population.  Mean  follow-up  period  was  18.2  months.  Patients  with  concealed  penis  after  circumcision  had  a  significantly  higher  number  of  febrile  UTI  attacks  (20 attacks in 8 patients vs 7 attacks in 5 patients)  compared  to  non-concealed  group. (P = .019)  All  febrile  UTI  attacks  except  one  in  this  group  occurred  below  the  age  of  12  months. A  total  of  10 patients  in  both  healthy  and  non-healthy  groups  had  postoperative  hemorrhage  after  circumcision  and  only  1  patient  had  a  wound  infection.          

  Concealed  penis  after  circumcision  does  not  lower  perimeatal  urethral  and  glanular  sulcus  uropathogenic  bacterial  colonization  in  healthy  patients  and does not  protect  unhealthy  patients  from  febrile  urinary  tract  infection  attacks.  If  circumcision  is  planned,  concealed  penis  should  be  avoided  and  also  parents  should  be  informed  about  the  possible  risks  due  to  concealed  penis  before  the  procedure,  particularly  in  patients  with  urinary  tract  abnormalities.

Neuromuscular blocking agents relax skeletal muscles relaxation operation or mechanical ventilation. Accidental injection of these agents is a medical error which can lead to a minor sequel or devastating complications. We report an inadvertent subcutaneous injection of atracurium in circumcision operation and also briefly review the international databases related to the reported case.

A two month-old infant was scheduled for circumcision under local anesthesia. Five minutes after subcutaneous injection of atracurium instead of lidocaine for local anesthesia, the patient developed respiratory apnea, cyanosis, muscle relaxation, and bradycardia. Then the patient was intubated and transferred to the Neonatal Intensive Care Unit (NICU) to receive supportive care and kept under follow up. After taking supportive and therapeutic cares, there was no complication. The patient, after complete recovery, was discharged without any problems.

Despite all efforts to prevent medical errors, they can happen. Reporting these cases highlights the importance of early diagnosis of errors, correcting therapeutic interventions, and delivering accurate management of conditions for control and elimination of symptoms and complications.

One of the most frequent complications after circumcision by thermocautery is phimosis. In this study, we aimed to present the functional and cosmetic results of the modified sleeve technique for the correction of this iatrogenic phimosis.

The study group included iatrogenic phimosis cases who underwent circumcision using thermocautery during the last eight years. Initially, steroid creams were applied on these patients for six weeks. Patients who did not respond to this treatment underwent surgery using the modified sleeve technique. Control visits were performed at the first and fourth postoperative weeks.

A total of 32 patients with a median age of 5.1 ± 1.1 years out of 13285 circumcisions by thermocautery were included in the study. No positive treatment outcomes were obtained by topical steroids, and all patients proceeded to surgery by modified sleeve technique. Median operative time was 25 ± 2.3 minutes. Cosmetic and functional outcomes were satisfactory in all cases.

There is no place for topical steroids in management of iatrogenic phimosis after thermocautery, thus early surgery is advised to avoid emotional stress. Our modified sleeve technique can achieve maximum cosmetic and functional outcomes without leading to extreme shortening of the penile skin and mucosa.

This study aimed to examine the short- and long-term complications of thermocautery-assisted circumcisions. A total of 1780 children who consecutively underwent thermocautery-assisted circumcisions from May 2014 to May 2016 in Yuksekova State Hospital in Turkey were included in this study. Thesechildren were classified into perioperative, early postoperative, and long-term complication groups. In addition, the age groups were compared in terms of complications. The patient age and surgical duration means were 4.16 ± 3.805 years old and 6.14 ± 1.703 minutes, respectively. Complications were observed in twelve patients, or 0.6% of the whole observation set. One patient exhibited bleeding and was included in the perioperative complications group. Four patients were included in the early postoperative complications group; three of them had bleeding and one had an infection. Finally, three patients had trapped penises, two patients had meatitis, one patient had a delayed wound healing issue, and one had
a glans-skin bridge. These seven patients fell into the long-term complications group. The patients younger than 3 years old had significantly higher complication rates when compared to the older patients, and this comparison was statistically significant (P = 0.001). The results showed that thermocautery-assisted circumcision is a safe and efficient surgical technique for use in children

Circumcision is proposed as the world’s oldest and most controversial operation and meatal stenosis as the most common complication of neonatal circumcision. Published studies in Iran are deficient regarding this complication. This research shows the rate of meatal stenosis in children less than one year in Birjand-Iran. This descriptive study incorporated all children younger than 12 months who had normal penile anatomy and were circumcised using the plastic disposable device by one urologist from March 2005 to January 20th, 2009. Children were examined 14 days after circumcision. Parents of the children were subsequently called for meatal stenosis screening. Those that had symptoms were examined in the office, and their urine flow was observed. During the study period, 518 children (mean age: 47.6 ± 2.7 days) were circumcised. Operation time for circumcision was 4 ± 0.8 minutes. Mean follow-up period was 26.5 ± 11.5 (8-55) months. A total of 12 (2.3%) children had meatal stenosis. Meatal stenosis was the most common complication of circumcision in this study. There is a need for more research on the prevention of this complication.

Postoperative pain from male circumcision (MC) is common especially in the sleep-related erection period. This study aims to explore the effect of interrupted rapid eye movement (IREM) sleep on relieving SRE-related incision pain and the improvement of other clinical outcomes.

This simple randomized controlled study was conducted between May and November 2016. Approval was obtained from the local ethical committee on 5 May 2016. Ninety participants who underwent male circumcision were divided into the interrupted rapid eye movement sleep group and the control group. The times and the cumulative time of erection-related moderate and severe pain in minutes at night for 3 days after the operation were observed and compared. We also compared the condition of the incision swelling and healing.
Sleep time at night was used to evaluate the safety of interrupted rapid eye movement sleep.

For the first 3 days after the operation, the times of sleep-related erection pain were significantly decreased in the IREM sleep group (P = .010). Five patients reported that there was no pain during night. The cumulative time of erection-related moderate and severe pain was statistically decreased in the interrupted rapid eye movement sleep group (P = .034). After 3 days, there was no moderate and severe pain related to sleep-related erection in the 2 groups. There were no significant differences in incision swelling (P = .768), healing (P = .626), and sleep time (P = .231).

Interrupted rapid eye movement sleep is an effective, simple, and free treatment to relieve incision pain of sleep-related erections.

Penile nerve block is the most popular nerve block for the circumcision in pediatric patients. This study aimed to compare the analgesic efficiency of penile nerve block and the pudendal nerve block on postoperative pain and additional analgesic requirements in children undergoing circumcision.
Material and

This prospective randomized double-blind study enrolled 85 children, aged 1 to10 years, undergoing circumcision. The patients were randomly divided into two groups either receiving dorsal penile block group (PNB-Group) or pudendal nerve block (PDB-Group). In the PNB-Group, 0.3 ml/kg 0.25 % bupivacaine was used; and, in the PDB-Group, 0.3 ml/kg bupivacaine was applied with nerve stimulator at a concentration of 0.25%. In the postoperative period, the modified CHEOPS pain scale scoring and additional analgesic demand were evaluated at the 5th and 30th minutes and at the 1st and 2nd hours. The subsequent pain evaluations were made by the parents at home, at the postoperative 6th, 12th, 18th and 24th hours.

Seven patients were excluded from the study, and seventy eight patients were evaluated for analysis. Patients in PDB-Group had significantly lower postoperative pain intensity and lower mCHEOPS scores (3.83 ± 0.98) when compared to the PNB-Group (6.47 ± 0.91) (P

Pudendal nerve block provided additional analgesic free period and had better analgesic efficiency compared to the penile nerve block lasting until 24 hours after operation.

To investigate the effects of ketamine騧嫎襚 and propofol뇫宫橷 anesthesia on surgical site hemorrhage during circumcision procedures.
The boys undergoing circumcision surgery were included in the study. The patients were divided into two groups. In Group 1 (n = 50), 0.01 mg/kg midazolam and 2 mg/kg IV ketamine were administered. In Group 2 (n = 50), 1 ?g/kg fentanyl, 1 mg/kg lidocaine 2%, and 2–3 mg/kg IV propofol were administered, and patency of airway was ensured with a laryngeal mask airway. The intraoperative bleeding scale was recorded during the procedure to evaluate surgical site bleeding. Hemorrhage was checked for the first three hours using the postoperative bleeding scale to follow the amount of hemorrhage.
Intraoperative bleeding scores were significantly higher in Group 1 as compared to Group 2. However, there was no significant difference between the groups regarding frequency of postoperative hemorrhage. The
mean blood pressure values measured at 5th, 10th, 15th minutes and recovery room were significantly higher in Group 1.
The intraoperative bleeding scores were significantly higher with ketamine騧嫎襚 compared to propofol뇫宫橷. On the other hand this hemorrhage can be controlled easily with appropriate hemostasis, and the amount of blood loss was not clinically significant. We think that our study makes a positive contribution to the literature about the effects of anesthetics on the surgical site bleeding during circumcision.

Circumcision is the most common surgical procedure throughout the world today and is usually performed in children for medical, cultural, or religious reasons. In most countries, nonsurgeons or traditional circumcisers perform this procedure, however, there is still a debate regarding the proper age of circumcision.

To determine the best and appropriate time for circumcision, we compared the late complications of this procedure between patients who are circumcised in different age groups.

This is a retrospective and descriptive study that was performed on patients who were referred for late circumcision complications. The patients were divided according to the age range of circumcision as well as the performed age, which were divided into 4 groups (neonate, infant, child, and adolescent) by the author, during the period of May 2010 to December 2013 at an urology clinic. All late complications that were obtained were analyzed and compared between these groups.

Overall, 120 cases of patients were enrolled. The mean age of neonates, infants, children, and adolescent were 14 ± 2.5 days, 4 ± 1.5 months, 6 ± 0.5 years, and 14 ± 1.8 years, respectively. All of them have been circumcised by the classic method. The most common complication (15 patients) was meatal stenosis (12.5%) and was more prevalent in neonates 8 (29.62%).

The ratio of late complications of circumcision is significantly higher in neonates and infants as compared to children as well as adolescents. The results of this study showed that for prevention of developing postoperative complications, the appropriate age of circumcision is to be a child as well as adolescent. For prevention of debilitating and prolonged complications, it should only be performed in medical institutions by suitably trained surgeons.