Nigerian Journal of Basic and Clinical Sciences

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 15  |  Issue : 1  |  Page : 5--8

Outcome of male circumcision: A comparison between plastibell and dorsal slit methods


LB Abdullah, AM Mohammad, LJ C Anyanwu, AU Farinyaro 
 Paediatric Surgery Unit, Surgery Department, Bayero University Kano/AKTH, Nigeria

Correspondence Address:
Dr. L B Abdullah
Paediatric Surgery Unit, Surgery Department, Bayero University Kano/AKTH
Nigeria

Abstract

Introduction: Circumcision is the surgical removal of the skin covering the glans penis (prepuce). Circumcision is performed worldwide, among many tribe and races. It is the commonest surgical procedure done in males. It is perform by both trained and non-trained medical personal. Aims and Objective: To compare the outcome of circumcision done by dorsal slit and plastibell methods. Methods and Materials: A prospective study was done over 1 year period. A structured questionnaire was used to collect data. It was a cross-sectional analytical study with sample size of 120 patients divided in to 2 study groups. Group A had dorsal slit while group B had plastibell type of circumcision. Results: The age of circumcision varies between 7days to 10 years. The average duration of the procedure was 12minutes for dorsal slit and 7 minutes, with estimated blood loss of 7mls and 4mls in the two methods. The most common complications observed in our study are surgical site infection, post operative haemorrhage, and delayed separation of the ring. While surgical site infection is more in plastibell method, post operative haemorrhage was found to be commoner in dorsal slit method. Conclusion: Our study showed that plastibell has an obvious advantage of shorter time of procedure, lower risk of post operative bleeding compared to the conventional dorsal slit method of circumcision.



How to cite this article:
Abdullah L B, Mohammad A M, Anyanwu LC, Farinyaro A U. Outcome of male circumcision: A comparison between plastibell and dorsal slit methods.Niger J Basic Clin Sci 2018;15:5-8


How to cite this URL:
Abdullah L B, Mohammad A M, Anyanwu LC, Farinyaro A U. Outcome of male circumcision: A comparison between plastibell and dorsal slit methods. Niger J Basic Clin Sci [serial online] 2018 [cited 2019 Aug 21 ];15:5-8
Available from: http://www.njbcs.net/text.asp?2018/15/1/5/228367


Full Text



 Introduction



Circumcision is the surgical removal of the skin covering the glans penis (prepuce), which is performed worldwide among many tribes and races. It is the most common surgical procedure done in males.[1] It is performed by both trained and nontrained medical personnel.

The percentage of circumcised males varies by geographic location, religious affiliation, and, to some extent, by socioeconomic classification.[2]

The benefit of circumcision has been described in numerous studies, such as in the reduction of the risk of penile cancer, cancer of the cervix uteri, urinary tract infections (UTIs), sexually transmitted diseases (STDs), and a reduction in human immunodeficiency virus (HIV) prevalence.[3]

In Nigeria, various methods are used for circumcision; freehand (dorsal slit) and plastibell methods are among the commonly performed techniques.[1],[2]

Dorsal slit

The dorsal slit technique of circumcision involves making a dorsal slit incision and excising the skin circumferentially; hemostasis is achieved and the skin edges are approximated using absorbable sutures [Figure 1].{Figure 1}

Plastibell method

The plastibell technique was developed in the 1950s.[4] After separating the penile skin from the glans adhesions, a plastic bell ring, similar in appearance to the metal Gomco bell [Figure 2], is placed completely over the glans. Hemostasis is insured by placing a strangulating suture at the plastic groove, which is left in place. The skin sloughs after a few days and the plastibell falls off. The size of the plastibell is selected based on the size of the glans penis. The proper size should be 2–4 mm above the widest diameter of the glans. Bigger-sized bells are better.{Figure 2}

 Materials and Methods



This is a prospective study conducted over 1-year period between 1st January 2013 and 31st December 2013. A structured questionnaire was used to collect data for the study. It was a cross-sectional analytical study with sample size of 120 patients divided in to two study groups [Table 1]. Group A participants underwent dorsal slit whereas group B had plastibell type of circumcision. The patients were randomly divided in to the groups. Patients with a history suggestive of urinary tract infection or bleeding disorder were excluded. Data was collected, analyzed, and the results are presented as figures, table and charts. The study was approved by the ethical committee of AKTH.{Table 1}

 Results



During the period of the study, 120 boys were included in the study, 60 underwent dorsal slit while the other 60 boys had plastibell circumcision. [Table 1] lists the total number of participants. The age at circumcision varied between 7 days and 10 years with majority of boys less than 3 years of age [Figure 3].{Figure 3}

The average duration of the procedure was 12 minutes for dorsal slit and 7 minutes for plastibell with an estimated blood loss of 7 ml and 4 ml for dorsal slit and plastibell methods of circumcision, respectively.

The average duration of wound healing was 8 days and 10 days for dorsal slit and plastibell methods of circumcision, respectively.

Three patients (5%) among the dorsal slit group had reactionary hemorrhage, one of which was controlled by applying pressure while the other two required reoperation and ligation of the bleeding vessels. Only one among the plastibell had postoperative hemorrhage after partial dislodgment of the ring which was corrected by revision of the plastibell. Postoperative bleeding was higher among the dorsal slit method, as documented in other studies.

Five children (4.3%) had surgical site infection [Table 2], of whom 2 (1.7%) underwent dorsal slit while 3 (2.6%) had plastibell method of circumcision. This was statistically significant.{Table 2}

One patient (1.8%) among the plastibell came back 12 days after circumcision with retained plastibell (studies have documented that the plastic ring usually falls off within 10 days of the procedure). None of our patients had urethrocutaneous fistula or penile amputation.

After the procedure, 91% of the parents/guardians were satisfied with the dorsal slit method while 97% of them were satisfied with plastibell method of circumcision using a 5-point Likert's scale.

 Discussion



Male circumcision consists of the surgical removal of a part or whole of the prepuce of the penis. It is one of the most common procedures in the world. In the United States, the procedure is most frequently performed during the newborn period.[4],[5]

Worldwide 1 out of every 4 males now born are said to be circumcised every year. The incidence is higher in countries like Nigeria.[3],[4]

The indication for circumcision in our environment is mainly nonmedical, cutting across social, ethnic, and religious barriers, which is similar to other centres.[5],[6],[7]

The age at circumcision varies between 7 days to 10 years. This is similar to some studies in Nigeria.[1],[5],[6]

There are many methods for circumcision; dorsal slit dissection or using the plastibell device are the methods most frequently employed for circumcision. The technique of choice remains controversial as there are few studies to compare the methods of circumcision.[7],[8],[9]

The average duration of the procedure was significantly higher in dorsal slit (12 minutes) compared to 7 minutes in plastibell method (P-value < 0.05). This was also documented in other studies.[10],[11],[12]

Average estimated blood loss was 7 ml and 4 ml in dorsal slit and plastibell methods, respectively. It was significantly higher in dorsal slit than plastibell method (P-value < 0.05). Similar findings have been documented in some studies.[13]

There was not much different in the duration of wound healing between the two methods. Postoperative bleeding was documented in 4 patients, and 3 (75%) of them underwent dorsal slit method which is statistically significant (P-value < 0.05). Postoperative bleeding was higher among the patients undergoing dorsal slit method, as documented in other studies.[13],[14],[15],[16],[17]

Surgical site infection was observed among 5 (4.2%) of our children; 2 among the dorsal slit group and 3 among the plastibell group had surgical site infection. The rate was slightly lower in dorsal slit than plastibell method. This is lower than those reported by Mak et al. (13.7% in plastibell and 14.9% in the dissection group), Fraser (4% with both techniques), and Sorensen (5% with plastibell device method).[16],[17],[18],[19]

Among the plastibell group, one child came back with retained plastibell 12 days after the procedure. This is lower than that documented in other studies.[7]

None of our patients has postoperative urine retention which is observed in some patients, as documented in some studies.[20],[21]

Most of the parents/guardians were satisfied with the procedure; 91% after the dorsal slit and 97% after the plastibell method. This is similar to some studies reported from other centres.[22],[23]

None of patients develop penile injury which is documented in some studies. Penile ulceration or concealed penis is also observed by in some patients after circumcision as documented in some studies but none was observed in our patients.[23]

 Conclusion



Our study showed that plastibell has an obvious advantage of shorter time of procedure and lower risk of postoperative bleeding compared to the conventional dorsal slit method of circumcision.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Krill AJ, Palmer LS, Palmer JP. Complication of circumcision. ScientificWorldJournal 2011;11:2458-68.
2Alagoa PJ, Gbobo I. Complications of Male Infant Circumcision in a Semi-Urban Niger Delta Town. Int J Trop Dis Health 2013;3:217-23.
3Leibowitz AA, Desmond K, Belin T. Determinants and policy implications of male circumcision in the US. Am J Pub Health 2009;99:138-45.
4Hutcheson JC. Male neonatal circumcision: Indications, controversies and complications. Urol Clin North Am 2004;31:461-7.
5Abdur-Rahman LO, Nasir AA, Adeniran JO. Circumcision: Perspective in a Nigerian teaching hospital. Afr J Paediatr Surg 2013;10:271-4.
6Pinto K. Circumcision controversies. Pediatr Clin North Am 2012;59:977-86.
7Ahmed AA, Mungadi IA. Techniques of Male Circumcision. J Surg Tech Case Rep 2013;5:1-7.
8Lazarus J, Alexander A, Rode H. Circumcision complications associated with the Plastibell device. South Afr Med J 2007;97:192-3.
9Okeke IL, Asinobi AA, Ikuerowo SO. Epidemiology of circumcision complications of male circumcision in Nigeria. BMC Urol 2006;6:21.
10Krill AJ, Palmer LS, Palmer JS. Complications of circumcision. ScientificWorldJournal 2011;11:2458-68.
11Ademuyiwa AO, Bode CO. Complications of neonatal circumcision: Avoiding common pitfalls in a common procedure. Afr J Paediatr Surg 2009;6:134-6.
12Peng YF, Cheng Y, Wang GY. Clinical application of a new device for minimally invasive circumcision. Asian J Androl 2008;10:447-54.
13Mousavi SA, Salehifar E. Circumcision Complications Associated with the Plastibell Device and Conventional Dissection Surgery: A Trial of 586 Infants of Ages up to 12 Months. Adv Urol. 2008:606123.
14Weiss HA, Larke N, Halperin D, Schenker I. Complications of circumcision in male neonates, infants and children: A systematic review. BMC Urol 2010;10:2.
15Bastos Netto JM, de Araújo JG Jr, de Almeida Noronha MF, Passos BR, de Bessa J Jr, Figueiredo AA, et al. Prospective randomized trial comparing dissection with Plastibell® circumcision. J Pediatr Urol 2010;6:572-7s.
16Bode CO, Ikhisemojie S, Ademuyiwa AO. Penile injuries from proximal migration of the Plastibell circumcision ring. J Pediatr Urol 2010;1:23-7.
17Duncan ND, Dundas SE, Brown B, Pinnock-Ramsaran C, Badal G. Newborn circumcision using the Plastibell device: An audit of practice. West Indian Med J 2004;53:23-6.
18Manji KP. Circumcision of the young infant in a developing country using Plastibell. Ann Trop Paediatr 2000;20:101-4.
19Nilesh G. Nagdeve. Parental evaluation of postoperative outcome of circumcision with Plastibell or conventional dissection by dorsal slit technique: A randomized controlled trial. J Pediatr Urol 2013;9:675-82.
20Mihssin N, Moorthy K, Houghton PW. Retention of urine: An unusual complication of the Plastibell device. BJU Int 1999;84:745.
21Lerman SE, Liao JC. Neonatal circumcision. Pediatr Clin North Am 2001;48:1539-57.
22Jimoh BM, Odunayo IS, Chinwe I, Akinfolarin OO, Oluwafemi A, Olusanmi AJ. Plastibell circumcision of 2,276 male infants: A multi-centre study. Pan Afr Med J 2016;23:35.
23Hammed A, Helal AA, Badway R, Goda SH, Yehya A, Razik MA, et al. Ten years experience with a novel modification of plastibell circumcision. Afr J Paediatr Surg 2014;11:179-83.