Prepuce; Accessory
Conditions
Brief summary
Aim of work: The aim of study is to comprehensively evaluate and compare the efficacy, safety, clinical outcomes, cosmetic appearance and complication rates associated with different technique of circumcisions.
Detailed description
The aim of study is to comprehensively evaluate and compare the efficacy, safety, clinical outcomes, cosmetic appearance and complication rates associated with different technique of circumcisions. Patients and methods: According to the method of circumcision used; infants were divided into 5 groups : 1. Group A: Conventional dissection technique; 2. Group B: Bone cutting ; 3. Group C: Electro-cauterization (bipolar) assisted circumcision; 4. Group D: Thermal cauterization assisted circumcision; 5. Group E: Gomco clamp technique; 6. Group F: Plastibell device technique. Place of the study: The study will be held in the department of Pediatric surgery at Sohag University Hospital. Type of the study: Prospective comparative Cohort study. Duration of the study: The study lasts for 6 months from the acceptance of the protocol (december 2024) to (Jone 2025). Inclusion criteria: All uncircumcised boys with intact prepuce aged below 15 years presented at our department for routine circumcision or for medical indications. Exclusion criteria: 1. Age above 15 years 2. Ambiguous genitalia 3. Congenital penile anomalies e.g. hypospadias, epispadias, buried penis, webbed penis, micropenis, congenital chordee, incomplete prepuce and mega-urethra. 4. Redo-circumcision 5. Balanitis or inflammatory process around the penis. 6. Bleeding disorders; hemophilia or thrombocytopenia
Interventions
PROCEDURE1. Conventional dissection technique (group A) :
In this group, circumcision is performed by the dorsal slit technique. A slit is made dorsally to the level of about 5 mm from the coronal sulcus, and the redundant foreskin and mucosa were excised circumferentially. Hemostasis is secured with ligation , and the cut edges are sutured with absorbable suture. Then, dressing is applied.
PROCEDURE2. Bone cutting forceps technique (Group B)
Two mosquito forceps are used to grasp the foreskin. The glans penis is squeezed back to avoid its injury. After that, bone cutting forceps is applied to the foreskin for 3 minutes, at the level of the mark, then the foreskin is excised by scalpel at the same level. Bleeding points are ligated and the cut edges are sutured with absorbable suture. Then, a dressing is applied
PROCEDURE3. Electro-cauterization (bipolar) assisted circumcision (Group C)
The skin is held by two hemostats to elevate the foreskin, and then the kocher clamp applied at the level of the skin to be removed for circumcision. Excess foreskin will be cut by scissor with hemostasis by bipolar cauterization. The skin retracted proximally after that to expose the glans. Sutures are made if there is separation between the skin and the mucous membrane.
PROCEDURE4. Thermal cauterization assisted circumcision (Group D)
The skin is held by two hemostats to elevate the foreskin, and then the kocher clamp applied at the level of the skin to be removed for circumcision. Excess foreskin will be cut by thermal cauterization. The skin retracted proximally after that to expose the glans. Sutures are made if there is separation between the skin and the mucous membrane.
PROCEDURE5. Gomco clamp technique (Group E):
The prepuce is grasped using two hemostats applied at 2 and 10 o'clock. A dorsal slit at 12 o'clock is made, appropriate-sized bell is placed over the glans, and the foreskin is brought over its top. The string is placed around the foreskin and the Plastibell device at the level of the mark in a groove that acted as the string placement guide. The string is then tightened and tied in a simple square knot. The excess foreskin is trimmed from around the bell using iris scissors. The handle is then broken off the device
PROCEDURE6. Plastibell device technique (Group F):
The prepuce is grasped using two hemostats applied at 2 and 10 o'clock. A dorsal slit at 12 o'clock is made, appropriate-sized bell is placed over the glans, and the foreskin is brought over its top. The string is placed around the foreskin and the Plastibell device at the level of the mark in a groove that acted as the string placement guide. The string is then tightened and tied in a simple square knot. The excess foreskin is trimmed from around the bell using iris scissors. The handle is then broken off the device
Sponsors
Sohag University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
MALE
Age
No minimum to 5 Years
Healthy volunteers
No
Inclusion criteria
1. All uncircumcised boys with intact prepuce 2. Age below 5 years presented at our department for routine circumcision or for medical indications.
Exclusion criteria
1. Age above 5 years 2. Ambiguous genitalia 3. Congenital penile anomalies 4. Redo-circumcision 5. Balanitis or inflammatory process around the penis. 6. Bleeding disorders
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Bleeding | 1 day | combine the number of dressing, Significant bleeding is considered if the dressing is completely soaked |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cosmetic appearance | 1 month | Score for parent and physician * Excellent 3 * Good 2 * Poor 1 |
Countries
Egypt
Contacts
Primary ContactMahmoud Bakr Ahmed
Outcome results
None listed