[Development of circumcision rates in Germany since the approval of ritual circumcision : A population-based analysis from 2013 to 2018]. / Entwicklung der Zirkumzisionszahlen in Deutschland seit Billigung der rituellen Beschneidung : Eine bevölkerungsbezogene Analyse von 2013 bis 2018.

INTRODUCTION: The religious and cultural circumcision of male infants in Germany is controversially discussed. After the passing of the religious circumcision bill in 2012, an increase of infant circumcisions without medical indication was feared. The aim of this study was to analyze the development of the circumcision case numbers. MATERIALS AND METHODS: We used the research database of the German Institute for Applied Health Research with a representative anonymous sample of 4.9 million insured persons to estimate the annual circumcision numbers in Germany from 2013-2018. We stratified the data according to age (< 18 vs. ≥ 18 years). The number of male adolescents in the study period was taken from the database of the German Federal Statistical Office. RESULTS: In the study period, 673,819 circumcisions were performed. From 2014, there was a significant decrease in the number of cases across all age groups (p = 0.049). Thereby, circumcisions in minors significantly increased (p = 0.002) and procedures in adults significantly decreased (p = 0.01) during the entire study period. The number of male minors increased by 4% from 6,709,137 (2013) to 6,992,943 (2018). The corresponding population-based number increased from 7.5 circumcisions per 1000 minors in 2013 to 8 in 2018 (p = 0.037). CONCLUSIONS: After the passage of the circumcision bill in 2012, there was a significant increase of circumcisions in the age group of < 18 years in Germany. A major limitation of our study is that presumably many ritual circumcisions might not be provided within the health care system.

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.

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.

Evidence-based circumcision policy for Australia.

The aim was (1) to perform an up-to-date systematic review of the male circumcision (MC) literature and (2) to determine the number of adverse medical conditions prevented by early MC in Australia. Searches of PubMed using "circumcision" with 39 keywords and bibliography searches yielded 278 publications meeting our inclusion criteria. Early MC provides immediate and lifetime benefits, including protection against: urinary tract infections, phimosis, inflammatory skin conditions, inferior penile hygiene, candidiasis, various STIs, and penile and prostate cancer. In female partners MC reduces risk of STIs and cervical cancer. A risk-benefit analysis found benefits exceeded procedural risks, which are predominantly minor, by approximately 200 to 1. It was estimated that more than 1 in 2 uncircumcised males will experience an adverse foreskin-related medical condition over their lifetime. An increase in early MC in Australia to mid-1950s prevalence of 85% from the current level of 18.75% would avoid 77,000 cases of infections and other adverse medical conditions over the lifetime for each annual birth cohort. Survey data, physiological measurements, and the anatomical location of penile sensory receptors responsible for sexual sensation indicate that MC has no detrimental effect on sexual function, sensitivity or pleasure. US studies found that early infant MC is cost saving. Evidence-based reviews by the AAP and CDC support early MC as a desirable public health measure. Although MC can be performed at any age, early MC maximizes benefits and minimises procedural risks. Parents should routinely be provided with accurate, up-to-date evidence-based information in an unbiased manner early in a pregnancy so that they have time to weigh benefits and risks of early MC and make an informed decision should they have a son. Parental choice should be respected. A well-trained competent practitioner is essential and local anaesthesia should be routinely used. Third party coverage of costs is advocated.

Critical evaluation of contrasting evidence on whether male circumcision has adverse psychological effects: A systematic review.

OBJECTIVE: To conduct the first systematic review critically examining evidence on whether early male circumcision has short- and long-term adverse psychological effects. METHODS: We searched PubMed, EMBASE, SCOPUS, Cochrane Library, and Google Scholar. RESULTS: Twenty-four studies with original data met the inclusion criteria. These comprised 11,173 total males, 4340 circumcised in infancy and 6908 uncircumcised. Nineteen were rated 1+, 2++ or 2+, and 5 were rated 2- by SIGN criteria. Neonatal circumcision, particularly without anesthetic, increased vaccination pain response, but had little effect on breastfeeding or cognitive ability. Studies reporting associations with sudden infant death syndrome, autism, alexithymia and impaired sexual function and pleasure had design flaws and were rated 2-. Sexual arousal, touch, pain, and warmth thresholds measured by quantitative sensory testing were not diminished in neonatally circumcised men. Neonatal circumcision was not associated with empathy in men, contradicting the hypothesis that procedural pain causes central nervous system changes. After correcting all associations with socioaffective processing parameters for multiple testing only higher sociosexual desire, dyadic sexual libido/drive, and stress remained significant. The relatively greater sexual activity found in circumcised men might reflect reduced sexual activity in uncircumcised men overall owing to pain and psychological aversion in those with foreskin-related medical conditions (reverse causality). Most studies employed case-control designs with limited follow-up. Studies beyond childhood were prone to confounding. CONCLUSION: The highest quality evidence suggest that neonatal and later circumcision has limited or no short-term or long-term adverse psychological effects.

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.

Neonatal Circumcision Trends from a Pediatric Urology Perspective: Results from a Survey of Members of the Societies for Pediatric Urology.

INTRODUCTION: Neonatal circumcision remains controversial, with rates varying over the years. The Centers for Disease Control and Prevention and the American Academy of Pediatrics acknowledge the health benefits of neonatal circumcision and support access to the procedure for families who choose it. Although more commonly performed by nonurological providers, pediatric urologists are often involved with pre-procedural or post-procedural concerns. Neonatal circumcision trends and perspectives were evaluated as determined by members of the Societies for Pediatric Urology nationwide. METHODS: A 20-question survey was distributed electronically via SurveyMonkey to members of the Societies for Pediatric Urology. The survey was developed to assess pediatric urologists' roles in and criteria for neonatal circumcision as well as attitudes towards nonurological provider circumcisions. Of the 20 questions 16 formed the basis of this study. Four questions evaluated "perceptions" and were excluded from study analysis due to subjectivity. RESULTS: Of the surveys 223 (37.2%) were returned. Most responders (80.1%, 177) perform neonatal circumcision. Significant differences exist across geographical regions nationally including common practices, techniques, and financial coverage of neonatal circumcision. However, 70.6% of responders noted a maximum age at time of circumcision of 12 weeks or younger and 48.9% noted a maximum weight of 12 pounds (5.44 kilograms) or less. CONCLUSIONS: This study assessed pediatric urologists' roles in and criteria for neonatal circumcision. The development of universal best practices as determined by pediatric urologists, as experts in the field, may prove beneficial for optimizing patient care and nonurological circumcision provider education and training.

Infant with swollen penis and apparent dysuria.

Circumcision is a common elective surgical procedure performed worldwide. The Plastibell ring is a plastic device placed between the penis and the foreskin to circumcise a newborn male. This device is used routinely in neonatal circumcision, but complications such as bleeding, infection, and retention may occur. This case report describes the retention of a Plastibell device in a 21-day-old male and an innovative method to remove the device using a ring cutter. Emergency physicians should be aware of ring retention as a complication of the Plastibell ring and the proposed removal technique.

Impact of male circumcision on risk of HIV infection in men in a changing epidemic context - systematic review and meta-analysis.

INTRODUCTION: WHO/UNAIDS recommended Voluntary Medical Male Circumcision in 2007 based on systematic review of observational studies prior to 1999 and three randomized controlled trials (RCTs). To inform updated WHO guidance, we conducted a systematic review and meta-analysis of impact of circumcision on the risk of HIV infection among heterosexual men. METHODS: Studies in PubMed of HIV incidence and changes in prevalence in heterosexual men by circumcision status were identified. Pooled incidence rate ratios were computed using fixed- and random-effects meta-analysis and risk of bias was assessed using the ROBINS-I tool. RESULTS AND DISCUSSION: In three RCTs, the pooled incidence ratio was 0.41 (95% CI 0.30 to 0.56), with risk difference 10 (8 to 12) fewer infections per 1000 person-years (py). Pooled incidence ratios were 0.34 (0.24 to 0.49) in two post-RCT follow-up studies, 0.29 (0.19 to 0.43) in men at high HIV risk (five cohorts), 0.48 (0.33 to 0.70) in four community-based cohorts before circumcision scale-up, and 0.56 (0.49 to 0.64) (7 [6 to 8] fewer per 1000 py) in six community-based cohorts during circumcision and antiretroviral treatment scale-up. Heterogeneity between studies was low except in men at high HIV risk. We estimated 520,000 (425,000 to 605,000) fewer infections occurred in men by end of 2018 from 22.7 million circumcisions performed since 2008 and increasing by 155,000 (125,000 to 180,000) annually if epidemic conditions remain similar. After exclusion of studies with high risk of bias and those conducted outside Africa, pooled incidence ratios were similar. There was no evidence of confounding nor changes in risk behaviour following circumcision. In post-hoc exploratory analyses we observed a trend of decreasing effectiveness of circumcision in cohorts with lower HIV incidence. CONCLUSIONS: Efficacy of medical male circumcision on HIV incidence from randomized controlled trials was supported by effectiveness from observational studies in populations with diverse HIV risk and changing epidemic contexts. Voluntary Medical Male Circumcision remains an important evidence-based intervention for control of generalized HIV epidemics.

The effectiveness of demand creation interventions for voluntary male medical circumcision for HIV prevention in sub-Saharan Africa: a mixed methods systematic review.

INTRODUCTION: UNAIDS has recommended that in 14 countries across sub-Saharan Africa (SSA), 90% of men aged 10 to 29 years should be circumcised by 2021 to help reduce transmission of HIV. To achieve this target demand creation programmes have been widely implemented to increase demand for Voluntary Medical Male Circumcision (VMMC). This review explores the effectiveness of demand creation interventions and factors affecting programme implementation. METHODS: We completed a mixed methods systematic review searching Medline, Embase, Global health, psycINFO and CINAHL databases in August 2018 with no time restrictions. Demand creation interventions conducted in SSA were categorized and quantitative data about VMMC uptake was used to compare relative and absolute effectiveness of interventions. Qualitative data were summarized into themes relevant to the delivery and impact of programmes. RESULTS AND DISCUSSION: Eighteen of the 904 titles were included in the review. Effective interventions were identified in each demand creation category: financial incentives, counselling or education, involvement of influencers and novel information delivery. Of the 11 randomized controlled trials (RCTs), the greatest absolute impact on VMMC prevalence was seen with a complex intervention including VMMC promotion training for religious leaders (compared to control: 23% (95% CI 22.8 to 23.8) absolute increase; odds ratio (OR) 3.2 (1.4 to 7.3)). Financial incentives generally produced the largest relative effects with men up to seven-times more likely to undergo VMMC in the intervention arm compared to control (adjusted OR 7.1 (95% CI 2.4 to 20.8), 7.1% (3.7 to 10.5) absolute increase). Qualitative findings suggest that interventions are more impactful when they are judged appropriate and acceptable by the target population; delivered by people with relevant personal experience; and addressing broader social and cultural influences through partnership with and education of community leaders. CONCLUSIONS: A range of demand creation interventions can increase VMMC uptake. The most acceptable and effective interventions are financial incentives framed as fair compensation (relative effect) and programmes of education or counselling delivered by people who are influential in the community (absolute effect). Future research should include larger studies with longer follow-up and a consistent definition of VMMC uptake.

[Application of disposable oval circumcision anastomat in pediatric urology].

Objective: To summarize the application experience of Ai Tong (Chinese Shang Ring) disposable oval circumcision anastomat in pediatric urology. Methods: A retrospective study of 1 481 cases of pediatric urology using a disposable oval circumcision anastomat at Xuzhou Children's Hospital from October 2014 to December 2017 was performed. The average age at the time of surgery was 5.2 (2-14 years) years. Among them, there were 1 226 cases of phimosis, 32 cases of scar phimosis in chronic infection, 23 cases of phimosis or redundant prepuce with urethral duplication, 29 cases of foreskin trauma, 35 cases of phimosis or redundant prepuce with urethral cyst, 3 cases of phimosis or redundant prepuce with urethral stricture, 108 cases of phimosis or redundant prepuce with webbed penis, 6 cases of phimosis with penile downward bending, 4 cases of phimosis with short frenulum preputii, and 15 cases of relatively normal foreskin development, I° and II° hypospadias with unapparent penile downward bending, and megalourethra with complete foreskin hypospadias. Results: All operations were completed successfully. The postoperative circumcision time was less than 5 days on 2 cases(0.1%), and was longer than 25 days on 9 cases(0.6%). The average postoperative circumcision time was 13.2 days. During a follow-up period of 3 months, except for 2 cases (0.1%) of frenulum preputii edema, all other cases had a satisfactory foreskin appearance. They had no obvious foreskin scar hyperplasia, the foreskin cutting edge was neat, the foreskin ligament was intact, the foreskin was left and right symmetrical, and the foreskin was preserved in the absence of erection to cover the coronary sulcus to 1/3 of the glans. All children with hypospadias had no urethral stricture and urethral fistula, and the penis was satisfactory. Conclusions: Ai Tong (Chinese Shang Ring) disposable oval circumcision anastomat is satisfactory in the treatment of various diseases of pediatric urology. With a low incidence of postoperative complications, it may be easy to carry out this procedure at grass-roots hospital.

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.

[Impact of organ sparing therapy in penile carcinoma on sexual and erectile function]. / Impacto da terapêutica conservadora de órgão do carcinoma do pénis na função sexual e erétil.

INTRODUCTION: Penile carcinoma is one of the less frequent tumors of the genitourinary system, however its effect on the patients' sex life and quality of life is of great impact. Studies about the influence on patients' sex life are scarce. OBJECTIVES: To characterize sexual activity with penetration of patients with penile carcinoma who underwent different conservative therapeutic approaches and to evaluate pre and post treatment erectile function. Secondarily, to compare the results between the patients who underwent partial penectomy to those subjected to other conservative therapies. MATERIAL AND METHODS: Review of patients' records diagnosed with penile carcinoma and observed at the Portuguese Institute of Oncology of Oporto between 2005 and 2015, to obtain demographic, clinical and histopathological data. Telephone interviews for the completion of the International Index of Erectile Function-5 (IIEF-5) questionnaire to patients undergoing treatment in that period. RESULTS: 16 out of the 107 patients met the inclusion criteria (n=16), with an average IIEF-5 score of 23.44 (10-25), lowering this value to 16.56 (5-25) after therapy, p<0,05. Fifteen out of the 16 patients kept sexual activity (93.8%) and one (6.25%) suspended due to erectile dysfunction. IIEF-5 score after treatment in the subgroup that underwent partial penectomy was lower when compared to the other subgroup of patients subjected to others conservative therapies, without statistical significance. CONCLUSION: Although penile carcinoma treatment has an impact in erectile function with statistical significance, the majority of patients keeps an active sexual life with penetration after treatment. It's not possible to conclude that less invasive therapies are associated with better erectile function.

[The impact of male circumcision on the natural history of genital HPV infection: a prospective cohort study].

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 (P(25), P(75)) 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 (χ(2)=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] (χ(2)=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.

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.