Four standard methods of adult circumcisions are glue, Stitches, Shang Ring, or Stapler (ZSR). We provide insights to help individuals make informed decisions about their choice of circumcision. Many patients are asking Dr. Khan about different ways of circumcising. Adult circumcision can be performed by:
Glue
Stitches
Shang ring device
ZSR or CircCurer (Langhe) staples suture device
However, wound healing takes longer than traditional circumcision in adults. In a report published in the Journal of Urology 2012, a randomised controlled trial of circumcision with a Shang ring versus conventional circumcision showed wound healing time in the circumcision with a Shang ring was longer.
A systematic review and meta-analysis of circumcision with Shang ring versus conventional circumcision was reported in Urology 2015. Overall, eight randomised controlled 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 showed a scar width of 3.7+/—1.6 mm (Clinical Medical Journal 2014). Healing showed a significant wound gap after removing the Shang ring, and this wound heals by secondary intention, scaring in some cases. No medical study stated how long adult patients feel pain after the Shang ring comes off.
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 less complication rate. Patients suffered pain due to secondary healing of gapped wounds for three months after Shang ring circumcision in some patients. This required further studies to address this issue in Shang ring circumcision.
Adult male circumcision with a circular stapler versus conventional circumcision: A prospective randomised controlled clinical trial, they studied the safety and efficacy of a new technique of male circumcision with a circular stapler. This study divided 879 adult male patients into two groups: 441 with stapler circumcision, and 438 undertook conventional circumcision.
The stapler group showed lower operative time and blood loss than the traditional group. Operative and post-operation pain were also lower in the staplers than in the standard group. Additionally, the stapler group had a lower complication rate than the conventional group (2.7% versus 7.8%, respectively).
However, the treatment expenses in the stapler were much higher than those in the traditional circumcision. Most patients (388/441, 88.0%) required the removal of residual staple nails in the case of the stapler group.
Overall, the present study has shown that stapler circumcision is a time-efficient and safe male circumcision technique, although it requires further improvement (Brazilian Journal of Medical and Biological Research (2015) 48: 577-582)
This systematic review assessed the safety and efficacy of the disposable circumcision suture device (DCSD) and conventional circumcision (CC) in treating redundant prepuce and phimosis. Nine controlled trials (1898 cases) were included. Compared with the CC group, the DCSD group had a shorter operative time, shorter wound healing time, less intraoperative blood loss, better cosmetic penile appearance, lower intra-operative pain score, lower 24‐h postoperative pain score, lower incidence of infection, less incision oedema, and fewer risks. There were no differences between the CC and DCSD groups in the incidences of dehiscence or haematoma. The results of these multiple studies indicated that the DCSD appeared safer and more effective than CC. (Asian Journal of Andrology (2017) 19, 362–367)
Circumcision using the CircCurer stapler is quick, offering several advantages over traditional stitching methods. Patients who undergo stapler circumcision experience shorter surgical times, higher satisfaction with the aesthetic appearance of the penis, reduced operative pain, minimal blood loss during surgery, and decreased postoperative wound bleeding. However, it is essential to note that wound healing may take longer than traditional circumcision methods in adults, and some patients may need to return to remove the staplers. We provide stapler circumcision in our clinic.
Traditionally, circumcision wounds are closed with absorbable sutures. In the study, tissue glue (iso-amyl 2-cyanoacrylate) has been compared with traditional circumcision with stitches. In this study, significantly less time was consumed in the glue group. They assessed cosmetic results, time consumed and incidence of infection in both groups.
The tissue glue group had less wound inflammation, bleeding, or haematoma rate and was cosmetically superior to suture circumcisions. The mean time for circumcision with tissue glue was 14.2 min, compared to 24.4 min using sutures. This difference was found to be highly significant. However, regarding after-operative pain, no reduction was observed when the glue was used during the circumcision.
In conclusion, this study showed that the use of tissue glue in comparison to sutures has the following advantages: 1. Cosmetically superior 2. Less time-consuming. (Indian J Urol. 2011 Oct-Dec; 27(4): 475–478)