Application of foam dressing combined with adhesive penile hood after circumcision in children / 中国实用护理杂志

Objective:To investigate the effect of applying foam dressing combined with self-made adhesive penile hood fixation in children after circumcision.Methods:A total of 101 cases of children who received circumcision from January to December 2020 in the urology department of the People′s Hospital of Xuancheng City were selected. The patients were randomly divided into experimental group (50 cases) and control group (51 cases). In the experimental group, the incision was wound with foam dressing combined with the self-made adhesive penile hood fixation method, while in the control group, the incision was wound with the conventional sterile gauze dressing combined with the simple plastic basket fixation method.The postoperative incision bleeding, prepuce edema, incision pain, incidence of complications and the satisfaction of the children′s family members on postoperative dressing and fixation were compared between the two groups.Results:The incidence of prepuce edema in the experimental group was 88.00% (44/50), 12.00% (6/50), 0, which in the control group was 43.14% (22/51), 45.10% (23/51), 11.76% (6/51), and the difference between the two groups was statistically significant ( Z= -4.80, P<0.05). In the experimental group, pain score at 24 hours after operation and at the time of dressing change were 3.50 ± 1.04, 2.48 ± 0.54, respectively, which were lower than that of the control group 5.31 ± 1.36 and 7.12 ± 0.97, and the difference between the two groups was statistically significant ( t=7.53, 29.66, all P<0.05). The incidence of postoperative infection and urinary retention in the experimental group were 0 and 2.00% (1/50), respectively, which were lower than 7.84% (4/51) and 7.84% (4/51) in the control group, and the difference between the two groups was statistically significant (Fisher′s exact probability method, P<0.05). The degree of family satisfaction in the experimental group was 96.00% (48/50), which was higher than that in the control group (78.43%, 40/51), and the difference between the two groups was statistically significant ( χ2=6.95, P<0.05). Conclusions:The application of foam dressing combined with pasting penile hood after circumcision can reduce the degree of foreskin edema, pain and the incidence of complications, and improve the satisfaction of the children′s family members.

Experience in circumcision of children aged 3-6 years under the intervention of modern holistic medical model / 国际外科学杂志

Objective Under the intervention of modern holistic medical model,the subjective feelings and objective effects of parents and children in circumcision were studied in children aged 3-6 years.Methods A prospective study was conducted to select 2012 children aged 3 to 6 years who underwent circumcision at the First Affiliated Hospital of Kunming Medical University from August 2013 to May 2017.The patients were divided into control group and experimental group by completely randomized grouping,there were 1 006 cases in each group.The children in the control group were treated with a single biomedical model,which was completed according to the conventional flow-type operation.The children in the experimental group adopted the modern holistic medical model,and the full modern holistic medical model intervention was performed before,during and after the operation.The medical treatment process highlighted the overall humanistic care for the children.The age of the control group was (4.19 ± 1.75) years old,and the age of the children in the experimental group was (4.26 ±1.68) years old.The operation time,the degree of surgical pain [with the pain visual analogue scale (VAS)],the postoperative complications (including postoperative hemorrhage,penile edema,infection,wound rupture),wound healing time,surgery satisfaction rate and fear level of children were compared between the two groups.Measurement data were expressed as mean ± standard deviation (Mean ± SD),t-test was used for comparison between groups;Chi-square test was used to compare the count data.Results In the control group,the operation time was (9.26 ± 1.87) min,the surgical pain VAS was (2.59 ±0.72),postoperative bleeding was 38 (3.8％),severe penile edema was 78 (7.8％),and infection was 12 (1.2％),wound rupture was 32 cases (3.2％),the wound healing time was (20.4 ± 2.56) d,and the surgical satisfaction rate was 67.4％.In the experimental group,the operation time of was (6.15 ± 1.23) min,the surgical pain VAS was (1.71 ± 0.54),postoperative bleeding was 6 cases (0.6％),severe penile edema was 12 cases (1.2％),and infection was 8 cases (0.8％),wound rupture was 2 cases (0.2％),the healing time was (15.2 ± 3.16) d,and the operation satisfaction rate was 98.8％.The operation time,surgical pain VAS,postoperative bleeding,severe penile edema,wound splitting rate,healing time and surgical satisfaction rate were statistically significant (P ＜ 0.05),and there was no statistical difference in wound infection rate between the two groups (P ＞ 0.05).The fear level of children in the experimental group was superior to the control group at levels 0,1,2 and 3,the difference was statistically significant (P ＜ 0.05).Conclusions Under the intervention of modern holistic medical model,the child's operation process is smooth,the children and parents have good subjective feelings,no obvious fear,good compliance,high satisfaction,good objective clinical effect,and positively improve the relationship between doctors and patients.The society has won a good reputation and deserves to be promoted clinically.

Experience in circumcision of children aged 3-6 years under the intervention of modern holistic medical model / 国际外科学杂志

Objective@#Under the intervention of modern holistic medical model, the subjective feelings and objective effects of parents and children in circumcision were studied in children aged 3-6 years.@*Methods@#A prospective study was conducted to select 2012 children aged 3 to 6 years who underwent circumcision at the First Affiliated Hospital of Kunming Medical University from August 2013 to May 2017. The patients were divided into control group and experimental group by completely randomized grouping, there were 1 006 cases in each group. The children in the control group were treated with a single biomedical model, which was completed according to the conventional flow-type operation. The children in the experimental group adopted the modern holistic medical model, and the full modern holistic medical model intervention was performed before, during and after the operation. The medical treatment process highlighted the overall humanistic care for the children. The age of the control group was (4.19±1.75) years old, and the age of the children in the experimental group was (4.26±1.68) years old. The operation time, the degree of surgical pain [with the pain visual analogue scale (VAS)], the postoperative complications (including postoperative hemorrhage, penile edema, infection, wound rupture), wound healing time, surgery satisfaction rate and fear level of children were compared between the two groups. Measurement data were expressed as mean±standard deviation (Mean±SD), t-test was used for comparison between groups; Chi-square test was used to compare the count data.@*Results@#In the control group, the operation time was (9.26±1.87) min, the surgical pain VAS was (2.59±0.72), postoperative bleeding was 38 (3.8%), severe penile edema was 78 (7.8%), and infection was 12 (1.2%), wound rupture was 32 cases (3.2%), the wound healing time was (20.4±2.56) d, and the surgical satisfaction rate was 67.4%. In the experimental group, the operation time of was (6.15±1.23) min, the surgical pain VAS was (1.71±0.54), postoperative bleeding was 6 cases (0.6%), severe penile edema was 12 cases (1.2%), and infection was 8 cases (0.8%), wound rupture was 2 cases (0.2%), the healing time was (15.2±3.16) d, and the operation satisfaction rate was 98.8%. The operation time, surgical pain VAS, postoperative bleeding, severe penile edema, wound splitting rate, healing time and surgical satisfaction rate were statistically significant (P<0.05), and there was no statistical difference in wound infection rate between the two groups (P>0.05). The fear level of children in the experimental group was superior to the control group at levels 0, 1, 2 and 3, the difference was statistically significant (P<0.05).@*Conclusions@#Under the intervention of modern holistic medical model, the child′s operation process is smooth, the children and parents have good subjective feelings, no obvious fear, good compliance, high satisfaction, good objective clinical effect, and positively improve the relationship between doctors and patients. The society has won a good reputation and deserves to be promoted clinically.

Circumcision: postoperative complications that required reoperation / Postectomia: complicações pós-operatórias necessitando reintervenção cirúrgica

ABSTRACT Objective To evaluate post-operative complications of circumcision requiring surgical reintervention. Methods Retrospective analysis of medical records of patients submitted to circumcision from May 1st, 2015 to May 31st, 2016. Results A total of 2,441 circumcisions were performed; in that, 1,940 using Plastibell and 501 by the classic technique. Complications requiring surgical reintervention were found in 3.27% of patients. When separated by surgical technique, 3.4% of circumcisions using Plastibell device required reoperation, as compared to 3% of conventional technique (p=0.79). Preputial stenosis was most frequently found in classic circumcision, with statistical significance (p<0.001). Bleeding was more frequent when using Plastibell device, but the difference was not statistically different (p=0.37). Patients' age was also evaluated to investigate if this variable influenced on the postoperative outcome, but no significant difference was found. Conclusion There was no statistically significant difference when comparing complications between the different techniques performed at this hospital. Preputial stenosis was most frequently found in the classic circumcision, while bleeding was more prevalent when using Plastibell device. Patients' age did not influence in complications.

RESUMO Objetivo Avaliar as complicações pós-operatórias de postectomia que necessitaram de reintervenção cirúrgica. Métodos Estudo retrospectivo com análise de prontuários de pacientes submetidos à postectomia entre 1o de maio de 2015 a 31 de Maio de 2016. Resultados Foram realizadas 2.441 postectomias no período, sendo 501 utilizando a técnica clássica e 1.940 utilizando o dispositivo Plastibell. Apresentaram complicações que necessitaram reintervenção cirúrgica 3,27% dos pacientes. Quando separados por técnica operatória, 3,4% das postectomias com Plastibell foram reoperadas, comparando com 3% das postectomias convencionais (p=0,79). A estenose de prepúcio foi mais frequentemente encontrada na técnica clássica, com significância estatística (p<0,001). Sangramento foi mais frequente nos casos com uso do Plastibell, porém sem diferença significativa (p=0,37). A idade dos pacientes também foi avaliada para investigar se esta variável influenciou na taxa de complicações pós-operatórias, porém não houve diferença significativa. Conclusão Não houve diferença estatisticamente significativa quando comparadas as complicações entre as diferentes técnicas cirúrgicas utilizadas neste serviço. A estenose de prepúcio foi mais frequentemente encontrada nos pacientes operados pela técnica convencional enquanto demonstrou-se tendência a maior sangramento com uso do Plastibell. A idade dos pacientes não influenciou na presença de complicações.

The impact of male circumcision on the natural history of genital HPV infection: a prospective cohort study / 中华预防医学杂志

Objective@#To analyze the correlation between circumcision and incidence and clearance of male genital HPV infection.@*Methods@#From May to July 2014, 18-55 year old men who had sexual behavior history were recruited from the general population in Liuzhou, Guangxi to set up a cohort. Totally, 113 circumcised and 560 uncircumcised men were enrolled and interviewed using a questionnaire (including information on demographic characteristics and sexual behaviors), then they were followed-up with 6-month interval for 2 times. On each visit, specimens of male external genitalia were collected and genotyped for HPV DNA. The differences of incidence and clearance of genital HPV infections between circumcised and uncircumcised men were analyzed by Log-rank test. Cox regression was used to analyze the relationship between circumcision and incidence and clearance of HPV infection.@*Results@#The median age (P25, P75) of circumcised and uncircumcised men were 28 (24, 35) and 32 (24, 31), respectively. The incidences of any HPV infections were 9.1 (95%CI: 2.4-15.7) and 8.4 (95% CI: 5.6-11.2) per 1 000 person-months (χ2=0.10, P=0.758), respectively. The clearance of circumcised men [136.3 (95%CI: 70.0-202.7) per 1 000 person-months] was higher than that in uncircumcised men [89.6 (95%CI: 65.9-113.3) per 1 000 person-months] (χ2=8.19, P=0.004). In multivariate COX regression analysis, compared with uncircumcised men, circumcised men had higher possibility to clear any HPV infections (HR: 2.41, 95%CI: 1.30-4.46). Compared with men having one sexual partner, people having more than 4 sexual partners had lower possibility to clear any HPV infections (HR: 0.49, 95%CI: 0.25-0.96). Compared with 18-25 years old men, men aged 26-35 years old had higher possibility to clear high-risk HPV infections (HR: 2.14, 95%CI: 1.08-4.23).@*Conclusion@#Circumcised and uncircumcised men had similar incidence of genital HPV infection, whereas, men conducted circumcision and having fewer sexual partners could increase the clearance of genital HPV infections.

Clinical effect of two-person of and one-person operations of disposable circumcision stitching instrument / 国际外科学杂志

Objective To compare the clinical effect of two-person operations of disposable circumcision stitching instrument and one-man operations of disposable circumcision stitching instrument.Methods Clinical data of 340 patients with redundant prepuce or phimosis from March 2015 to August 2017 were randomly divided into control group which patients with two-person operation of disposable circumcision stitching instrument and study group which patients with one-man operation of disposable circumcision stitching instrument were reviewed prospectively.There were 188 patients in the study group,including 22 patients with phimosis and 166 patients with redundant prepuce;Among the 152 patients in the control group,there were 17 cases with phimosis and 135 cases with redundant prepuce.Two groups with operation time,intraoperative blood loss,postoperative skin staple missing,2 hours postoperative pain,postoperative edema,the swelling subsided time,postoperative complications,postoperative patient satisfaction,and so on.Measurement data were represented as (x) ± s,and comparison between groups was analyzed using t test;count data were represented as percentage and comparison between groups was analyzed chi-square.Results All operations were finished successfully for the patients by two-person or one-man of operations of disposable circumcision stitching instrument.In terms of operation,the operation time of the observation group and the control group was (7.76 ±0.45) minutes and (7.86 ±0.91) minutes respectively,and the difference was not statistically significant(P ＞ 0.05).Intraoperative hemorrhage of observation group and control group were (1.77 ± 0.22) ml and (1.72 ± 0.26) ml,and the difference was not statistically significant (P ＞ 0.05).There was no statistically significant difference between the observation group and the control group (P ＞ 0.05) in the postoperative 2 hours pain score and skin staple missing.In the postoperative complications,the deviation rate of the prepuce was 1.11％,significantly lower than the control group 5.92％,and the difference was statistically significant (P ＜ 0.05).There was no statistically significant difference between the observation group and the control group in terms of edema on the third postoperative day,short postoperative anastomosis,patient satisfaction,and postoperative infection.Conclusion The way of one-man operation of disposable circumcision stitching instrumente not only saves labor costs,but also has a good postoperative clinical effect,meanwhile,it has high efficiency and strong operability,and is worthy of promotion for clinical first-line urologists.

Effects of midazolam on the agitation and wake time of the postoperative resuscitation in pediatric circumcision / 中国基层医药

Objective To explore the effect of midazolam on the agitation and wake time of the postoperative resuscitation in pediatric circumcision.Methods Clinical data of 170 cases of pediatric circumcision were retrospectively analyzed.They were divided into control group and observation group according to the anesthesia scheme ,85 cases in each group.The control group was anesthetized with sevoflurane compound ketamine ,and the observation group was given trifluorothane and ketamine combined with midazolam .The effects of the two groups were compared .Results The cardiac rhythm and the central arterial pressure at first 10min of operation in the observation group were (99.64 ±5.97) times/min,(65.81 ±5.63) mmHg,respectively,which in the control group were (122.38 ± 12.54)times/min,(86.49 ±12.35) mmHg,respectively,the differences between the two groups were statistically significant(t=8.749,9.438,all P<0.05).The total amount of ketamine,waking time,pain score,Watcha score, PAED score in the observation group were (42.33 ±5.85)mg,(5.56 ±2.03)min,(2.16 ±1.05)points,(1.65 ± 0.59)points,(5.23 ±1.04) points,respectively,which in the control group were (72.53 ±16.58) mg,(13.29 ± 4.66)min,(4.29 ±2.35) points,(2.84 ±1.46)points,(8.75 ±2.19)points,respectively,the differences between the two groups were statistically significant(t=11.698,8.239,7.763,6.997,8.168,all P<0.05).The incidence rates of respiratory inhibition ,fidgety,nausea and vomiting of the observation group were 1.18％,3.53％,3.53％, respectively,which of the control group were 9.41％,15.29％,16.47％,respectively,the differences between the two groups were statistically significant(χ2 =4.174,3.589,4.281,all P<0.05).Conclusion Application of midazolam in pediatric prepuce intraoperatively has little influence on the vital signs of children ,and can relieve postoperative awaken agitation , reduce the time of awakening and anesthesia complications , and it is worthy of popularizing in clinical application .

Observation time and spontaneous resolution of primary phimosis in children / Tempo de observação e resolução espontânea de fimose primária em crianças

ABSTRACT Objective: to investigate spontaneous resolution rate of a series of patients with physiologic phimosis in relation to observation time and presence of symptoms. Methods: retrospective and longitudinal follow-up study of patients with physiologic phimosis, that did not apply topic treatment. These patients were invited for a new visit for reevaluation, or recent data were obtained by chart analysis. Spontaneous resolution rate was determined and statistically compared to age, presence of symptoms at first medical visit and time until reevaluation. Results: seventy one patients were included. Medium time of observation from first visit to reevaluation was 37.4 months. There was spontaneous resolution of phimosis in 32 (45%) patients. Children with spontaneous resolution were younger at initial diagnosis and were observed during a longer period of time. Most asymptomatic patients at first visit presented spontaneous resolution. However, it was not possible to stablish a significant relationship between presence of symptoms and evolution of physiologic phimosis. Conclusions: time of observation was the main determinant of spontaneous resolution of patients with physiologic phimosis, reinforcing the current more conservative approach regarding circumcision of those patients.

RESUMO Objetivo: investigar a taxa de resolução espontânea de uma série de pacientes com diagnóstico de fimose fisiológica e sua relação com o tempo de observação e com a presença de sintomas. Métodos: estudo retrospectivo e de seguimento longitudinal e observacional de pacientes em acompanhamento por fimose fisiológica, que não haviam realizado tratamento tópico. Estes pacientes foram convocados para uma consulta médica de reavaliação ou tiveram dados recentes obtidos a partir da análise dos prontuários. A taxa de resolução espontânea foi determinada e comparada estatisticamente de acordo com a idade, com a presença de sintomas no momento da primeira consulta e com o tempo transcorrido entre a primeira consulta e a reavaliação. Resultados: setenta e um pacientes foram incluídos no estudo. O tempo médio de observação, entre a primeira consulta e a reavaliação foi de 37,4 meses. Houve resolução espontânea da fimose em 32 (45%) pacientes. As crianças que apresentaram resolução espontânea eram mais jovens no momento do diagnóstico inicial e foram observadas por um maior intervalo de tempo. A maior parte dos pacientes assintomáticos na primeira consulta apresentou resolução espontânea. No entanto, não foi possível estabelecer uma relação significativa entre a presença de sintomas e a evolução da fimose fisiológica. Conclusões: o tempo de observação foi o maior determinante para a resolução espontânea de pacientes com fimose fisiológica, o que reforça a tendência atual mais conservadora em relação às indicações de circuncisão para estes pacientes.

Novel penile circumcision suturing devices versus the shang ring for adult male circumcision: a prospective study

ABSTRACT Introduction To evaluate the safety and efficacy of a novel penile circumcision suturing devices PCSD and Shang ring (SR) for circumcision in an adult population. Materials and Methods A total of 124 outpatients were randomly assigned to receive PCSD (n=62) or SR (n=62). Patient characteristics, operative time, blood loss, return to normal activities time (RNAT), visual analogue scale (VAS), scar width, wound healing time, cosmetic result, and complications were recorded. Results There were no significant differences in blood loss, RNAT, or complications between the two groups. There were no significant differences in the VAS scores at the operation, at 6 or 24 hours after surgery (P>0.05). The wound scar width was wider in the SR group than in the PCSD group (P<0.01). Patients in the SR group had significantly longer wound healing time compared with those in the PCSD group (P<0.01). Patients who underwent PCSD were significantly more satisfied with the cosmetic results (P<0.01). Conclusions SR and PCSD are safe and effective minimally invasive techniques for adult male circumcision. Compared with SRs, PCSDs have the advantages of faster postoperative incision healing and a good effect on wound cosmetics.

Comparative effect of dorsal slit circumcision and disposable circumcision suture device / 中华全科医师杂志

Objective To compare the safety and effectiveness of disposable circumcision suture device (DCSD) with conventional circumcision in surgical treatment of phimosis and redundant prepuce . Methods One hundred and sixty one patients with phimosis or redundant prepuce were randomly assigned to be treated by circumcision using disposable circumcision suture device ( DCSD group , n =89 ) or conventional circumcision (CC group,n =72),respectively.Results The operation time was (3.8 ± 0.5)min in DCSD group and (31.6 ±2.7)min in CC group (F=71.21,P=0.000),blood loss was 1.0(0.9, 1.2)ml in DCSD group and 6.2(5.7, 7.0)ml in CC group (Z =-10.90,P=0.000).There were no significant differences in intraoperative pain score (1.4 ±0.6 vs.2.9 ±0.8, F=2.08, P=0.151) and wound healing time [(14.0 ±1.3) vs.(16.8 ±2.1) d, F=0.10, P=0.754] between two groups.There was no need to change the dressing for patients in DSCD group 3 days after the operation , while patients in CC group changed dressing 3 times after the operation .No significant differences in postoperative complication rate [10%(9/89) vs.4%(3/72),χ2 =2.04,P=0.153] and satisfaction rate with the penile appearance [98%(87/89) vs.94%(68/72), χ2 =0.47,P=0.494] were found between two groups .Conclusion DCSD exhibits superiority over CC for shorter operation time and less blood loss in circumcision .

A fast, easy circumcision procedure combining a CO2 laser and cyanoacrylate adhesive: a non-randomized comparative trial

ABSTRACT Background Circumcision is performed as a routine operation in many countries, more commonly for religious and cultural reasons than for indicated conditions, such as phimosis and balanitis. There are many techniques available, and recently electrocautery and both Nd:YAG and CO2 lasers, instead of blades, have been used for skin and mucosal incisions. However, the infection risk in circumcisions performed using a CO2 laser was 10% higher. There are also reports of sutureless procedures using cyanoacrylate, but these have higher risks of hematoma and hemorrhage. We combined a CO2 laser and cyanoacrylate to shorten the operation time and to decrease bleeding complications. Materials and Methods : Circumcisions were performed under general anesthesia with CO2 laser and cyanoacrylate combination in 75 6–9-year-old boys between May 2013 and August 2014 only for religious reasons. As a control, we compared them retrospectively with 75 age-matched patients who were circumcised using the conventional guillotine method in our clinic. Results No hematomas, bleeding, or wound infections were observed. One wound dehiscence (1.33%) occurred during the early postoperative period and healed without any additional procedures. The median operating time was 7 (range 6–9) minutes. The conventional guillotine group comprised one hematoma (1.3%), two wound dehiscences (2.6%), and two hemorrhages (2.6%), and the median operating time was 22 (range 20–26) minutes. The difference in surgical time was significant (p<0.001), with no significant difference in the rate of complications between the two groups. Conclusion The combined CO2 laser and cyanoacrylate procedure not only decreased the operating time markedly, but also eliminated the disadvantages associated with each individual procedure alone.

Clinical study on 34 concealed penis in children after being mistaken for reshaping / 中国医师杂志

Objective To investigate surgical method and effect on concealed penis in children after being mistaken for reshaping to provide the basis for clinical diagnosis and treatment.Methods The clinical data of 34 patients with concealed penis were analyzed retrospectively.All patients underwent surgical treatment of improving devine technique and transferred of the penile ventral flap.In the case,the congenital dartoic fascia dysplasia of penile shaft were resected and dennodesis of root of the penile were applied with transferred of the penile ventral flap to make up the defected skin of the back side for summary of surgical methods and techniques.Results Thirty four cases of children were successfully reshaped,and 27 cases were followed-up of 2 ～ 38 months.All 27 cases had normal penile development,results were satisfactory.Conclusions The surgical treatment can effectively treat concealed penis and the modified devine incision with transferred of the penile ventral flap is one of the ideal surgical treatment to correct the disease in children with simple,quick recovery,less complications,and beautiful appearance of penis with satisfactory efficacy.It is worth of clinical popularization and application.

What is the benefit of the biomedical and behavioral interventions in preventing HIV transmission? / Qual é o benefício das intervenções biomédicas e comportamentais na prevenção da transmissão do HIV?

ABSTRACT Introduction: Scientific evidence supports the sinergy between biomedical and behavioral interventions aimed at preventing the transmission of HIV as a strategy to eradicate AIDS. Objective: To characterize comparatively the benefits from biomedical and behavioral interventions to prevent HIV transmission. Methods: Narrative review. We performed a comparative analysis of the benefits of studied interventions by means of estimating the number needed to treat (NNT). Evaluated interventions: counseling activities for behavior change to prevent exposure to HIV; antiretroviral pre-exposure prophylaxis (PrEP) and antiretroviral post-exposure prophylasis (PEP) for HIV and treatment of serodiscordant couples as a strategy for prevention of HIV transmission (TasP). Results: counseling interventions and TasP have smaller NNTs, equal to, respectively, 11 (95%CI 9 - 18) at 12 months and 34 (95%CI 23 - 54) in 42 months comparatively to PrEP interventions, that resulted in 41 (95%CI 28 - 67) individuals receiving antiretrovirals in order to prevent one case of HIV infection at 36 months for men and serodiscordant couples. PEP interventions are associated with protective effects estimated at 81%. Lack of trials evaluating PEP prevents estimate of NNT. Conclusion: The estimate of the NNT can be a helpful parameter in the comparison between the effectiveness of different behavioral and biomedical HIV prevention strategies. Studies evaluating the benefit and safety of combined behavioral and biomedical interventions are needed, especially considering the attributable fraction of each component. Integration of behavioral and biomedical interventions is required to achieve complete suppression of the virus, and thus reducing viral replication, infectivity and the number of cases.

RESUMO Introdução: Evidências científicas sustentam a integração entre intervenções biomédicas e comportamentais visando à prevenção da transmissão do HIV como estratégia de erradicação da epidemia de AIDS. Objetivo: Caracterizar o benefício comparado de intervenções biomédicas e comportamentais na prevenção da transmissão do HIV. Métodos: Revisão narrativa. Análise comparativa dos benefícios das intervenções mediante estimativa do número necessário para tratamento (NNT). Intervenções avaliadas: aconselhamento para mudança de comportamentos relacionados à exposição ao HIV; profilaxia antirretroviral pré (PrEP) e pósexposição (PEP) ao HIV; tratamento de casais sorodiscordantes como prevenção da transmissão do vírus (TcP). Resultados: Estratégias de aconselhamento e de TcP apresentam NNT menores, iguais a, respectivamente, 11 (IC95% 9 - 18), em 12 meses, e 34 (IC95% 23 - 54), em 42 meses, do que intervenções de PrEP, equivalentes a 41 (IC95% 28 - 67) indivíduos para evitar um caso de infecção pelo HIV em 36 meses para homens e casais sorodiscordantes. Intervenções de PEP estão associadas a efeito protetor estimado em 81%. Ausência de ensaios clínicos avaliando PEP impede a estimativa de NNT. Conclusão: A estimativa do NNT pode ser parâmetro útil de comparação da efetividade de diferentes estratégias comportamentais e biomédicas de prevenção da transmissão do HIV. Estudos avaliando o benefício e a segurança de intervenções comportamentais e biomédicas combinadas são necessários, sobretudo considerando a fração atribuível de cada componente. A integração entre intervenções comportamentais e biomédicas é necessária para que a supressão completa do vírus se torne possível, reduzindo a replicação viral, a infectividade e, consequentemente, o número de casos.

Traumatic neuroma of the penis after circumcision - Case report

Abstract Traumatic neuromas are tumors resulting from hyperplasia of axons and nerve sheath cells after section or injury to the nervous tissue1. We present a case of this tumor, confirmed by anatomopathological examination, in a male patient with history of circumcision. Knowledge of this entity is very important in achieving the differential diagnosis with other lesions that affect the genital area such as condyloma acuminata, bowenoid papulosis, lichen nitidus, sebaceous gland hyperplasia, achrochordon and pearly penile papules.

Os desafios éticos da mutilação genital feminina e da circuncisão masculina / Los desafíos éticos de la mutilación genital femenina y de la circuncisión masculina / Ethical challenges of female genital mutilation and of male circumcision

O trabalho aborda os desafios éticos concernentes à mutilação genital feminina e à circuncisão masculina, mostrando similitudes e diferenças. A circuncisão masculina é um procedimento médico para determinadas condições clínicas da saúde genital masculina. Os povos que praticam a mutilação genital feminina também praticam a circuncisão masculina ritualística, sendo que há povos e religiões que praticam a circuncisão masculina sem que haja mutilação genital feminina. A mutilação genital feminina se concentra em bolsões de pobreza, sendo atentatória aos direitos humanos, havendo diversos movimentos mundiais em prol de sua erradicação. A circuncisão masculina pode se associar a complicações bastante sérias, de modo que não é aceitável sua realização sem indicação clínica precisa.

Este artículo enfoca los desafíos éticos acerca de la mutilación genital femenina y la circuncisión masculina, demostrando las similitudes y diferencias. La circuncisión masculina es un procedimiento médico para determinadas condiciones clínicas de la salud genital masculina. Los pueblos que practican la mutilación genital femenina también practican la circuncisión masculina ritualista, habiendo pueblos y religiones que practican la circuncisión masculina sin que exista la mutilación genital femenina. La mutilación genital femenina se concentra en zonas de pobreza y ofende a los derechos humanos, habiendo muchos movimientos mundiales en favor de su erradicación. La circuncisión masculina puede estar asociada con complicaciones muy graves, por lo que no es aceptable su realización sin una indicación clínica precisa.

This article is about the ethical challenges related to female genital mutilation and male circumcision, by showing similarities and differences. Male circumcision is a medical procedure to some clinical conditions of male genital health. The peoples that carry out the female genital mutilation also carry out together the ritual of male circumcision, but there are peoples and religions that carry out male circumcision without female genital mutilation. Female genital mutilation occurs concentrated in very poor regions and it is against Human Rights, so there are several worldwide movements for its eradication. Male circumcision can be associated to seriously dangerous complications, so that it is not ethically acceptable to be carried out without a precise clinical indication.

Comparison of Postoperative Analgesic Efficacy of Penile Block, Caudal Block and Intravenous Paracetamol for Circumcision: A prospective Randomized Study

Purpose To evaluate the postoperative analgesic efficacy of penile block, caudal block and intravenous paracetamol administration following circumcision. Materials and Methods In this prospective randomized study a total of 159 patients underwent circumcision under general anesthesia at urology clinic of Ufuk University Faculty of Medicine and Sorgun State Hospital between May 2012 and September 2012. The patients were randomized to three groups to receive penile block (Group 1), caudal block (Group 2) and intravenous paracetamol administration (group 3). Pain measurement of the patients was done via CHEOPS scoring system at 30,60,120 and 180 minutes postoperatively and compared. Statistical tests were performed with a conventional statistics program and statistical significance was set at a p value of < 0.05. Results The mean age of the patients was 5.7 years. Patients in group 1 had significantly lower pain score at 30 minutes compared to other two groups. At 60 minutes groups 1 and 2 had significantly lower score compared to group 3. At 120 and 180 minutes no difference between the groups was observed. No significant major complications were observed in all 3 groups. Conclusion Penile block and caudal block provide similar pain scores and painless postoperative periods after circumcision under general anesthesia. Intravenous paracetamol is insufficient at the early postoperative period. The three procedures were shown to be safe for analgesia following circumcision. .

Circuncisão por motivos médicos no sistema público de saúde do Brasil: epidemiologia e tendências / Circumcisions for medical reasons in the Brazilian public health system: epidemiology and trends

OBJETIVO: Avaliar os fatores epidemiológicos associados à circuncisão por motivos médicos, tendo por base os dados do sistema público de saúde do Brasil. MÉTODOS: Utilizando os dados públicos do Sistema Único de Saúde de 1984 e 2010, foi realizada busca de admissões hospitalares associadas ao tratamento cirúrgico da fimose. Um total de 668.818 homens admitidos nos hospitais públicos e submetidos à circuncisão foram identificados e incluídos neste estudo. RESULTADOS: A média±desvio padrão de 47,8±13,4 circuncisões/100 mil homens por ano foi realizada no Sistema Único de Saúde por razões médicas. No período de 27 anos em que o procedimento foi avaliado, 1,3% da população masculina necessitou de circuncisão por indicação médica. O número total de circuncisões e a taxa de circuncisões aumentou na infância e decaiu progressivamente depois de 5 anos de idade, voltando a aumentar após a sexta década de vida. Nas regiões do país com melhor acesso aos serviços de saúde, 5,8% dos meninos de 1 a 9 anos de idade necessitaram de circuncisões. De 1992 a 2010, houve 63 mortes associadas à circuncisão, com taxa de mortalidade de 0,013%. CONCLUSÃO: Por meio do presente estudo, foi possível estimar as taxas de circuncisão anuais no Brasil, e uma taxa de mortalidade muito baixa foi associada a esses procedimentos. As circuncisões são realizadas mais frequentemente em crianças na primeira década de vida, e um segundo pico de incidência de doenças no prepúcio ocorre depois da sexta década de vida quando a circuncisão é progressivamente realizada novamente.

OBJECTIVE: To evaluate the epidemiological factors associated to medical circumcision, based on data from the Brazilian public health system. METHODS: Using the Unified Health System public database between 1984 and 2010, hospital admissions associated with surgical treatment of phimosis were searched. A total of 668,818 men admitted to public hospitals who underwent circumcision were identified and included in the present study. RESULTS: A mean±standard deviation of 47.8±13.4 circumcisions/100,000 men/year was performed through the Unified Health System for medical reasons. During the 27-year period evaluated, 1.3% of the male population required circumcision for medical reasons. Total number of circumcisions and circumcision rate increased in childhood, declined progressively after 5 years of age and rose again progressively after the sixth decade of life. In the regions of the country with better access to healthcare, 5.8% of boys aged 1 to 9 years old required circumcisions. From 1992 to 2010 there were 63 deaths associated with circumcisions (mortality rate of 0.013%). CONCLUSION: In conclusion, yearly circumcision rates could be estimated in Brazil, and a very low mortality rate was associated with this procedures. Circumcision is mostly performed in children in the first decade of life and a second peak of incidence of penile foreskin diseases occurs after the sixth decade of life, when circumcision is progressively performed again.

Comparison of therapeutic effect of foreskin cerclage,traditional circumcision and the Uygur "circumcision" / 中华全科医师杂志

The outpatient service data of 2889 cases of phimosis or redundant prepuce treated in our hospital and the follow-up data of 1660 cases of the Uygur"circumcision"from April 2002 to April 2007were retrospectively analyzed.The therapeutic effect of foreskin cerclage,traditional circumcision and Uygur"circumcision"were compared.The incidence of postoperative complications of foreskin cerclage group was the lowest,the incidence of postoperative complications of traditional circumcision group was lower than that of the Uygur"circumcision"group.