Design and development of a new type of phimosis dilatation retractor for children

BACKGROUND Phimosis is one of the most common diseases in children.Early selection of appropriate treatment for phimosis in children is beneficial to the development of their reproductive organs and significantly improves the prognosis of phimosis in children.Although traditional circumcision is the most widely used,it has many disadvantages,including postoperative bleeding and incision infection,pain,obvious scars on the surgical incision,and unsatisfactory appearance.In addition,there is much contro-versy regarding treatment options and timing at home and abroad.Surgical procedures such as circumcision and cerclage for children with excessively long foreskin will greatly affect the normal life of children after the operation.Young children need general anesthesia,but this anesthesia carries a great risk.AIM To design a new children phimosis dilatation retractor for children phimosis.METHODS The children phimosis was dilated with an elastic dilation frame,in order to expand the foreskin mouth and expose the penis head,and after that,the phimosis was cured.RESULTS A new type of phimosis dilatation retractor was designed,which can gently dilate the prepuce at multiple angles and in multiple directions at the same time.It has obtained the national patent for clinical application.CONCLUSION The phimosis dilatation retractor based on the principle of elastically expanding the prepuce can achieve the purpose of expanding the phimosis.The clinical application shows that the effect of the children phimosis retractor is significant,which is worth promoting.

Safety and Efficacy of Circumcision Stapler in the Treatment for Children with Phimosis and Redundant Prepuce

Objective: To observe the clinical effect and safety of circumcision stapler in children with phimosis and redundant prepuce. Methods: From July 2013 to July 2017, 40 children were prospectively randomized and assigned to experiment group (circumcision stapler n = 20) or control group (conventional circumcision, n = 20). Outcomes were operation time, intraoperative blood loss and postoperative complications. Results: There was significant difference between the two groups for operation time (5.35 min vs 30.30 min, P < 0.05) and intraoperative blood loss (2.56 ml vs 10.40 ml, P < 0.05) respectively. Conclusion: Circumcision staplers are superior to conventional circumcision for the advantages of shorter operation time and fewer blood losses.

Observation on the Clinical Effect of Modified Circumcision in the Treatment of Phimosis and Excessive Foreskin

Objective:To study the clinical effect of modified circumcision in the treatment of phimosis and excessive foreskin.Methods:110 patients with overly long foreskin or phimosis were divided into experimental group and control group by random number table method,with 55 cases in each group.The experimental group was treated with modified circumcision,and the control group was treated with traditional manual cutting and suture.Then the clinical effects of the two treatments were compared.Results:Two different surgical procedures were performed.During the operation,the blood loss of the experimental group was less than that of the control group;the operation time and wound healing time were shorter than those of the control group;after the operation,the incidence of related complications in the experimental group was 14.55%,which was significantly lower than For 25.45%of the control group,the clinical treatment effect was obvious,and the difference was statistically significant(P<0.05).Conclusion:The clinical effect of modified circumcision in the treatment of patients with phimosis and excessive foreskin is good.Compared with the traditional manual cutting and suture treatment,it not only has the advantages of simple operation and clinical application,but also benefits the rehabilitation of patients.Rehabilitation time reduces the incidence of postoperative complications.It is an ideal treatment plan for this type of disease in the current clinic,and it is worthy of popularization and application in general surgery and reproductive surgery.

Clinical application of a new device for minimally invasive circumcision

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.

Use of a disposable circumcision suture device versus conventional circumcision： a systematic review and meta-analysis

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.

Circumcision with ＂no-flip Shang Ring＂ and ＂Dorsal Slit＂ methods for adult males： a single-centered, prospective, clinical study

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.

Modified one-cut circumcision technique by clamp： reports of 2000 cases

In the western countries, circumcision has been .performed for a long time. However, because of religious and cultural differences, circumcision was rare in China before the 20th century. As a result, penile cancer, accounting for 17% of all cancers, was more common.With the introduction of western medicine in the 1920s, especially after the establishment of urology as a separate department, gradually more circumcisions were carried out.

Benign penile skin anomalies in children:a primer for pediatricians

Background:Abnormalities involving the skin coverage of the penis are diffi cult to defi ne,but they can significantly alter penile appearance,and be a cause of parental concern.Data sources:The present review was based on a non-systematic search of the English language medical literature using a combination of key words including"penile skin anomalies"and the specific names of the different conditions.Results:Conditions were addressed in the following order,those mainly affecting the prepuce(phimosis,balanitis xerotica obliterans,balanitis,paraphimosis),those which alter penile configuration(inconspicuous penis and penile torsion),and lastly focal lesions(cysts,nevi and vascular lesions).Most of these anomalies are congenital,have no or minimal influence on urinary function,and can be detected on clinical examination.Spontaneous improvement is possible.In the majority of cases undergoing surgery,the potential psychological implications of genital malformation on patient development are the main reason for treatment,and the age generally recommended for surgery is after 12 months of age.Conclusion:This review provides the pediatrician with a handy tool to identify the most common penile skin anomalies,counsel parents adequately,make sensible and evidence based choices for management,and recognize complications or untoward outcomes in patients undergoing surgery.