PMID- 30520424
OWN - NLM
STAT- MEDLINE
DCOM- 20200518
LR  - 20200518
IS  - 1745-7262 (Electronic)
IS  - 1008-682X (Print)
IS  - 1008-682X (Linking)
VI  - 21
IP  - 4
DP  - 2019 Jul-Aug
TI  - Simplifying the ShangRing technique for circumcision in boys and men: use of the 
      no-flip technique with randomization to removal at 7 days versus spontaneous 
      detachment.
PG  - 324-331
LID - 10.4103/aja.aja_91_18 [doi]
AB  - To assess safety of the no-flip ShangRing male circumcision technique and to 
      determine clinical course and safety of spontaneous detachment (i.e., allowing 
      the device to fall off), we conducted a case series of no-flip ShangRing 
      circumcision combined with a randomized controlled trial of removal 7 days 
      postcircumcision versus spontaneous detachment at two health facilities in Kenya. 
      The primary outcome was the safety of the no-flip technique based on moderate and 
      severe adverse events (AEs) during the procedure and through 42-day follow-up. A 
      main secondary outcome was clinical course and safety of spontaneous detachment. 
      Two hundred and thirty males 10 years and older underwent no-flip circumcision; 
      114 randomized to 7-day removal and 116 to spontaneous detachment. All 
      circumcisions were successfully completed. Overall 5.3% (6/114) of participants 
      in the 7-day group and 1.7% (2/116) in the spontaneous group had an AE; with no 
      differences when compared to the 3% AE rate in historical data from African 
      studies using the original flip technique (P = 0.07 and P = 0.79, respectively). 
      Overall 72.4% (84/116) of participants in the spontaneous group wore the 
      ShangRing until it detached. Among the remaining (27.6%; 32/116), the ring was 
      removed, primarily at the participants' request, due to pain or discomfort. There 
      was no difference in AE rates (P = 0.169), visit day declared healed (P = 0.324), 
      or satisfaction (P = 0.371) between randomization groups. The median time to 
      detachment was 14.0 (IQR: 7-21, range: 5-35) days. The no-flip technique and 
      spontaneous detachment are safe, effective, and acceptable to boys and men 10 
      years and older. Phimosis and penile adhesions do not limit successful ShangRing 
      circumcision with the no-flip technique.
FAU - Barone, Mark A
AU  - Barone MA
AD  - EngenderHealth, Washington, DC 20004, USA.
FAU - Li, Philip S
AU  - Li PS
AD  - Center for Male Reproductive Medicine and Surgery, Department of Urology, Weill 
      Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA.
FAU - Lee, Richard K
AU  - Lee RK
AD  - Center for Male Reproductive Medicine and Surgery, Department of Urology, Weill 
      Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA.
FAU - Ouma, Daniel
AU  - Ouma D
AD  - EngenderHealth, Nairobi 00100, Kenya.
FAU - Oundo, Millicent
AU  - Oundo M
AD  - EngenderHealth, Nairobi 00100, Kenya.
FAU - Barasa, Mukhaye
AU  - Barasa M
AD  - Bon Sante Consulting, Nairobi 00100, Kenya.
FAU - Oketch, Jairus
AU  - Oketch J
AD  - Homa Bay County Teaching and Referral Hospital, Homa Bay 40300, Kenya.
FAU - Otiende, Patrick
AU  - Otiende P
AD  - Homa Bay County Teaching and Referral Hospital, Homa Bay 40300, Kenya.
FAU - Nyangweso, Nixon
AU  - Nyangweso N
AD  - Homa Bay County Teaching and Referral Hospital, Homa Bay 40300, Kenya.
FAU - Maina, Mary
AU  - Maina M
AD  - Vipingo Health Centre, Vipingo 80119, Kenya.
FAU - Kiswi, Nicholas
AU  - Kiswi N
AD  - Vipingo Health Centre, Vipingo 80119, Kenya.
FAU - Chirchir, Betty
AU  - Chirchir B
AD  - Bon Sante Consulting, Nairobi 00100, Kenya.
FAU - Goldstein, Marc
AU  - Goldstein M
AD  - Center for Male Reproductive Medicine and Surgery, Department of Urology, Weill 
      Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA.
FAU - Awori, Quentin D
AU  - Awori QD
AD  - EngenderHealth, Nairobi 00100, Kenya.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - China
TA  - Asian J Androl
JT  - Asian journal of andrology
JID - 100942132
SB  - IM
CIN - Asian J Androl. 2019 Jul-Aug;21(4):423-424. PMID: 31115361
MH  - Adolescent
MH  - Adult
MH  - Child
MH  - Circumcision, Male/*methods
MH  - Humans
MH  - Kenya
MH  - Male
MH  - Middle Aged
MH  - Patient Satisfaction
MH  - Treatment Outcome
MH  - Wound Healing
MH  - Young Adult
PMC - PMC6628734
OTO - NOTNLM
OT  - HIV prevention
OT  - ShangRing
OT  - male circumcision device
OT  - no-flip technique
OT  - voluntary medical male circumcision
EDAT- 2018/12/07 06:00
MHDA- 2020/05/19 06:00
PMCR- 2019/07/01
CRDT- 2018/12/07 06:00
PHST- 2018/12/07 06:00 [pubmed]
PHST- 2020/05/19 06:00 [medline]
PHST- 2018/12/07 06:00 [entrez]
PHST- 2019/07/01 00:00 [pmc-release]
AID - 246732 [pii]
AID - AJA-21-324 [pii]
AID - 10.4103/aja.aja_91_18 [doi]
PST - ppublish
SO  - Asian J Androl. 2019 Jul-Aug;21(4):324-331. doi: 10.4103/aja.aja_91_18.