Circumcision for phimosis and other medical indications in Western Australian boys

OBJECTIVE: To investigate the incidence rate of circumcision for phimosis and other medically indicated reasons in Western Australian boys from 1 January 1981 to 31 December 1999. DESIGN AND SETTING: A population-based incidence study using hospital discharge data of all circumcisions performed in all WA hospitals during the study period. MAIN OUTCOME MEASURES: Changes in the incidence rate of circumcision for medically indicated reasons. RESULTS: The rate of medically indicated circumcisions increased in boys aged less than 15 years during the study period. Phimosis was the most common medical indication for circumcision in all age groups. The rate of circumcision associated with phimosis was eight times that associated with balanoposthitis and 21 times that of balanitis xerotica obliterans. Boys aged less than five years had the highest rate of circumcision to treat phimosis, at 4.6 per 1000 person-years, representing about 300 circumcisions per year. Boys aged less than five years living in country areas were 1.5 times more likely to be circumcised for phimosis than boys living in metropolitan Perth. CONCLUSION: The rate of circumcision to treat phimosis in boys aged less than 15 years is seven times the expected incidence rate for phimosis. Many boys are circumcised before reaching five years of age, despite phimosis being rare in this age group.     

Circumcision : A Time to Rethink

Background

Circumcision is one of the most routinely done surgery world over but has no scientific basis to enforce it on all patients. Of late, the operation has been criticized, non-operative methods have been tried and operations preserving the skin of prepuce have been recommended. The presence of physiological phimosis, which is self-correcting by the age of 15 years in children, needs to be differentiated from the pathological variety.

Method

The child population reporting to Surgery OPD was taken as sectional representative of the Indian communities and socioeconomic strata. A simple protocol was adapted to differentiate true phimosis from the physiological one and data collected. An observational study was done and data collected for last six years.

Result

566 children were referred to the hospital and only 212 were subjected to circumcision. Of these, 169 were cases of true phimosis, 7 had paraphimosis and the rest included 9 ritual circumcisions.

Conclusion

The incidence in this study is much less as compared to the series from the west. Though rare, this simple surgery is often fraught with complications. A refined approach has been planned for referring cases and selection for surgery thereby reducing unnecessary referrals and circumcisions.Key Words: Circumcision, Phimosis     

Childhood circumcision in Northern Ireland: a barometer of the current practice of general paediatric surgery

Purpose:

Studies undertaken in England and Scotland have identified a decrease in the number of circumcision operations being performed during childhood. The aims of this study were two-fold. Firstly, to determine the trend in circumcision operations performed in boys in Northern Ireland over a ten year period. Secondly, to compare the number of operations performed by paediatric surgeons with the number performed by general surgeons over the same period.

Method:

Data were collected from the Northern Ireland Department of Health and Social Services and Public Safety. A retrospective analysis was conducted of the number of circumcisions performed in boys aged between 0 and 13 years for the year beginning 1^st September 1991 to the 1^st of September 1992 and for the year beginning 1^st September 2001 until the 1^st of September 2002.

Results:

769 circumcisions were performed in the year 1991 to 1992 compared with 264 in the year 2001 to 2002, representing a 66% decrease. In the ten year study period, the number of circumcisions performed by general surgeons fell by 71% whilst specialist paediatric surgeons performed 56% less.

Conclusions:

The decrease in rates of circumcision in boys aged 0 to 13 years in Northern Ireland is consistent with trends in the remainder of the United Kingdom. The results also suggest a greater decrease in the proportion of circumcisions being performed by general surgeons in district general hospitals compared to those performed by paediatric surgeons.     

Colles筋膜外包皮内板袖状切除术治疗包皮过长的临床疗效

目的：评价采用阴茎Colles筋膜外包皮内板袖状切除术治疗包皮过长的临床疗效。方法：1997～2007年共收治包皮过长的患者512例,随机分两组手术对比治疗。一组为改良组257例（A组）,采用Colles筋膜外包皮内板袖状切除术治疗包皮过长;另一组为对照组255例（B组）,采用传统远端包皮环切术治疗包皮过长。结果：改良组与传统组相比较,在术中操作、术中出血量、术后疼痛时间、外观与功能以及术后并发症等方面均优于传统手术组。结论：与传统手术方法治疗包皮过长相比较,Colles筋膜外包皮内板袖状切除术,方法易于掌握,术后并发症少,疗程短,安全可靠,成功率高,患者易于接受。     

老年人包皮环切术30例的治疗体会

目的:探讨包皮环切术治疗老年人包皮过长和包茎的临床效果。方法:30例老年人(68～78岁)行包皮环切术。结果:30例患者1期愈合,阴茎自然美观,不适感消失,无并发症,术后痛苦少,恢复满意,患者性生活满意度提高。结论:包皮环切术治疗老年人包皮过长和包茎效果满意。     

袖套式与传统式包皮环切术治疗小儿阴茎包皮过长及包茎的临床对比研究

目的探讨袖套式与传统式包皮环切术治疗小儿阴茎包皮过长及包茎的临床效果,以期提高临床诊治水平。方法选取2011年3月至2013年4月重庆市合川区妇幼保健院及重庆市合川区钱塘中心卫生院收治的300例小儿阴茎包皮过长及包茎患者为研究对象,分成传统式包皮环切术组和袖套式包皮环切术组,传统式包皮环切术组采用传统式包皮环切术,袖套式包皮环切术组采用袖套式包皮环切术,比较两组治疗后的临床效果情况。结果传统式包皮环切术组与袖套式包皮环切术组的手术时间[(46.6±8.3)min vs(32.8±7.7)min]、术中出血量[(11.9±2.5)mL vs(7.5±1.6)mL]、术后疼痛持续时间[(46.7±10.7)h vs(23.7±6.4)h]进行比较,差异均有统计学意义(P<0.05)。从术后并发症情况看,传统式包皮环切术在出血或血肿、伤口感染、阴茎水肿、包皮畸形、外形不美观、硬结形成、伤口粘连、伤口裂开等并发症共计125例次,并发症率为83.3%;袖套式包皮环切术相对应的并发症共60例次,并发症发生率为40.0%,两组并发症发生率比较,差异有统计学意义(P<0.05)。结论袖套式包皮环切术治疗小儿阴茎包皮过长及包茎临床效果满意,术后并发症发生率低。     

儿童包皮环切术739例治疗体会

目的观察一次性包皮环切吻合器行儿童包皮环切术的临床运用效果,探讨应用一次性包皮环切吻合器行儿童包皮环切术的优越性。方法应用一次性包皮环切吻合器对739例包皮过长及包茎儿童行包皮环切术,对手术时间、术后并发症、术后恢复时间和外观情况进行观察。结果手术时间(5.2±1.3)分钟,主要并发症为术后感染9例(1.22%)、出血5例(0.68%)和水肿27例(3.65%)。术后包皮创口完全愈合时间为(19.90±5.33)天。结论应用一次性包皮环切吻合器行儿童包皮环切术具有手术时间短、术中疼痛轻、术后并发症少、外观满意度高、受术者易于接受等优点,值得在临床推广应用。     

新型包皮环切缝合器治疗小儿包茎包皮过长的成本效果

目的观察新型包皮环切缝合器配合复方利多卡因乳膏局部浸润麻醉治疗小儿包茎及包皮过长的效果和安全性,并探讨其成本效果。方法遵循临床流行病学与卫生经济学的原理和方法,选择2012年5月-2014年8月四川省隆昌县人民医院236例包茎及包皮过长患者为研究对象,将其中118例接受新型包皮环切缝合器治疗（治疗组）与118例接受传统环切术治疗（对照组）的患儿进行对比,记录两组患儿的临床疗效和费用,计算并比较两组的成本效果。结果治疗组患儿麻醉疼痛、手术时间、家长满意度、术中出血量、术后愈合时间、术后并发症、切口外观、医疗费用、总体评价得分情况均优于对照组,差异均有高度统计学意义（P〈0.01）。两组的成本效果比（C/E）分别为999.88和1267.61,在获得相同的总体评价得分时,治疗组比对照组节省267.73元,所需医疗费用仅为对照组的78.9%;以对照组为基准,增量C/E为519.01,治疗组每增加1%的总体评价得分率仅比对照组多用5.19元。结论新型包皮环切缝合器配合复方利多卡因乳膏局部浸润麻醉治疗小儿包茎及包皮过长在临床疗效、治疗成本等方面均令人满意,值得在临床上推广应用。     

小儿包皮环切术套环法800例体会

目的：总结包皮环切术套环法治疗小儿包皮过长的经验。方法对2003～2013年来我院行包皮环切术套环法治疗小儿包皮过长的800例患儿行回顾性分析。结果800例行小儿包皮环切术套环法患儿术后效果良好。套环脱落时间为7～20d,脱落后切缘整齐,外形美观。26例出现不同程度的并发症。其中,术后出血4例;包皮感染、红肿8例;套环不脱落5例;包皮撕裂3例;包皮环嵌入冠状沟4例;尿潴留2例。结论小儿包皮环切术套环法具有手术时间短,手术出血少,创伤小,并发症少,患儿痛苦小,术后护理方便等优点,手术简单易于推广。     

包皮环扎术、传统环切术及维吾尔族割礼三种术式疗效比较

回顾分析2002年4月至2007年4月采用包皮环扎术（1224例）和传统环切术（1665例）治疗包茎及包皮过长患者、行维吾尔族割礼者（1660例）的随访资料,比较3种术式的治疗效果。手术后外观满意无并发症率分别为99．51％（1218／1224）,92．61％（1542／1665）和88．80％（1474／1660）,手术并发症发生率环扎术组最低0．49％（6／1224）,传统环切术组为7．39％（123／1665）,低于割礼组的11．20％（186／1660）。     

一次性包皮环切缝合器与商环治疗包皮过长和包茎的疗效对比分析

目的：比较分析一次性包皮环切缝合器和商环治疗包皮过长和包茎的临床疗效。方法选取行包皮环切术的290例患者,应用一次性包皮环切缝合器手术145例（A组）,应用商环手术145例（B组）。分别观察两组手术时间、术中及术后勃起疼痛评分、术中出血量、切口愈合时间、术后并发症（水肿、出血、感染、切口开裂）及患者满意度。结果两组患者手术时间及术后疼痛评分的差异均无统计学意义（均P＞0.05）,术中勃起疼痛评分、术中出血量、切口愈合时间及术后并发症发生率的差异均有统计学意义（P＜0.05或0.01）。结论两种包皮环切术均获得满意效果。一次性包皮环切缝合器法可明显减轻围手术期疼痛,缩短切口愈合时间,降低术后（水肿、出血、感染、切口开裂）等并发症的发生率;而商环手术后出血和皮下血肿发生率较少。     

一次性包皮切割缝合器在儿童包皮环切术中的疗效：前瞻性随机对照研究

目的探讨一次性包皮切割缝合器在儿童包皮环切术中的优势。方法前瞻性研究入组我院门诊就诊的包茎和包皮过长 并行包皮环切术的儿童,随机分成包皮切割缝合器组和传统包皮环切手术组;共纳入236例男童,其中一次性包皮切割缝合器 组132例,传统手术方式104例。通过评估两种手术方式局部麻醉方式占比,手术时间,术中出血量,术中和术后疼痛评分,术后 阴茎外观满意率,术后并发症发生率,切口愈合时间,术后总体满意率的差异;比较一次性包皮切割缝合器在儿童包皮环切术中 的优势。结果与传统包皮环切术组对比,包皮切割缝合器组具有局麻方式占比高（P<0.001）,手术时间短（P<0.001）,术中出血 少（P<0.001）,术中和术后疼痛更轻（P<0.001）,术后切口愈合时间短（P<0.001）,术后阴茎外观满意率更高（P=0.03）,术后并发 症发生率更低（P=0.04）,切口愈合时间更短（P<0.001）,总体满意度更高（P<0.005）等优点。结论使用一次性包皮切割缝合器 的包皮环切术具有手术时间短、局麻耐受性好,围手术期疼痛轻、恢复快及术后外观漂亮等显著优势,更易于儿童及家长接受, 值得临床广泛应用。     

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。     

Local anesthesia for neonatal circumcision. Effects on distress and cortisol response

A controlled, double-blind investigation was conducted to determine whether the dorsal penile nerve block using lidocaine hydrochloride without epinephrine would effectively reduce behavioral distress and adrenocortical responses to routine neonatal circumcision. The subjects were healthy male newborns whose parents had requested circumcision. Equal numbers (n = 20) were randomly assigned to circumcision with lidocaine, saline, or no injection. Dorsal penile nerve block was found to be a safe and easy technique that was effective in reducing behavioral distress and modifying the adrenocortical stress response. The injection itself did not increase stress reactions and did not offset the beneficial effects of anesthesia. If circumcisions are to be performed, they should be done as humanely as possible.     

应用“商环”行包皮环切与传统环切术临床疗效对比观察

目的对比应用＂商环＂行包皮环切与传统包皮环切术两种术式的临床疗效。方法对167例包皮过长、包茎患者,行商环包皮环切术81例（商环组）、行传统包皮环切术86例（传统组）。对其术式优越性、安全性进行对比分析。结果行商环包皮环切术组在手术时间、术中出血量、手术并发症、术后阴茎美观方面优于行传统包皮环切组,两者有统计学意义（P〈0.05）。结论应用＂商环＂行包皮环切术操作简单、安全可靠、并发症少,值得临床推广和应用。     

圣环包皮术与包皮环切术的临床疗效对比

目的比较圣环包皮术与包皮环切术的临床疗效。方法对287例包茎、包皮过长患者行包皮环切术(A组),对301例行圣环包皮术(B组),对比分析上述两组患者手术时间、术中及术后出血量、术后并发症等情况。结果两种术式的手术时间、术中及术后出血量间差异均有统计学意义(P<0.05)。两组患者换药率、术后感染率、拆线率以及术后并发症率间差异亦均有统计学意义(P<0.05)。结论圣环包皮术明显优于包皮环切术组,具有微创的特点,值得在临床推广。     

圣环包皮环切术与传统环切术、袖套状环切术临床疗效对比观察

目的比较圣环包皮环切术、袖套状包皮环切术及传统包皮环切术治疗包皮过长及包茎的临床疗效。方法对298例包皮过长及包茎患者分别行传统包皮环切术(剪刀法)86例(传统组)、袖套状包皮环切术82例(袖套组)、圣环包皮环切术130例(圣环组)。对比分析3组手术时间、术中出血量、术后疼痛持续时间、术后并发症、患者手术前后国际勃起功能评分-5(international index of erectile function,IIEF-5)和勃起功能障碍患者及性伴侣治疗满意度(treatment satisfaction scale,TSS)评分。结果传统组术后疼痛时间[(47.62±13.05)h]显著大于其他2组,术后切口感染率(6.9%)、血肿发生率(15.1%)和包皮畸形发生率(8.1%)显著高于其他2组(P<0.05),术后IIEF-5评分显著降低(P<0.05)而TSS评分无显著变化(P>0.05);袖套组手术时间[(44.21±10.55)min]和术中出血量[(11.02±2.44)ml]显著高于其他2组(P<0.05),术后TSS评分显著提高(P<0.05)而IIEF-5评分无显著变化(P>0.05);圣环组手术时间[(4.37±1.33)min]和术中出血量[(0.79±0.20)ml]显著低于其他2组(P<0.05)、术后阴茎水肿发生率(44.6%)显著高于其他2组(P<0.05),手术后TSS评分显著提高(P<0.05)而IIEF-5评分无显著变化(P>0.05)。结论圣环包皮术操作简单、快捷、安全,较传统术式和袖套状术式临床疗效佳。     

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。     

Experience with a Diabetic Service in an “Open” Hospital

A survey of the management of diabetes mellitus in an “open” hospital, Calgary General Hospital, was conducted in 1954 by reviewing the records of 100 consecutive diabetic admissions and by interviewing medical, nursing and dietetic staff members. The diabetic state was controlled satisfactorily by diet and insulin, but early diabetic complications and patient education tended to be overlooked by physicians. Diabetic management from the nursing, administrative and dietetic standpoints was considered to be inefficient, unpredictable and incomplete.

In 1955 a comprehensive diabetic service was instituted which co-ordinated the activities of medical, nursing and dietetic staffs and provided for patient education. A repeat survey conducted in 1961, in which the records of 87 consecutive diabetic admissions were reviewed, showed marked improvement in all areas of diabetic patient care.

Objections to voluntary conformity by staff members were surprisingly absent. The institution of a diabetic service is recommended for all hospitals as a means of improving diabetic care.