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Use of a disposable circumcision suture device versus conventional circumcision: a systematic review and meta-analysis 认领 引用 被引量：22
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作者 Zhong-Chao Huo Gang Liu +6 位作者 Xiao-Yan Li Fei Liu Wen-Ju Fan Ru-Hua Guan Pei-Feng Li De-Yang Mo Yong-Zhi He 《Asian Journal of Andrology》 SCIE CAS CSCD 2017年第3期362-367,共6页
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 re... 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. 展开更多
关键词 conventional circumcision disposable circumcision suture device meta-analysis phimosis redundant prepuce systematic review
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Disposable circumcision suture device: clinical effect and patient satisfaction 认领 引用 被引量：56
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作者 Bo-Dong Lv Shi-Geng Zhang +6 位作者 Xuan-Wen Zhu Jie Zhang Gang Chen Min-Fu Chen Hong-Liang Shen Zai-Jun Pei Zhao-Dian Chen 《Asian Journal of Andrology》 SCIE CAS CSCD 2014年第3期453-456,共4页
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 dev... 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. 展开更多
关键词 circumcision disposable circumcision suture device patient satisfaction penis appearance pre-operative and post-operative pain Shang ring ~
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Clinical application of a new device for minimally invasive circumcision 认领 引用 被引量：117
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作者 Yi-Feng Peng Yue Cheng +7 位作者 Guo-Yao Wang Suo-Qun Wang Chao Jia Ben-Hai Yang Ru Zhu Shu-Chuan Jian Qing-Wen Li Da-Wei Geng 《Asian Journal of Andrology》 SCIE CAS 2008年第3期447-454,共8页
Aim： To study the clinical effects of a disposable circumcision device in treatment of male patients of different ages with either phimosis or excess foreskin. Methods： One thousand two hundred patients between the ... Aim： To study the clinical effects of a disposable circumcision device in treatment of male patients of different ages with either phimosis or excess foreskin. Methods： One thousand two hundred patients between the age of 5 and 95 years underwent circumcision using this procedure in the 2-year period between October 2005 and September 2007. Of these cases, 904 had excess foreskin and 296 were cases of phimosis. Results： In 96.33% of the cases the incision healed, leaving a minimal amount of the inner foreskin with no scarring and producing good cosmetic results. There were no incidents of device dislocation or damage to the frenulum. The average operative time was 2.5 min for excess foreskin, and 3.5 min for phimosis. During the 7 days of wearing the device, mild to moderate edema occurred in 10.08 % of cases with excess foreskin and in 2.58 % of those with phimosis. Edema in the frenulum was seen in 1.67% of patients, and only 0.67% had an infection of the incision. A total of 86.25% of patients reported pain due to penile erection. After removal of the device, 0.58% of the cases had minimal bleeding around the incision, and 2.42% had wound dehiscence. Conclusion： The new device can be applied to an overwhelming majority of patients with phimosis and excess foreskin. This technique is relatively simple to perform, and patients who underwent this surgery had very few complications. Antibiotics were not required and patients reported less pain than those who were circumcised using conventional methods. Circumcision with this device requires minimal tissue manipulation, and is quicker and safer than circumcision using conventional techniques. 展开更多
关键词 excess foreskin phimosis circumcision device
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Effects of circumcision on male sexual functions:systematic review and meta-analysis 认领 引用 被引量：18
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作者 Ye Tian Wei Liu +3 位作者 Jian-Zhong Wang Romel Wazir Xuan Yue Kun-Jie Wang 《Asian Journal of Andrology》 SCIE CAS CSCD 2013年第5期662-666,共5页
This meta-analysis was performed to assess sexual functions following adult male circumcision.We searched the Cochrane Central Register of Controlled Trials,PUBMED,EMBASE,the Cochrane Database of Systematic Review and... This meta-analysis was performed to assess sexual functions following adult male circumcision.We searched the Cochrane Central Register of Controlled Trials,PUBMED,EMBASE,the Cochrane Database of Systematic Review and Web of Science from their inception until January 2013 to identify all eligible studies that reported on men's sexual function after circumcision.The Cochrane Collaboration's RevMan 5.2 software was employed for data analysis,and the fixed or the random effect model was selected depending on the proportion of heterogeneity.We identified 10 studies,which described a total of 9317 circumcised and 9423 uncircumcised men who were evaluated for the association of circumcision with male sexual function.There were no significant differences in sexual desire(odds ratio(OR):0.99;95%confidence interval(CI):0.92-1.06),dyspareunia(OR:1.12;95%Ch 0.52-2.44),premature ejaculation(OR.1.13;95%Ch 0.83-1.54),ejaculation latency time(OR:1.33;95%Ch 0.69-1.97),erectile dysfunctions(OR:0.90;95%Ch 0.65-1.25)and orgasm difficulties(OR:0.97;95%Ch 0.83-1.13).These findings suggest that circumcision is unlikely to adversely affect male sexual functions.However,these results should be evaluated in light of the low quality of the existing evidence and the significant heterogeneity across the various studies.Well-designed and prospective studies are required for a further understanding of this topic. 展开更多
关键词 complications male circumcision review sexual function
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Relationship between circumcision and human papillomavirus infection: a systematic review and meta-analysis 认领 引用 被引量：13
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作者 Yi-Ping Zhu Zhong-Wei Jia +4 位作者 Bo Dai Ding-Wei Ye Yun-Yi Kong Kun Chang Yue Wang 《Asian Journal of Andrology》 SCIE CAS CSCD 2017年第1期125-131,共7页
Male circumcision （MC） is reported to reduce human papillomavirus （HPV） prevalence in men. However, the efficacy remains imprecise. The aim of this study was to conduct a systematic review and meta-analysis to ass... Male circumcision （MC） is reported to reduce human papillomavirus （HPV） prevalence in men. However, the efficacy remains imprecise. The aim of this study was to conduct a systematic review and meta-analysis to assess the relationship between MC and genital HPV infection and genital warts. PUBMED, EMBASE, and Web of Science were searched from inception to March 22, 2015. We identified 30 papers, including a total of 12149 circumcised and 12252 uncircumcised men who were evaluated for the association of circumcision with genital HPV or genital warts. Compared with men who were not circumcised, circumcised men may have had significantly reduced odds of genital HPV prevalence （odds ratio [OR]： 0.68; 95% confidence interval [95% CI]： 0.56-0.82）. There was no significant association between MC and genital HPV acquisition of new infections （OR： 0.99; 95% CI： 0.62-1.60）, genital HPV clearance （OR： 1.38; 95% Ch 0.96-1.97）, and prevalence of genital warts （OR： 1.17; 95% CI： 0.63-2.17）. This meta-analysis suggests that circumcision reduces the prevalence of genital HPV infections. However, no clear evidence was found that circumcision was associated with decreased HPV acquisition, increased HPV clearance, or decreased the prevalence of genital warts. More studies are required to evaluate adequately the effect of MC on the acquisition and clearance of HPV infections and prevalence of genital warts. 展开更多
关键词 genital warts human papillomavirus male circumcision prevalence
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Circumcision with "no-flip Shang Ring" and "Dorsal Slit" methods for adult males: a single-centered, prospective, clinical study 认领 引用 被引量：7
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作者 Jun-Hao Lei Liang-Ren Liu +6 位作者 Qiang Wei Wen-Ben Xue Tu-Run Song Shi-Bing Yan Lu Yang Ping Han Yu-Chun Zhu 《Asian Journal of Andrology》 SCIE CAS CSCD 2016年第5期798-802,共5页
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-cent... 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. 展开更多
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 认领 引用 被引量：3
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作者 Mark A Barone Philip S Li +11 位作者 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 《Asian Journal of Andrology》 SCIE CAS CSCD 2019年第4期324-331,共8页
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-f... 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. 展开更多
关键词 HIV prevention male circumcision device no-flip technique ShangRing voluntary medical male circumcision
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The ultrasonic harmonic scalpel for circumcision:experimental evaluation using dogs 认领 引用 被引量：2
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作者 Mou Peng Zhe Meng +1 位作者 Zhong-Hua Yang Xing-Huan Wang 《Asian Journal of Andrology》 SCIE CAS CSCD 2013年第1期93-96,共4页
Male circumcision is one of the most commonly performed operations worldwide,and many novel techniques have been developed for better postoperative outcomes.The purpose of this study was to explore the feasibility of ... Male circumcision is one of the most commonly performed operations worldwide,and many novel techniques have been developed for better postoperative outcomes.The purpose of this study was to explore the feasibility of applying the ultracision harmonic scalpel(UHS)for circumcision by using dogs.Sixteen adult male dogs were divided into two groups:the UHS group and the control group.The dogs were circumcised with either the UHS or a conventional scalpel.The UHS circumcision procedure and the effects were imaged 1 week after surgery.The two groups were compared with respect to the operative time and volume of blood loss.Postoperative complications,including oedema,infection,bleeding of the incision and wound dehiscence,were recorded for both groups.The mean operative time for the UHS group was only 5.1 min compared with the 35.5 min of the conventional group.The mean blood loss was less than 2 ml for the UHS group and 15 ml for the conventional group.There was only one case of mild oedema in the UHS group,but the postoperative complications in the conventional group included two cases of mild oedema,one infection of the incision and one Case of bleeding of the incision.In conclusion,circumcision using UHS is a novel technique to treat patients with phimosis and excessive foreskin,and this method has a short operative time,less blood loss and fewer complications than the conventional scalpel method.This small animal study orovides a basis for embarking on a larger-scale clinical trial of the UHS. 展开更多
关键词 conventional circumcision dog electrocautery technique Plastibell device ultracision harmonic scalpel
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Ischemic glans penis after circumcision 认领 引用 被引量：2
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作者 Yuan-ShengTzeng Shou-HungTang +2 位作者 EnMeng Teng-FuLin Guang-HuanSun 《Asian Journal of Andrology》 SCIE CAS 2004年第2期161-163,共3页
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 tr... 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. 展开更多
关键词 circumcision glans penis hyperbaric oxygenation
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Countries with high circumcision prevalence have ower prostate cancer mortality 认领 引用 被引量：1
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作者 Mitchell S Wachtel Shengping Yang Brian J Morris 《Asian Journal of Andrology》 SCIE CAS CSCD 2016年第1期39-42,共4页
The present study determined the relationship of male circumcision （MC） prevalence with prostatic carcinoma mortality rate in the 85 countries globally for which data on each were available. MC prevalence in differe... The present study determined the relationship of male circumcision （MC） prevalence with prostatic carcinoma mortality rate in the 85 countries globally for which data on each were available. MC prevalence in different countries were obtained from a WHO report and allocated to WHO categories of 81%-100%, 20%-80%, and 0%-19%. Prostatic carcinoma mortality data were from Globoscan, gross national income per capita as well as male life expectancy were from a World Bank report, and percentages of Jews and Muslims by country were from the Pew Research Institute and the North American Jewish Data Bank. Negative binomial regression was used to estimate prostatic carcinoma mortality rate ratios. Compared to countries with 81%-100% MC prevalence, prostatic carcinoma mortality rate was higher in those with MC prevalence of 0%-19% （adjusted OR [adjOR] =1.82; 95% CI 1.14, 2.91） and 20%-80% （adjOR = 1.80; 95% CI, 1.16, 2.78）. Higher Muslim percentage （adjOR = 0.92 [95% CI 0.87, 0.98] for each 10% increase） and longer life expectancy （adjOR = 0.82 [95% CI 0.72, 0.93] for each 5 additional years） were associated with lower prostatic carcinoma mortality. Higher gross national income per capita （adjOR = 1.10 [95% CI 1.01, 1.20] for double this parameter） correlated with higher mortality. Compared with American countries, prostatic carcinoma mortality rate was similar in Eastern Mediterranean countries （adjOR = 1.02; 95% CI 0.58, 1.76）, but was lower in European （adjOR = 0.60; 95% CI 0.50, 0.74） and Western Pacific countries （adjOR = 0.54, 95% CI 0.37, 0.78）. Thus, prostate cancer mortality is significantly lower in countries in which MC prevalence exceeds 80%. 展开更多
关键词 circumcision country comparisons epidemiology global prostate cancer public health urology
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Male circumcision: towards a World Health Organisation normative practice in resource limited settings 认领 引用 被引量：12
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作者 Tim Hargreave 《Asian Journal of Andrology》 SCIE CAS 2010年第5期628-638,共11页
There is now grade 1 evidence that male circumcision （MC） reduces the risk of a man acquiring HIV. Modelling studies indicate MC could in the next 10 years save up to 2 million lives in those African countries with ... There is now grade 1 evidence that male circumcision （MC） reduces the risk of a man acquiring HIV. Modelling studies indicate MC could in the next 10 years save up to 2 million lives in those African countries with high HIV prevalence. Several African countries are now scaling up public health MC programmes. The most effective immediate public health MC programmes in Africa will need to target 18-20 years old men. In the longer term there is a need for infant circumcision programmes. In order to implement more widespread MC there is a need to make the surgical procedures as simple as possible so that safe operations can be performed by paramedical staff. The WHO Manual of Male Circumcision under local anaesthetic was written with these objectives in mind. Included in the manual are three adult techniques and four paediatric procedures. The adult procedures are the dorsal slit, the for- ceps guided and the sleeve resection methods. Paediatric methods included are the plastibell technique, the Mogen and Gomco shield method and a standard surgical dorsal slit procedure. Each method is described in a step by step manner with photographic and line drawing illustrations. In addition to the WHO manual of surgical technique a teaching course has been developed and using this course it has been possible in one week to train a circumcision surgeon who has had no or minimal previous surgical experience. Further scaling will require training of circumcision surgeons, monitoring performance, training the trainer workshops as well as advocacy at national, international and government meetings. In addition to proceeding with standardised methods work is in progress to assess novel techniques in adults such as stay on ring devices and policies are being formulated as to how to assess new devices. Also work is in progress to explore efficiencies in surgical processing by task sharing. Proper informed consent and safety remain paramount and great care has to be taken as programmes in Africa scale up. In continental China where the HIV epidemic is at a much earlier stage there may be a case for considering infant circumcision but great care will be needed to ensure that there is no harm. 展开更多
关键词 Africa HIV male circumcision
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Circumcision of Infants and Children: Short-Term Trauma and Long-Term Psychosexual Harm 认领 引用 被引量：2
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作者 Gregory J. Boyle 《Advances in Sexual Medicine》 2015年第2期22-38,共17页
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 sur... 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. 展开更多
关键词 Circumcision Sexual Reduction Surgery Circumcision-Related Deaths Male Genital Mutilation
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Combination of Circumcision and Microwave in Treatment of Genital Warts in Uncircumcised Patients 认领 引用
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作者 樊翌明 马泽 +2 位作者 吴志华 李顺凡 陈秋霞 《Chinese Journal of Sexually Transmitted Infections》 2003年第2期17-21,67,共5页
Objective: To investigate the efficacy of combina-tion of circumcision and microwave on genital wartsin uncircumcised men. Methods: A randomized, prospective study of 109uncircumcised adult men with genital warts was ... Objective: To investigate the efficacy of combina-tion of circumcision and microwave on genital wartsin uncircumcised men. Methods: A randomized, prospective study of 109uncircumcised adult men with genital warts was con-ducted in a STD clinic in Zhanjiang, Guangdong. Onegroup (n=54) received microwave therapy only, whilethe other group (n=55) was taken the combination ofcircumcision and microwave therapy. The recurrenceswere observed at the end of months 3, 6 and 12, andoperative complications were also recorded. Results: There were no significant differences inthe mean age and duration of the disease between twogroups (P>0.05). No serious operative complicationswere documented. The recurrence rate in circumci-sion plus microwave group was markedly lower thanthat in microwave group (12.7% vs 29.6%, P0.05). Conclusion: Circumcision can be safely performedunder local anesthesia in an outpatient setting. Com-bination of circumcision and microwave can produceexcellent effect as well as less tissue damage,therefore, it may be ideal for uncircumcised patientswith extensive condylomas. 展开更多
关键词 genital warts circumcision microwave therapy
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Critical evaluation of unscientific arguments disparaging affirmative infant male circumcision policy 认领 引用 被引量：5
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作者 Brian J Morris John N Krieger Jeffrey D Klausner 《World Journal of Clinical Pediatrics》 2016年第3期251-261,共11页
We evaluate recent claims opposing infant male circumcision,a procedure now supported by the evidencebased policy of the American Academy of Pediatrics.We find those criticisms depend on speculative claims about the f... We evaluate recent claims opposing infant male circumcision,a procedure now supported by the evidencebased policy of the American Academy of Pediatrics.We find those criticisms depend on speculative claims about the foreskin and obfuscation of the strong scientific evidence supporting pediatric policy development.An argument that circumcision should be delayed to allow a boy to make up his own mind as an adult fails to appreciate the psychological,scheduling and financial burdens later circumcision entails,so reducing the likelihood that it will occur.In contrast,early infant circumcision is convenient,safer,quicker,lower risk,healing is faster,cosmetic outcome is routinely good and the lifetime benefits accrue immediately.Benefits include reduction in urinary tract infections,inflammatory skin conditions,foreskin problems,and,when older,substantial protection against sexually transmitted infections and genital cancers in the male and his female sexual partners.Some authorities regard the failure to offer parents early infant circumcision as unethical,just as it would be unethical to fail to encourage the vaccination of children.In conclusion,the criticisms of evidence-based infant male circumcision policy are seriously flawed and should be dismissed as unhelpful to evidence-based development and implementation of pediatric policy intended to improve public health and individual wellbeing. 展开更多
关键词 Male circumcision Policy American Academy of Pediatrics Newborn Foreskin
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Early infant male circumcision:Systematic review,risk-benefit analysis,and progress in policy 认领 引用 被引量：6
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作者 Brian J Morris Sean E Kennedy +6 位作者 Alex D Wodak Adrian Mindel David Golovsky Leslie Schrieber Eugenie R Lumbers David J Handelsman John B Ziegler 《World Journal of Clinical Pediatrics》 2017年第1期89-102,共14页
AIM To determine whether recent evidence-based United States polices on male circumcision(MC)apply to comparable Anglophone countries,Australia and New Zealand.METHODS Articles in 2005 through 2015 were retrieved from... AIM To determine whether recent evidence-based United States polices on male circumcision(MC)apply to comparable Anglophone countries,Australia and New Zealand.METHODS Articles in 2005 through 2015 were retrieved from PubM ed using the keyword"circumcision"together with 36 relevant subtopics.A further PubM ed search was performed for articles published in 2016.Searches of the EMBASE and Cochrane databases did not yield additional citable articles.Articles were assessed for quality and those rated 2+and above according to the Scottish Intercollegiate Grading System were studied further.The most relevant andrepresentative of the topic were included.Bibliographies were examined to retrieve further key references.Randomized controlled trials,recent high quality systematic reviews or meta-analyses(level 1++or 1+evidence)were prioritized for inclusion.A risk-benefit analysis of articles rated for quality was performed.For efficiency and reliability,recent randomized controlled trials,metaanalyses,high quality systematic reviews and large welldesigned studies were used if available.Internet searches were conducted for other relevant information,including policies and Australian data on claims under Medicare for MC.RESULTS Evidence-based policy statements by the American Academy of Pediatrics(AAP)and the Centers for Disease Control and Prevention(CDC)support infant and later age male circumcision(MC)as a desirable public health measure.Our systematic review of relevant literature over the past decade yielded 140 journal articles that met our inclusion criteria.Together,these showed that early infant MC confers immediate and lifelong benefits by protecting against urinary tract infections having potential adverse long-term renal effects,phimosis that causes difficult and painful erections and"ballooning"during urination,inflammatory skin conditions,inferior penile hygiene,candidiasis,various sexually transmissible infections in both sexes,genital ulcers,and penile,prostate and cervical cancer.Our risk-benefit analysis showed that benefits exceeded procedural risks,which are predominantly minor,by up to 200 to 1.We estimated that more than 1 in 2 uncircumcised males will experience an adverse foreskin-related medical condition over their lifetime.Wide-ranging evidence from surveys,physiological measurements,and the anatomical location of penile sensory receptors responsible for sexual sensation strongly and consistently suggested that MC has no detrimental effect on sexual function,sensitivity or pleasure.United States studies showed that early infant MC is cost saving.The evidence supporting early infant MC has further strengthened since the positive AAP and CDC reviews.CONCLUSION Affirmative MC policies are needed in Australia and New Zealand.Routine provision of accurate,unbiased education,and access in public hospitals,will maximize health and financial benefits. 展开更多
关键词 Male circumcision Evidence-based policy Infants Adults Urinary tract infections Adverse events Sexually transmitted infections Genital cancers Riskbenefit analysis Cost-benefit
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Infant male circumcision: An evidence-based policy statement 认领 引用 被引量：5
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作者 Brian J. Morris Alex D. Wodak +9 位作者 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 《Open Journal of Preventive Medicine》 2012年第1期79-92,共14页
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. Evide... 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. 展开更多
关键词 Male Circumcision Public Health Infant Infections Sexually Transmitted Infections Cervical Cancer
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Male Circumcision Does Not Reduce Sexual Function, Sensitivity or Satisfaction 认领 引用 被引量：1
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作者 Brian J. Morris John N. Krieger 《Advances in Sexual Medicine》 2015年第3期53-60,共8页
We disagree with Boyle’s recent article questioning our systematic review in Journal of Sexual Medicine in 2013 (Volume 10, pages 2644-2657). In particular, he disputed the quality ranking we assigned to 7 of the 36 ... We disagree with Boyle’s recent article questioning our systematic review in Journal of Sexual Medicine in 2013 (Volume 10, pages 2644-2657). In particular, he disputed the quality ranking we assigned to 7 of the 36 articles that met our inclusion criteria. These had been ranked for quality by the Scottish Intercollegiate Guidelines Network (SIGN) grading system. We found that, “the highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation or satisfaction.” This conclusion was supported by two randomized controlled trials, regarded as high-quality (1++) evidence and the majority of surveys and studies involving physiological measurements comparing uncircumcised and circumcised men. Here we explain why the 2 randomized controlled trials merit a 1++ ranking and why 4 reports that Boyle believes merit a higher ranking only meet the criteria set down for low quality (2?) evidence according to the SIGN system. We therefore stand by our conclusions. These are supported by a meta-analysis of sexual dysfunctions and by a recent detailed systematic review of the histological correlates of male sexual sensation. 展开更多
关键词 Circumcision Erectile Function Sexual Satisfaction Premature Ejaculation Penile Sensitivity
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Glans ischemia after circumcision in children:Two case reports 认领 引用
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作者 Daniela Codrich Alessandro Boscarelli +5 位作者 Alessia Cerrina Maria-Grazia Scarpa Marianna Iaquinto Damiana Olenik Edoardo Guida Jurgen Schleef 《World Journal of Clinical Pediatrics》 2021年第4期79-83,共5页
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 childhood.Even though circumcision is a well-standardized operation,several m... 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 childhood.Even though circumcision is a well-standardized operation,several minor and major complications may be experienced by paediatric surgeons.Glans ischemia(GI)has been widely reported in the paediatric literature as a complication following circumcision.Nonetheless,etiopathogenesis of GI is not well defined and management guidelines are lacking.CASE SUMMARY We describe our experience with this rare and scary complication using subcutaneous enoxaparin alone or in association with a topical vasodilator.CONCLUSION Hypothetical causes and different management strategies are discussed. 展开更多
关键词 Circumcision Children Complications Glans penis Ischemia Case report
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Comments by opponents on the British Medical Association’s guidance on non-therapeutic male circumcision of children seem one-sided and may undermine public health 认领 引用
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作者 Stephen Moreton Guy Cox +3 位作者 Mark Sheldon Stefan A Bailis Jeffrey D Klausner Brian J Morris 《World Journal of Clinical Pediatrics》 2023年第5期244-262,共19页
The British Medical Association(BMA)guidance on non-therapeutic circumcision(NTMC)of male children is limited to ethical,legal and religious issues.Here we evaluate criticisms of the BMA’s guidance by Lempert et al.W... The British Medical Association(BMA)guidance on non-therapeutic circumcision(NTMC)of male children is limited to ethical,legal and religious issues.Here we evaluate criticisms of the BMA’s guidance by Lempert et al.While their arguments promoting autonomy and consent might be superficially appealing,their claim of high procedural risks and negligible benefits seem one-sided and contrast with high quality evidence of low risk and lifelong benefits.Extensive literature reviews by the American Academy of Pediatrics and the United States Centers for Disease Control and Prevention in developing evidence-based policies,as well as risk-benefit analyses,have found that the medical benefits of infant NTMC greatly exceed the risks,and there is no reduction in sexual function and pleasure.The BMA’s failure to consider the medical benefits of early childhood NTMC may partly explain why this prophylactic intervention is discouraged in the United Kingdom.The consequence is higher prevalence of preventable infections,adverse medical conditions,suffering and net costs to the UK’s National Health Service for treatment of these.Many of the issues and contradictions in the BMA guidance identified by Lempert et al stem from the BMA’s guidance not being sufficiently evidence-based.Indeed,that document called for a review by others of the medical issues surrounding NTMC.While societal factors apply,ultimately,NTMC can only be justified rationally on scientific,evidence-based grounds.Parents are entitled to an accurate presentation of the medical evidence so that they can make an informed decision.Their decision either for or against NTMC should then be respected. 展开更多
关键词 Circumcision,Male Child Infections Risk Policy Public health
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The“ARM”principle and practice:Preventing postoperative complications of circumcision 认领 引用
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作者 Chen Cheng Yiwen Zhou +2 位作者 Quan Zhang Yang Liu Kaixiang Cheng 《Chinese Journal of Plastic and Reconstructive Surgery》 2022年第3期119-122,共4页
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 c... 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 circumcision.Methods: 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 procedure.Conclusion: The “ARM” principle may help surgeons to prevent postoperative complications of circumcision.Maintaining the fascia during the procedure can increase the diameter of the surgical region. 展开更多
关键词 Circumcision Complication Stenosis Lymphatic circulation
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