AUA 2018: Learning Curve With The No-Flip Shangring Circumcision in Kenya

San Francisco, CA USA (UroToday.com) Omar Al Hussein Alawamlh, MD, a clinical urologist from New York, NY, presented on a study looking at the learning curve involved with a male circumcision device. Voluntary medical male circumcision (VMMC) has been shown by three large randomized control trials in Africa to decrease HIV incidence in men by 50-60%. Given this, the UNAIDS and WHO have recommended that VMMC be included as part of their HIV prevention strategies. As a result, 14 sub-Saharan African countries have started to scale up male circumcision services. However, in 2016 only less than half of the goal was achieved. This can be attributed to the lack of medical resources and health care providers to perform the traditional male circumcision procedures. However, FDA approval of single-use disposable circumcision device, the Shangring, provides a plausible solution.

In the study, 571 males were enrolled in two study sites in Kenya. The circumcisions were completed by 6 healthcare providers, 5 non-physician and 1 physician. The circumcisions utilized the no-flip Shangring technique, which first involves determining the correct size of device by wrapping the Shangring tape around the penis. Afterwards, the inner plastic ring is inserted under the foreskin, which can be facilitated by a dorsal split of the foreskin if necessary. This is followed by securely clamping the outer ring onto the inner ring from outside of the foreskin to provide hemostatic occlusion. Finally, the foreskin is excised from the over side of the device. Adverse events, pain score, and operative time were all metrics collected from the participants of the study.

For the results, all participants were successfully circumcised with the no-flip Shangring technique. Five out of six providers showed significant improvement in pain scores and operative time in second half of cases when compared to the first half. Low rates of adverse events were maintained in the first and second half of the procedures performed. Majority of all participants achieved full wound healing by the last scheduled follow up visit (day 42) and were satisfied with penile cosmesis.

In conclusion, the Shangring device is a useful tool that can scaled up male circumcision globally. Specifically when used with the no-flip technique, it is shown to be a safe, quick and effective method of male circumcision in the hands of both physicians and non-physician healthcare providers for patients ranging from young adolescence to adult.

Presented by: Omar Al Hussein Alawamlh, MD

Written by: Whitney Zhang, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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