Adult Circumcision, a standard surgical procedure for adult males, involves the removal of the foreskin. Various techniques for adult circumcision have been developed to optimise outcomes, including the Shang ring, circular stapler (ZSR), and tissue glue methods.
This analysis compares these approaches, evaluating their safety, efficacy, patient satisfaction, and limitations based on peer-reviewed studies and clinical observations.
Shang Ring Circumcision vs Traditional Circumcision
In the Shang ring circumcision, wound healing takes longer than traditional circumcision in adults. In a report published in the Journal of Urology in 2012, a circumcision with a Shang ring versus conventional circumcision showed that wound healing time in the circumcision with a Shang ring was longer.
Another report, Urology 2015, reported circumcision with a Shang ring versus conventional circumcision. Eight trials involving 3314 patients were included.
Compared with traditional circumcision, Shang circumcision is associated with shorter surgical time, higher patient satisfaction with penile looks, lower operative pain, less operative blood loss, lower risks, and lower wound bleeding post-operatively. Shang circumcision appears safer and more practical than circumcision with stitches for male patients.
One long-term study reported a scar width of 3.7 ± 1.6 mm (Clinical Medical Journal, 2014). Healing showed a significant wound gap after removal of the Shang ring, and the wound healed by secondary intention, with scarring in some cases. No medical study has reported how long adult patients experience pain after the Shang ring is removed.
Dr Khan has performed three revision circumcisions with glue after Shang ring circumcision and treated one wound dehiscence. Glue circumcision provides excellent cosmetic results with less pain and a lower complication rate.
Patients suffered pain due to secondary healing of gapped wounds for three months after Shang ring circumcision in some patients. Further studies are required to address this issue in the Shang ring circumcision.
Stapler Circumcision (ZSR/CircCurer) vs Traditional Circumcision.
Researchers studied the safety and efficacy of a male circumcision technique using a circular stapler. They divided 879 adult males into two groups: 441 underwent stapler circumcision, and 438 had traditional circumcision.
The circumcision with the stapler experienced lower operative time and blood loss.
Additionally, they reported less pain during and after the procedure and had a lower complication rate (2.7% vs. 7.8%). However, treatment expenses for stapler circumcision were significantly higher, with most patients (388/441, 88.0%) needing the removal of a residual staple at the circumcision site.
This study demonstrates that stapler circumcision is efficient and safe, although further improvements are needed (Brazilian Journal of Medical and Biological Research (2015) 48: 577-582).
Studies evaluated the safety and efficacy of the disposable circumcision suture device (DCSD) compared to conventional circumcision (CC) for treating redundant prepuce and phimosis.
Nine trials involving 1,898 cases were included. Compared with the CC group, the stapler group had shorter operative time, shorter wound-healing duration, less intraoperative blood loss, improved cosmetic appearance of the penis, lower intraoperative pain scores, lower 24-hour postoperative pain scores, lower incidence of infection, decreased incisional oedema, and fewer overall risks.
No significant differences were observed between traditional and stapler circumcision regarding the incidences of wound disruptions or haematoma. The findings from these multiple studies suggest that circumcision with staplers is safer and more effective than traditional methods. (Asian Journal of Andrology (2017) 19, 362–367)
Benefits of Circumcision with CircCurer or ZSR Stapler
Circumcision with the CircCurer stapler is quick (5-10 minutes), offering several advantages over conventional stitching methods, like minimum bleeding, a neat circular cut
Patients who undergo stapler circumcision experience shorter surgical durations, greater satisfaction with the aesthetic appearance of the penis, reduced operative pain, minimal blood loss during the procedure, and decreased postoperative wound bleeding.
However, it is essential to note that wound healing may take longer than with traditional circumcision methods in adults, and some patients may need to return for stapler removal.
We offer stapler circumcision at our clinic.
Circumcision with Glue or Stitches
Traditionally, circumcision wounds are closed with absorbable sutures. In this study, tissue glue (iso-amyl 2-cyanoacrylate) was compared with traditional circumcision using stitches. The results indicated that significantly less time was consumed in the glue group. The researchers also assessed cosmetic outcomes, time required, and infection incidence in both groups.
The Circumcision with tissue glue demonstrated reduced rates of wound inflammation, bleeding, and haematoma and was cosmetically superior to circumcisions with sutures. The mean time for circumcision using tissue glue was 14.2 minutes, compared to 24.4 minutes with sutures, a highly significant difference. However, no reduction in post-operative pain was observed when glue was used during the circumcision.
Conclusion
In conclusion, this study indicated that using tissue glue, compared to sutures, offers the following advantages:
- Cosmetically superior
- Less time-consuming
(Indian J Urol. 2011 Oct-Dec; 27(4): 475–478)
Furthermore, based on medical literature and online photos, our results with glue circumcision were superior to those of all other methods. Circumcision with a stapler ZSR is almost an identical result.
Many patients’ feedback supports these findings.