Bipolar scissors circumcision is a safe, fast, and bloodless procedure in children

Purpose

The aim of this study is to evaluate bipolar scissors circumcision by comparing it with standard freehand scalpel procedure.

Patients and Methods

Data were analyzed from a prospective, randomized study, comparing 2 different surgical techniques for pediatric circumcision: the bipolar diathermy scissors circumcision technique with those of a conventional scalpel technique. A total of 230 pediatric patients younger than 16 years (115 in each arm of the trial) who were undergoing circumcision were reviewed prospectively. Operative time, surgical bleeding, complications, and postoperative morbidity were analyzed. Differences between bipolar scissors circumcision and conventional surgery were compared.

Results

Median blood loss for bipolar circumcision was 0.2 mL (range, 0-0.8 mL) compared with 2.1 mL in the standard group (range, 0.9-4.2 mL) (P < .001). Operative time in the bipolar diathermy treated group was significantly decreased compared with conventionally treated patients (10.8 ± 1.2 vs 19.1 ± 2.6 minutes; P < .01). Early and late postoperative morbidity were significantly decreased in circumcised patients who underwent the bipolar circumcision technique as compared with those who underwent the conventional approach regardless of the postoperative edema (22 vs 10; P = .02).

Conclusions

Bipolar scissors circumcision approach is an effective and safe procedure alternative to the standard scalpel technique in pediatric circumcision with no significant morbidity.     

100例儿童包皮环扎术的护理

目的探讨包皮环扎术治疗儿童包皮过长、包茎的效果及相关护理措施。方法随机抽取2000年1月至2008年9月接受包皮环切术及包皮环扎术的患儿各100例,比较与其护理相关的手术方式、术后并发症、住院时间及费用、术后美容效果等。结果包皮环扎术手术方式简单、患儿痛苦小、并发症少、费用低、美容效果好并且家长满意度高。结论包皮环扎术及其相关护理措施效果优良,可以推广应用。     

1-6岁儿童包皮过长包茎引起的生殖器疾病初步分析

目的：探讨1－6岁就诊患儿生殖器疾病与包皮过长和包茎之间的关系。方法：将在门诊就诊的1862名患儿分为1－3岁和4－6岁两组进行检查治疗和愈后评估。结果：所患生殖器疾病均与包皮过长，包茎有关。随着年龄的增长，所患疾病呈下降趋势，结论：包皮过长和包茎是小儿常见的先天性异常之一，所引起的生殖器疾病应引起广泛重视。     

Local steroid therapy as the first-line treatment for boys with symptomatic phimosis - a long-term prospective study

Aim: Phimosis is a common paediatric urological disorder and often necessitates circumcision. We prospectively evaluated local steroid therapy (LST) as the first choice therapy for such children. Methods: Two hundred and sixty symptomatic boys up to 15 years of age (mean 34 months) with phimosis were started on betamethasone dipropionate (0.05%) application on gently stretched prepuce twice a day. Follow‐up visits were arranged at the end of weeks 1, 2 and 4 and 6 months. Grade of phimosis was objectively graded. Results: Ninety one percent of the boys showed a successful outcome at the end of 4 weeks; 72% responded in first week, further 16% responded in week 2, and only 2.6% achieved alleviation of phimosis on further application of LST beyond 2 weeks. Fourty two (17.8%) boys had a recurrence of phimosis on a long‐term follow‐up (mean – 25.4 months, range 6–48 months); thus, the long‐term success rate was 77%, while 60 (23%) boys underwent surgery. Conclusion: Local steroid therapy is safe and successful in alleviating symptomatic tight foreskin in a large majority of children. The response can be seen as early as 1 week; most of the children respond by week 2 and continuing therapy further may not be very effective.     

HK型环扎去除包皮器械治疗包茎及包皮过长584例体会

目的总结包皮环扎术在包茎及包皮过长治疗中的经验。方法采用一次性包皮去除环对584例包茎及包皮过长患者施行新型环扎术以切除多余包皮。观察总结手术效果。结果手术时间平均只需6min,术中几乎无出血,术后2例因环扎器滑脱出血,所有患者均无血肿、感染。术后1～3个月随访,测量包皮保留部分,切缘平整美观。结论包皮环扎术是对传统包皮切除术的简化和改进,具有应用简便、易于掌握、效果满意、并发症少等优点,是一种可供选择推广的包皮切除新方法。     

袖套式与传统式包皮环切术比较治疗阴茎包皮过长及包茎疗效的系统评价与Meta分析

目的:系统评价袖套式包皮环切术对治疗男性阴茎包皮过长及包茎的疗效。方法:通过计算机检索PubMed,Cochrane Library,CNKI,CBM和Wanfang数据库中自建库至2012年9月中公开发表的关于比较袖套式包皮环切术与传统包皮环切术疗效的随机对照试验(RCT)。由2名评价者独立进行质量评价及资料提取后,采用RevMan 5.1软件对纳入的RCT进行Meta分析。结果:共纳入9个RCT,合计8 353例受试患者。Meta分析结果显示:与传统环切术相比,袖套组的手术时间较长[SMD=2.89,95%CI(1.67,4.11),P<0.001],但术中出血量少[SMD=-5.05,95%CI(-6.90,-3.21),P<0.001]、术后疼痛时间短[SMD=-2.05,95%CI(-3.59,-0.51),P=0.009]、水肿发生率低[OR=0.14,95%CI(0.06,0.33),P<0.001]、出血/血肿发生率低[OR=0.14,95%CI(0.06,0.32),P<0.001]、感染发生率低[OR=0.27,95%CI(0.11,0.64),P=0.003]。结论:袖套式包皮环切术手术时间较传统环切术长,但其术中失血量少、术后疼痛时间短、术后并发症的总发生率比传统术式低。因此,袖套式包皮环切术是一种疗效安全可靠、并发症少的治疗男性包茎、包皮过长的微创术式。但鉴于纳入研究的证据强度有限,有必要进一步开展高质量、大样本的临床RCT进一步评价。     

成年男性应用商环包皮环切术与CO2激光包皮环切术临床疗效比较

目的对比分析成年男性应用商环包皮环切术与CO2激光包皮环切术的临床疗效和手术并发症。方法336例成年男性包皮过长和包茎患者随机分为两组,其中168例行商环包皮环切术（商环组）,168例行CO2激光包皮环切术（激光组）,比较两种手术方法的手术时间、术中出血量、愈合时间及手术后并发症情况,包括术后血肿、包皮水肿、术后感染、伤口裂开及包皮外观满意率。结果商环组在手术时间、术后血肿、包皮水肿、术后感染及包皮外观满意率等方面均优于激光组,但两者的术中出血量,伤口裂开及愈合时间差异无统计学意义。结论商环包皮环切术操作简单,手术时间短,并发症少,外观美观,值得临床推广及应用。     

包皮环套术治疗包茎及包皮过长311例体会

目的探讨包皮环套术治疗包皮过长、包茎的方法。方法 2010年1月至2010年12月采用一次性包皮环切吻合器行包皮环套扎术治疗311例,观察手术疗效。结果手术成功306,成功率为98.4%,平均手术时间7 min,包皮内板撕裂3例,失败2例,切口裂开3例,术后随访1～3个月,切口愈合光滑、平整,恢复良好。结论包皮环套术治疗包茎、包皮过长是一种操作较简易、痛苦小、安全性高、疗效好的理想方法。