包皮环切后包皮龟头炎,包皮垢及人乳头瘤病毒感染的年龄分布调查

目的：探讨不同年龄包皮环切后人群包皮中包皮龟头炎，包皮垢及人乳头瘤病毒感染的发生率。方法：对２１９例包皮环切后通过问诊和体检，了解我民皮龟头炎和包皮垢的情况，采用ＰＣＲ扩增的方法检测包皮中ＨＰＶ－６，１１，１６，１８及３３型ＤＮＡ保守片段。结果：包皮龟头炎，包皮垢及ＨＰＶ感染的发生率分别为２１．０％，４３．３％和４１．１％。     

包皮中人乳头瘤病毒的感染及意义

目的和方法：人乳头瘤病毒１６、１８型染与宫颈癌及阴茎癌的发生有密切关系，从预防角度出发，我们采用ＰＣＲ－ＤＮＡ扩增的方法，检测了４８例包皮环切标本中ＨＰＶ６，１１，１６，１８，３３型的ＤＮＡ保守片段。结果：２０例阳性，阳性率为４１．７％，按年龄、有无包皮垢及有无感染史分组，各组间均无显著性差异。结论：主张男孩应尽早行包皮环切术。     

包皮中人乳头瘤病毒的感染及意义

目的和方法：人孔头瘤病毒16、18型感染与宫颈癌及阴茎癌的发生有密切关系，从预防角度出发，我们采用PCR－DNA扩增的方法，检测了48例包皮环切标本中HPV6，11，16，18，33型的DNA保守片段。结果：20例阳性，阳性率为41．7％。按年龄、有无包皮垢及有无感染史分组，各组间均无显著性差异。结论：主张男孩应尽早行包皮环切术。     

包皮环切术治疗包皮龟头念珠菌感染528例

目的:观察分析应用包皮环切术治疗男性念珠菌性龟头炎的疗效。方法:本组528例患者均确诊为念珠菌性龟头感染,全部采用包皮环切术。结果:术中无1例并发症,所有患者均全愈,对疗效满意,随访6个月无复发。结论:采用包皮环切器治疗男性龟头念珠菌感染,操作简单,疗效可靠,值得临床广泛应用。     

包皮环套术及传统包皮环切术的应用效果对比

目的 对比分析包皮环套术和包皮环切术两种术式在治疗成人与儿童包皮过长或包茎中的应用效果.方法 临床上顺序收集成人(18～35岁)及儿童(6～13岁)包皮过长或包茎患者197例,予以包皮环套术或包皮环切术.术后随访3个月,采用视觉模拟评分法(VAS)记录患者术后ld至10d的疼痛强度,同时记录各组患者的常见术后并发症情况,计算并发症发生率并作对比分析.结果 包皮环套术手术时间及术中出血量明显少于传统包皮环切术,成人环套组在术后1、3、7d时VAS评分明显高于儿童环套组,而儿童环切组在术后ld和5d评分明显高于环套组.成人组环套术和环切术后包皮水肿发生率分别是21％和10％,儿童组环套术后环切术后包皮水肿发生率分别是5％和15％.结论 儿童包皮过长或包茎患者更适合选择包皮环套术;成人包皮环套术的应用效果相对儿童较差,在行术式选择时最好结合患者要求,若要求较好术后包皮外观及较短手术时间可选择环套术.     

包皮环切缝合器手术与传统包皮环切术的临床对比分析

【摘要】目的观察包皮环切缝合器手术与传统包皮环切术的疗效对比。方法回顾性分析2015年7月至2016年7月间采取2种不同方法进行的包皮环切术共203例,其中传统手术114例,包皮环切缝合器手术89例,比较2种手术的手术时间,术中出血量,疼痛感,术后并发症发生情况,切口愈合时间及阴茎外形满意度。结果环切缝合器手术的手术时间,术中出血量,术中疼痛VAS,术后伤口愈合时间均明显小于传统手术（P<0.05）;阴茎外形满意度高于传统手术（P<0.05）;环切缝合器手术的术后出血、伤口感染及切口裂开等并发症发生率低于传统手术（P<0.05）;包皮水肿发生率2组无差异。结论环切缝合器在包皮环切术的应用,具有简便、快捷、微创、美容及并发症低的优点。     

包皮环切术后并发重度包皮与阴茎头坏死的处理

目的：探讨包皮环切术后并发重度包皮与阴茎头坏死的处理方法。方法：诊治1例此类患者：18天前行包皮环切术，术后第2天诉阴茎头部上方疼痛、肿胀、发黑，约2／3阴茎体皮肤发黑，以腹侧为重，表面可见脓苔，有臭味；阴茎头腹侧2／3发黑，表面皮肤已坏死。即行局部清创、适时植皮等综合处理。结果：阴茎创面完全愈合，随访6个月，阴茎外观尚可，排尿通畅，尿道远端缺损约1．5cm，勃起正常，可射精。准备后续行尿道成形术并阴茎头成形术。结论：对于包皮环切术后重度包皮并阴茎头坏死患者，宜行局部清创、适时植皮等综合治疗，这是此类患者有效的处理办法。     

一次性包皮环切吻合器与传统包皮环切术的临床疗效分析

目的：应用一次性包皮环吻合器与传统包皮环切两种术式进行临床疗效比较。方法：随机对包皮过长、包茎患者,采用两种手术方法（吻合器组235例,传统手术组120例）在其安全性、术式优越性及疗效等方面进行对比。结果：在手术时间、术中出血量以及术后并发症等方面,包皮环吻合器切除组明显优于传统包皮环切组,差异有统计学意义（P〈0.01）,且术后不需换药,切缘光整,外形美观。结论：应用一次性包皮环切吻合器进行包皮环切术,与传统常规手术比较,手术更加简单、方便、安全,并发症少,效果更加满意。符合现代微创手术要求,值得临床推广应用。     

包皮内板切除矫治包皮过长

目的：评估包皮内板切除矫治包皮过长的效果。方法：将150例包皮过长患者随机分为包皮内板切除组（A组）和传统包皮环切组（B组）。A组患者90例,保留冠状沟处包皮内板5mm,保留系带10mm,切除其余包皮内板,使阴茎的血管和神经保持完整;B组患者60例,采用传统包皮环切术。对两组术中出血量、术后创口出血、血肿、水肿、疼痛、感染、等并发症以及阴茎外形满意度进行比较。结果：A组术中出血量为（5±3）ml,B组为（22±5）ml（P〈0.001）;A组术后疼痛持续时间为（12±4）h,B组为（36±10）h（P〈0.05）;A组术后阴茎外形满意度98.3%,发生创口水肿者0例,伴出血、血肿者0例,发生局部感染者1例,总并发症率为1.1%。B组阴茎外形满意度75%,术后创口出血、血肿1例,水肿4例,感染2例,总并发症率为10%（P〈0.05）。所有对比项目在两组之间的差异均有统计学意义。结论：包皮内板切除矫治包皮过长手术比传统的包皮环切术更具有优越性。     

内板切除在包皮环切术中的应用及评价

目的探讨内板切除法在包皮环切术中的应用及疗效评价。方法对96例包皮过长患者采用内板切除法行包皮环切术;同期对108例患者采用传统手术方法,对两组术后出血、感染、系带水肿及阴茎外形满意度进行对比。结果两组术后出血均为2例（P〉O．05）两组术后均无感染发生。内板切除组术后发生2例系带水肿,而传统手术组术后22例系带水肿．两组的差异有统计学意义（P〈0．01）。内板切除组阴茎外形满意度96．9％,传统手术组为89．8％,两组的差异有统计学意义（P〈O．05）。结论内板切除应用于包皮环切术疗效理想,优于传统手术。     

包皮中人乳头瘤病毒感染的临床意义

目的:探讨包皮中人乳头瘤病毒感染的临床意义。方法:采用PCR-DNA扩增的方法检测了48例包皮环切标本中HPV-6、11、16、18及33型的DNA保守片段。结果:48例中,20例阳性,阳性率为41.7%;其中不同年龄段、有无包皮垢及有无感染史组间HPV阳性率均无显著性差异。结论:对需行包皮环切的男孩,应尽早施行包皮环切术。只有尽早消灭致癌因素,才有可能对阴茎癌起到预防作用。     

Knowledge and attitudes of Korean parents towards their son's circumcision: a nationwide questionnaire study

OBJECTIVE: To evaluate knowledge about the foreskin and circumcision, and to understand the attitudes of parents to circumcision in Korea, where circumcision in childhood is widely practised with no particular religious or medical background. SUBJECTS AND METHODS: A nationwide study involving questionnaires was conducted on 5500 parents with at least one son attending elementary school. Responses were obtained from one of the parents. RESULTS: The response rate was 76.1% (4183); circumcision was most common in boys when aged 11 years, followed by neonatal circumcision. Of the parents, 91.3% believed that circumcision is necessary, while 2.1% believed it to be unnecessary. The principal reasons given for circumcision were 'to improve penile hygiene' (82.4%), followed by 'to improve future sexual potency' (7.5%). Among those who did not believe circumcision to be necessary, the most common reason was the expectation of spontaneous retraction of the prepuce with age (55.1%). Most (88.4%) of the parents believed that smegma is not a clean material, and is infected by microorganisms. Most parents (80.6%) thought that circumcision would prevent genital tract infection of the future spouse. Peer pressure was one of the most influential factors in deciding upon circumcision; 41.9% of the parents were anxious that their child might be ridiculed by his peer group unless he was circumcised, while 27.4% of the parents believed that their child might be ridiculed if he was circumcised. Mothers were more positive about circumcision than fathers (P < 0.05). Parents with a higher education and higher socio-economic status were also more positive about circumcision (P < 0.05). Mothers were prone to emphasize improved sexual potency (P < 0.05). There was no significant difference in response between urban and rural areas. CONCLUSION: This study indicates that common beliefs held by parents about the prepuce or circumcision differ significantly from current medical knowledge, and these beliefs have a major influence on the practice of circumcision in Korea. More clinical research on the natural history of the foreskin is needed, and it is critical that both children and parents are informed about the potential benefits and disadvantages of circumcision.     

Developmental factors of urethral human papillomavirus lesions: correlation with circumcision.

OBJECTIVE: To assess the relationship between circumcision and urethral human papillomavirus (HPV) lesions, and the influence of urethritis on the development of urethral HPV infections on inducing squamous metaplasia of the urethral epithelium. PATIENTS AND METHODS: The study included 210 heterosexual, HIV-negative men (median age 29 years) who all had female partners with genital HPV infection. The patients were divided into three groups according to clinical findings, i.e. 97 patients with no clinical HPV lesions on peniscopy and urethroscopy, 70 patients with balanopreputial lesions but no urethral lesions, and 43 patients with urethral HPV lesions, including 17 who had associated penile lesions. They all underwent meatopeniscopy for HPV screening, urethral biopsy for histological analysis, and bacterial cultures were taken. The results in each subgroup were compared between circumcised and uncircumcised men. RESULTS: There was no significant difference in the incidence of HPV infection (58% vs 42%, odds ratio, OR, 1.8; 95% confidence interval, CI, 0.98-3.62) between uncircumcised and circumcised men, but this relationship differed with the developmental site of HPV lesions (shaft-foreskin, P<0.02; urethra, not significant). There was also a significant difference in the prevalence of urethritis between uncircumcised and circumcised men (34.5% vs 19%, OR 2.35, 95% CI 1. 08-5.11), and between HPV-infected and uninfected men (41.5% vs 18%, OR 3.17, 95% CI 1.71-5.83). This positive relationship of the prevalence of urethritis for both factors (circumcision and HPV) depended on the type of organism (sexually transmitted disease, not significant; common organism, P<0.02). The frequency of urethritis was related to the site of HPV lesions; urethritis was present in 36% of the patients with preputial HPV lesions, compared with 51% of those with urethral HPV lesions. Chlamydia trachomatis was detected in 1% of the patients without and in 7% of those with HPV lesions. In 68% of the patients, histological analysis of the urethral mucosa showed a squamous metaplasia of the urethral epithelium associated with urethritis. CONCLUSIONS: Being uncircumcised did not seem to increase the risk of HPV urethral infection in young men. Genital bacterial infections and urethral HPV lesions appear to be linked. Urethritis can induce squamous metaplasia of the urethral epithelium, which appears to favour the colonization of the anterior urethra by HPVs.     

The incidence of phimosis in boys.

OBJECTIVE: To establish the incidence of pathological phimosis in boys. PATIENTS AND METHODS: A 2-year review of circumcisions was performed for phimosis among a known population of boys, with the histological findings of the circumcision specimens assessed. RESULTS: Sixty-two boys (all but one aged 5-14 years) had typical pathological (cicatrizing) phimosis and among the 51 circumcision specimens examined histologically, 43 (84%) showed appearances of balanitis xerotica obliterans. During the same period, 30 boys were circumcised for developmental unretractability of the foreskin ('physiological phimosis'). CONCLUSIONS: The incidence of pathological phimosis in boys was 0.4 cases/1000 boys per year, or 0. 6% of boys affected by their 15th birthday, a value lower than previous estimates and exceeded more than eight-fold by the proportion of English boys currently circumcised for 'phimosis'.     

Low frequency of male circumcision and unwillingness to be circumcised among MSM in Buenos Aires,Argentina: association with sexually transmitted infections

Objective

The aims of this study were to investigate the frequency of male circumcision among men who have sex with men (MSM) in Buenos Aires, Argentina; the association between circumcision and sexually transmitted infections (STIs); and, among those uncircumcised, the willingness to be circumcised.

Methods

A cross-sectional study was conducted among 500 MSM recruited through the respondent-driven sampling (RDS) technique. Participants underwent a consent process, responded to a Web-based survey that included questions on demographic information, sexual behaviour, and circumcision and provided biological samples. HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum, and human papiloma virus (HPV) diagnoses were performed using standard methodologies. For all analyses, data were weighted based on participants’ network size.

Results

Only 64 (13%) of the 500 MSM in our study reported being circumcised. Among uncircumcised men (n=418), 302 (70.4%) said that they would not be willing to get circumcised even if the procedure could reduce the risk of HIV infection. When considering all participants, circumcision status was not significantly associated with HIV, HBV, HCV, T. pallidum or HPV infections. However, when we restricted the sample to men who do not practice receptive anal intercourse (RAI) and compared circumcised to uncircumcised men, the former (N=33) had no cases of HIV infection, while 34 of 231 (14.8%) uncircumcised men were HIV positive (p=0.020). Regarding HPV, uncircumcised men had a significantly larger number of different HPV types compared with circumcised men (mean 1.83 vs. 1.09, p<0.001) and a higher frequency of high-risk-HPV genotypes (47.6% vs. 12.5%, p=0.012).

Conclusions

Consistent with international evidence, male circumcision appears to have a partial protective effect among MSM. The efficacy of circumcision in reducing risk of HIV infection among MSM appears to be correlated with sexual practices. Given the lack of motivation among MSM with regard to circumcision, proper awareness on the risks and benefits of circumcision needs to be created, if circumcision has to be introduced as a prevention strategy.     

Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction

PURPOSE: Evidence concerning the effect of circumcision on sexual function is lacking. Men circumcised as adults are potentially in a unique position to comment on the effect of a prepuce on sexual intercourse. We examine sexual function outcomes in men who have experienced sexual intercourse in the uncircumcised and circumcised states. MATERIALS AND METHODS: Men 18 years old or older when circumcised were identified by billing records during a 5-year period at an academic medical center. Medical charts were reviewed for confirmation of the procedure and to identify the indication(s). These men were surveyed to assess erectile function, penile sensitivity, sexual activity and overall satisfaction. Data were analyzed using paired t tests to compare category scores before and after circumcision. RESULTS: A total of 123 men were circumcised as adults. Indications for circumcision included phimosis in 64% of cases, balanitis in 17%, condyloma in 10%, redundant foreskin in 9% and elective in 7%. The response rate was 44% among potential responders. Mean age of responders was 42 years at circumcision and 46 years at survey. Adult circumcision appears to result in worsened erectile function (p = 0.01), decreased penile sensitivity (p = 0.08), no change in sexual activity (p = 0.22) and improved satisfaction (p = 0.04). Of the men 50% reported benefits and 38% reported harm. Overall, 62% of men were satisfied with having been circumcised. CONCLUSIONS: Our findings may help urologists better counsel men undergoing circumcision as adults. Prospective studies are needed to better understand the relationship between circumcision and sexual function.     

Diabetes-related need for circumcision

A twelve-year retrospective study reviewing circumcision in 107 patients showed that of 94 patients with balanoposthitis 25.5 per cent had diagnosed diabetes mellitus while 3.2 per cent had unknown diabetes. In the fifty- to sixty-year-old age group, 83.3 per cent of circumcised patients had diabetes. In this age bracket there is a definite correlation of a diabetes-related need for circumcision. There is no significant histologic difference by light microscopy between prepuces in diabetic and nondiabetic patients.     

The effect of male circumcision on sexuality

OBJECTIVE: To prospectively study, using a questionnaire, the sexuality of men circumcised as adults compared to uncircumcised men, and to compare their sex lives before and after circumcision. SUBJECTS AND METHODS: The study included 373 sexually active men, of whom 255 were circumcised and 118 were not. Of the 255 circumcised men, 138 had been sexually active before circumcision, and all were circumcised at >20 years of age. As the Brief Male Sexual Function Inventory does not specifically address the quality of sex life, questions were added to compare sexual and masturbatory pleasure before and after circumcision. RESULTS: There were no significant differences in sexual drive, erection, ejaculation, and ejaculation latency time between circumcised and uncircumcised men. Masturbatory pleasure decreased after circumcision in 48% of the respondents, while 8% reported increased pleasure. Masturbatory difficulty increased after circumcision in 63% of the respondents but was easier in 37%. About 6% answered that their sex lives improved, while 20% reported a worse sex life after circumcision. CONCLUSION: There was a decrease in masturbatory pleasure and sexual enjoyment after circumcision, indicating that adult circumcision adversely affects sexual function in many men, possibly because of complications of the surgery and a loss of nerve endings.     

已行和未行包皮环切术的青年男性对包皮及包皮环切术认识和态度的比较研究

目的:探讨青年男性对包皮及包皮环切术知识的掌握程度以及他们是否接受包皮环切术的影响因素。方法:采用自行设计的问卷对泌尿外科门诊已行和未行包皮环切术的青年男性各100名进行调查研究。统计学方法采用SPSS 11.0软件包中χ2检验。结果:已行包皮环切术的青年男性接受该手术的原因依次为:使阴茎更卫生、为预防阴茎癌和期望提高性功能,分别占63%、27%和26%;青年男性未行包皮环切术的主要原因是不清楚包皮环切术的益处和担心术后并发症,分别占47%和24%。同时,周围同龄人的影响也是决定是否接受包皮环切术的重要因素。已行包皮环切术的青年男性对何时进行该手术并不十分清楚。结论:青年男性接受包皮环切术的主要因素是认为术后可改善阴茎局部卫生和期待提高性功能;而拒绝该手术者则不清楚包皮环切术的益处和担心术后并发症。故应加强对包皮和包皮环切术相关知识的宣教工作。