Utilization of subcutaneous indwelling 2-0 silk thread for inner plate frenulum alignment in circumcision using a disposable circumcision suture device: A modified surgical technique.

Abstract

This prospective nonrandomized controlled study aimed to compare the surgical outcomes, postoperative complications, and patient experiences between a modified circumcision technique using a disposable circumcision suture device and the standard circumcision method using a disposable circumcision suture device in Chinese patients with excess foreskin or phimosis at our department of urology and andrology. A total of 456 patients underwent circumcision at our center from May 2021 to September 2022, with 228 patients in the modified disposable circumcision suture device group (mean age: 29.8 years; range: 16.8-44.9 years) and 228 patients in the disposable circumcision suture device group (mean age: 29.6 years; range: 16.4-45.1 years). Key surgical outcomes, including surgical time, intraoperative blood loss, postoperative edema duration, time for complete shedding of titanium pins, and incision healing time, were recorded and analyzed. Additionally, postoperative complications (such as injury to the penile frenulum, frenulum misalignment, glans ischemia, severe bleeding, and infection) as well as patient experiences (including intraoperative and postoperative pain scores and satisfaction with the cosmetic appearance of the penis) were evaluated. All surgeries were successfully completed. The surgical duration was significantly longer in the modified disposable circumcision suture device group (5.7 ± 0.5 minutes) compared to the disposable circumcision suture device group (4.2 ± 0.6 minutes) (P < .05), indicating that the modified procedure took longer to perform. However, no significant differences were found between the 2 groups regarding intraoperative blood loss (3.2 ± 0.2 mL vs 3.2 ± 0.1 mL; P > .05), postoperative edema duration (8.2 ± 2.0 days vs 8.9 ± 1.9 days; P > .05), time for complete shedding of titanium pins (13.7 ± 1.3 days vs 13.8 ± 1.3 days; P > .05), and healing time (21.8 ± 1.7 days vs 21.9 ± 1.8 days; P > .05). The incidence of complications, including injury to the penile frenulum (0% vs 0%), glans ischemia (0% vs 0%), severe bleeding (1.3% vs 1.8%), and infection (2.6% vs 3.1%), was comparable between the 2 groups (P > .05 for all comparisons). Notably, the incidence of frenulum misalignment was significantly lower in the modified disposable circumcision suture device group (2.2% vs 16.7% in the disposable circumcision suture device group; P < .05). Moreover, patient satisfaction with the cosmetic appearance of the penis was higher in the modified disposable circumcision suture device group compared with the disposable circumcision suture device group (96.5% vs 86.8%; P < .05). The pain scores recorded during and after the procedures showed no significant intergroup differences (intraoperative: 1.7 ± 1.0 vs 1.7 ± 0.9; postoperative: 1.3 ± 1.0 vs 1.3 ± 1.0; P > .05 for all comparisons). The modified circumcision technique using a DCSD is associated with a longer operative time; however, it effectively minimizes the risk of preputial frenulum misalignment and enhances postoperative cosmetic satisfaction.