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What is Circumcision?
Circumcision is the procedure of excision of the excess skin covering the glans penis to expose the glans.
Despite being regarded as one of the safest and most performed procedure, there are over two million patients present for elective circumcision yearly in United States alone, with 37% - 39% of global male population (newborn and adult) being subjected to this procedure, occasionally surgeon’s skill can’t compensate for the high numbers which might lead to complication or undesired outcome.
In addition, World Health Organization (WHO) had previously recommended conventional circumcision methods using forceps guided; dorsal slit and guillotine methods (with or without stitching), and those methods are regularly practiced in Malaysia and most of the countries where circumcision is practiced regularly.
However, those methods, are known to be time consuming, painful and the end result is very much dependant on the surgeon skills, patient tolerance of the procedure, due to the fact that most of the patient undergo circumcision are young males between the ages of 4-12 years old, for whom the idea of using conventional methods (blades, suture and needles) less appealing for this kind of audience.
Frequently Asked Questions (FAQs)
Are there any other alternatives for conventional circumcision methods?
There are plenty of devices that have been suggested as alternatives for the conventionally used methods, which can be sub-classified into using disposable or non-disposable devices. Disposable devices include plastibell, tara klamp, ali’s klamp, Ismail klamp, circular stapler, smart clamp, Accu cric, Unicric, Sunathorne.
For adult circumcision and among WHO approved disposable devices is Shang Ring. On the other hand, non-disposable devices include Gomco and Mogen clamps.
What are the advantages of using circumcision devices?
The use of circumcision devices has proven to be superior to conventional methods on many different levels, including reduction of operation time, decline of complication rates, quicken the recovery process and are of better cosmetic outcome. Not to mention they can be done within a friendlier environment as opposed to a hospital setting.
What are the devices available in DTAP KL Eco City for adult circumcision?
Currently in our practice we are utilising Shang Ring; a small safe and effective device developed in china. With Shang ring; male circumcision can be carried out within a considerably shorter duration compared to conventional circumcision methods. In addition, patients who underwent a Shang ring circumcision have experienced lesser blood loss and lower pain score. Not to mention, employing Shang ring for circumcision has recorded higher satisfaction rates, less complications and better cosmetic outcomes.
What is the Shang Ring circumcision procedure?
Shang ring consists of two rings; inner ring lined with silicon pad and outer ring consisting of two halves hinged together on one side and can clutch on the other end to lock over the inner ring. Those two rings will sandwich the extra foreskin during circumcision.
Patients consented to undertake Shang ring circumcision would go through these steps.
- Patients will be measured to determine the suitable Shang Ring size from available 13 sizes.
- After preparing the proper size; local anaesthesia is applied using topical local anaesthetic or in some cases nerve block.
- After the anaesthesia effect takes place; the inner ring is placed on the inner side of the foreskin, at the level of the glans and perpendicular to it. Once the rig is in the right place, the outer ring is clamped on the outer side of the foreskin, trapping it in between the two rings. Once the rings are confirmed to be at the right plane; the clamp will be tightened and the extra skin emerging from the top of the clamped two pieces are removed using special surgical scissors. The wound is cleaned and dressed later and the patient will be discharged with medications and a set of instructions on how to manage the wound until the next visit.
- Patient is given an appointment to follow-up within 7-10 days for wound inspection and to remove the rings once the wound closure is confirmed.
Is Shang Ring circumcision a complication free procedure?
There is no medical procedure that doesn’t incur a minimal percent of complication including Shang Ring circumcision.
In a study conducted in China has reported a 8.16% complication rate (55 patient out of 674), however these numbers has shown improvement over the past few years of practice.
Complications associated with Shang Ring circumcision can be grouped into 9 types
- Most common is tissue edema (water retention), which happens in 4.45% of the cases.
- Wound dehiscence (wound failure to close), which happens in 0.59% of the cases.
- Outer ring displacement (0.30%).
- Partial protrusion (0.59%) or
- Partial deletion of the outer plate (0.47%).
- Misalignment of the wound (0.47%)
- Unappealing penile scar (0.30%).
- Wound infection (0.30%) and
- Bleeding (0.30%).
As mentioned earlier; it was found out that these numbers has improved in later studies as it was shown that most of the complications related to the technical aspect of the procedure is due to lack of experience and/or those complicated cases were preformed by trainees.
The second group of complications related to outcome or post-operative incidents of infection and bleeding was most likely due to mismanagement of the wound by the patients who were not oriented properly or adequately.
What was the general feedback of males that underwent Shang Ring circumcision?
In a study conducted in China following up patients who underwent adult circumcision using this device, a total percent of 99.5% were very satisfied with the general outcome of the procedure, including the healing process and the cosmetic result of the scar.
Do you recommend using this device over conventional circumcision?
Few studies showed the superiority of Shang Ring over conventional circumcision when it comes to operation time, blood loss, pain score, however erectile function was comparable between the two types.
Other studies have also proven that Shang Ring procedure required lesser time to be performed, blood loss was lesser, pain score post-operatively and 24 hours after the procedure was minimal, wound healing and cosmetic outcome was better, complications were negligible when performed by experienced doctors and satisfaction level is better. However wound-healing time was longer with Shang ring and cost of using Shang ring was more compared to conventional method.
Speak to our doctors for more information on sutureless circumcision or Shang Ring today.
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Clinic Location: DTAP Clinic @ KL Eco City
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