Evaluation of the safety and efficiency of the dorsal slit and sleeve methods of male circumcision provided by physicians and clinical officers in Rakai, Uganda.
BJU Int
; 109(1): 104-8, 2012 Jan.
Article
em En
| MEDLINE
| ID: mdl-21627752
ABSTRACT
OBJECTIVE:
To assess the safety and efficiency of the dorsal slit and sleeve male circumcision (MC) procedures performed by physicians and clinical officers (COs). PATIENTS ANDMETHODS:
We evaluated the time required for the MC procedure (efficiency) and moderate/severe adverse events (AEs) for MC (safety) by trained physicians and COs using the sleeve and dorsal slit MC methods in a service programme. Univariate and multiple regressions with robust variance estimation were used to assess factors associated with operative duration (linear) and AEs (logistic).RESULTS:
Six physicians and eight COs conducted 1934 and 3218 MCs, respectively; there were 2471 dorsal slit and 2681 sleeve MC procedures. The overall mean operative duration was 33 min for newly trained providers, which decreased to ≈20 min after ≈100 MCs. The adjusted mean operative duration for dorsal slit MC was significantly shorter than that for the sleeve MC method (Δ - 2.7 min, P < 0.001). The operative duration was longer for COs than physicians for the sleeve procedure, but not the dorsal slit procedure; however this difference reduced with increasing numbers of MCs completed. The unadjusted AE rates were 0.6% for dorsal slit MC and 1.4% for the sleeve method (P = 0.006) and 1.5% for physicians and 0.68% for COs (P = 0.003); however, there were no significant differences after multivariate adjustment. Use of bipolar cautery significantly reduced operative duration (Δ - 4.0 min, P = 0.008), but was associated with higher AE rates (adjusted odds ratio 2.13, 95% confidence interval 1.26-3.61, P = 0.005).CONCLUSION:
The dorsal slit MC method is faster than sleeve resection, and can be safely performed by non-physicians; however, use of bipolar cautery may be inadvisable in this setting.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Médicos
/
Adaptação Psicológica
/
Circuncisão Masculina
/
Satisfação do Paciente
/
Competência Clínica
Tipo de estudo:
Clinical_trials
Limite:
Adolescent
/
Adult
/
Aged
/
Child
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
Africa
Idioma:
En
Revista:
BJU Int
Assunto da revista:
UROLOGIA
Ano de publicação:
2012
Tipo de documento:
Article
País de afiliação:
Uganda