Shang ring, CircCurer (ZSR) or Glue circumcision for adults

Glue circumcision gives better result.

Many patients are asking from Dr Khan about different ways of to circumcise. Adult circumcision can be performed by:

  1. Glue
  2. Stitches
  3. Shang ring device
  4. ZSR or CircCurer (LangHe) staples suture device

Adult circumcision with Shang ring is a quick procedure, however, wound healing takes longer than traditional circumcision in adults. In a report published in Journal of Urology 2012, a randomised controlled trial with a circumcision with Shang ring versus conventional circumcision showed wound healing time in the circumcision with Shang ring was longer. 

A systematic review and meta-analysis of circumcision with Shang ring vs conventional circumcision was reported in Urology 2015. This showed Overall, 8 randomised controlled trials involving 3314 patients were included. When they compared with the conventional 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 postoperatively. Shang circumcision appears to be a safer and more effective choice in comparison with circumcision with stitches for male patients.

One long term study showed scar width is 3.7+/- 1.6 mm (Clinical Medical Journal 2014). Healing showed a significant wound edges gap after removal of Shang ring and this wound heals by secondary intention, scaring with some cases. No medical study stated that how long adult patient feel pain after Shang ring came off.

Dr. Khan has performed three revision circumcisions with glue after Shang ring circumcision and treated one wound dehiscence. Glue circumcision provides excellent cosmetic result with less pain and less complication rate. Patients suffered pain due to secondary healing of gapped wound for three months after Shang ring circumcision in some patients. This required further studies to conduct addressing 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. In this study total, 879 adult male patients were divided into two groups: 441 with stapler circumcision, and 438 undertook conventional circumcision. The stapler group showed that the operative time and blood loss were lower as compared to the conventional group. The operative and after operation pain were lower in the stapler group than in the conventional group. Additionally, the stapler group had less complication rate than the conventional group (2.7% vs 7.8%, respectively). However, the treatment expenses in the stapler group were much higher than those in the conventional circumcision. The majority of the patients (388/441, 88.0%) required removal of residual staple nails in case of 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 the treatment of 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 intraoperative 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 to be safer and more effective than CC. (Asian Journal of Andrology (2017) 19, 362–367)

Circumcision with Glue or Stitches

Traditionally, circumcision wounds are closed with absorbable sutures. In the study, the use of tissue glue (iso amyl 2-cyanoacrylate) has been compared with traditional circumcision with stitches. In this study, it is significantly less time consumed in glue group. They assessed in terms of cosmetic result, time consumed and incidence of infection in both groups.

The tissue glue group has been observed to have less wound inflammation, bleeding or haematoma rate and was cosmetically superior as compared to suture circumcisions. The mean time taken for circumcision was 14.2 min in circumcision with tissue glue. However, it was 24.4 min in case of the use of sutures. This difference was found as highly significant. However, regarding after operative pain, no reduction was observed when glue was used during the circumcision.

In conclusions, this study showed that the use of tissue glue in comparison to sutures is having the following advantages: 1. Cosmetically superior 2. Less time consuming. (Indian J Urol. 2011 Oct-Dec; 27(4): 475–478)

By looking the medical literature, photos on the internet, our results with glue circumcision were superior to all other methods and these results are endorsed by many patient’s feedbacks.