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Male circumcision (mc) was among the first surgeries done by mankind. This method has the ability to reduce the risk of sexually transmitted illnesses such human papillomavirus (HPV), genital ulcer disease, and HIV infection. The Problems such as haemorrhage, edoema, and poor cosmetic outcomes remain prevalent in individuals who have traditional mc. Furthermore, traditional mc is time-consuming. Objective: The objective of this study was to compare the clinical results of adult male circumcision using a circular stapler to traditional methods. Primary and secondary outcomes were used to conduct a comparative assessment. Methods: We used a comparative randomised control to examine numerous characteristics and results of male circumcision using a circular stapler vs traditional male circumcision in adults in Central India. The surgical time, pain score, blood loss volume, healing time, treatment expenses, and postoperative complications were compared in the two groups. Results: The stapler group had a considerably shorter operation time and lower blood loss volume compared to the traditional group (6.8 ± 3.1 vs 24.2 ± 3.2 min and 1.8 ± 1.8 vs 9.4 ± 1.5 mL, respectively; P<0.01). The stapler group had substantially lower intraoperative and postoperative pain levels than the traditional group (0.8 ± 0.5 vs 2.4 ± 0.8 and 4.0 ±0.9 vs 5.8 ± 1.0, respectively; P<0.01). Furthermore, the stapler group had considerably less problems than the traditional group (2.7% vs 7.8%, respectively; P<0.01). However, the stapler group had significantly greater treatment expenses than the traditional group (8000 ± 500.20 vs 1000.50 ± 125.00, respectively; P<0.01). Conclusion: Overall, the current research demonstrated that stapler circumcision is a time-saving and safe male circumcision procedure. [ABSTRACT FROM AUTHOR]

To investigate the prevalence of male circumcision and the willingness to undergo male circumcision and influencing factors among MSM in Maanshan City, we conducted a cross-sectional study from June 2016 to December 2019. Respondent-driven sampling (RDS) was used to recruit participants. Influential factors of willingness to accept circumcision were identified by a multivariable logistic regression model. The multivariable logistic regression model revealed that five variables were independent influential factors for willingness to participate. The factors include that used condoms during last anal intercourse (OR = 1.87, 95% CI:1.03–3.41, P = 0.04), sex with female sex partners (OR = 0.499, 95% CI:0.298–0.860, P = 0.012, level of education (junior college: OR = 0.413, 95% CI:0.200–0.854, P = 0.017; bachelor's degree or higher: OR = 0.442, 95% CI:0.208–0.938, P = 0.033), condom use during oral sex in the last six months (OR = 4.20, 95% CI:1.47–12.0, P = 0.007) and level of knowledge of PrEP (OR = 5.09, 95% CI:1.39–18.7, P = 0.014). Given the willingness of MSM to accept circumcision was low in China, establishing a proper understanding of circumcision is essential if it is to be used as a strategy to prevent HIV infection among MSM. Therefore, publicity and education on the operation should be strengthened to increase the willingness to undergo male circumcision. [ABSTRACT FROM AUTHOR]

In Zimbabwe, the ZAZIC consortium employs two-way, text-based (2wT) follow-up to strengthen post-operative care for voluntary medical male circumcision (VMMC). 2wT scaled nationally with evidence of client support and strengthened follow-up. However, 2wT uptake among healthcare providers remains suboptimal. Understanding the gap between mobile health (mHealth) potential for innovation expansion and scale-up realization is critical for 2wT and other mHealth innovations. Therefore, we conducted an exploratory qualitative study with the objective of identifying 2wT program strengths, challenges, and suggestions for scale up as part of routine VMMC services. A total of 16 in-depth interviews (IDIs) with diverse 2wT stakeholders were conducted, including nurses, monitoring & evaluation teams, and technology partners–a combination of perspectives that provide new insights. We used both inductive and deductive coding for thematic analysis. Among 2wT drivers of expansion success, interviewees noted: 2wT care benefits for clients; effective hands-on 2wT training; ease of app use for providers; 2wT saved time and money; and 2wT strengthened client/provider interaction. For 2wT scale-up challenges, staff shortages; network infrastructure constraints; client costs; duplication of paper and electronic reporting; and complexity of digital tools integration. To improve 2wT robustness, respondents suggested: more staff training to offset turnover; making 2wT free for clients; using 2wT to replace paper VMMC reporting; integrating with routine VMMC reporting systems; and expanding 2wT to other health areas. High stakeholder participation in app design, implementation strengthening, and evaluation were appreciated. Several 2wT improvements stemmed from this study, including enrollment of multiple people on one number to account for phone sharing; 2wT inclusion of minors ages 15+; clients provided with $1 to offset SMS costs; and reduced SMS messages to clients. Continued 2wT mentoring for staff, harmonization of 2wT with Ministry e-health data systems, and increased awareness of 2wT's client and provider benefits will help ensure successful 2wT scale-up. [ABSTRACT FROM AUTHOR]

The formation of penile keloid after circumcision is an uncommon complication. Herein, we report two pediatric cases of large circumferential keloids that developed post‐circumcision and were successfully treated by surgical excision and intralesional triamcinolone injections. In addition, we provide a comprehensive review of the reported cases of penile keloids that developed after circumcision in the literature to highlight the various presentations, treatment options, and outcomes for this condition. [ABSTRACT FROM AUTHOR]

Chronic GvHD of the penile tract in male pediatric patients has not been described well in the literature and is often under-diagnosed. We report three cases of penile chronic GvHD in adolescent male patients who received HSCT before the onset of puberty. Their penile cGvHD became symptomatic upon the onset of penile growth associated with puberty in combination with the fibrotic changes in the foreskin. Symptoms did not respond to systemic chronic GvHD medication but require circumcision for alleviation of symptoms. This case series highlights the need for frequent monitoring of the prepubertal pediatric HSCT patient who has the presence of sclerotic cGvHD and enters puberty. This population is particularly reluctant to allow a thorough examination of the genitalia. In addition, optimization of systemic and topical immunosuppression treatment for patients with chronic GvHD of the penile tract potentially with the introduction of novel agents that target the tissue repair and fibrosis pathway is needed to prevent circumcision as the only option in the future. [ABSTRACT FROM AUTHOR]

Objective We tried to explore the optimal dose of esketamine combined sevoflurane for the daytime pediatric circumcision. Methods According to the random number table, children who underwent daytime circumcision were randomly divided into Group A (0.5 mL/kg esketamine), Group B (0.75 mL/kgesketamine), and Group C (1mL/kg esketamine) with 30 cases in each group. Each group were induced with sevoflurane inhalation anesthesia by mask and given a single intravenous dose of the corresponding esketamine after the eyelash reflex disappeared. The occurrence of intraoperative movement and esketamine bolus times was recorded. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) and respiratory rate (RR) were monitored at the time of entry (T0), the beginning of surgery (T1), intraoperative ligation (T2) and the end of surgery (T3). The times of opening eyes and talking after surgery were also recorded. Modified Alertness/Sedation Score (MOAA/S score) at 15 min, 30 min and 60 min after surgery, the Eastern Ontario Children's Hospital Pain Score (CHEOPS score), Bieri Modified Facial expression score and verbal rating scale (VRS) score at the time of awakening, 2 h and 6 h after surgery were all recorded. Moreover, intraoperative and postoperative adverse reactions (respiratory depression, laryngeal spasm, agitation, nausea and vomiting, dizziness and diplopia ect.) were all marked. Results The incidence of intraoperative body movement andesketamine bolus times in Group B and C were all less than that in Group A (P < 0.05). The time of opening eyes and talking in Group A and Group B were shorter than those in Group C (P < 0.05). There was no significant difference in intraoperative vital signs, postoperative alertness score and pain score among the 3 groups (P < 0.05). There was no significant difference in the incidence of adverse reactions among the 3 groups (P < 0.05). Conclusion A does of 0.75 mg/kg esketamine combined with sevoflurane could effectively meet the anesthetic and analgesic needs of children's prepuce operation and shorten postoperative recovery time. It is the optimal dose and deserving promotion in daytime pediatric circumcision. [ABSTRACT FROM AUTHOR]

Background. About 70% (25.6 million) of the global HIV/AIDS burden is from Sub-Saharan Africa. Safe male circumcision (SMC) is one of the measures that were adopted by the Ugandan government aimed at reducing the risk of HIV infection contraction, as recommended by the WHO. Its main goal was to maximize HIV prevention impact with voluntary medical circumcision services to all adult men and adolescent boys. The objective of our study was to assess the knowledge, perception, and practice of safe medical circumcision on HIV infection risk reduction among undergraduate students of a public university in Northern Uganda. Methods. We conducted a cross-sectional survey among 556 randomly selected Lira University undergraduate students from March 2023 to June 2023. With the use of a self-administered questionnaire, we collected data on the knowledge and perceptions of undergraduate students towards safe medical circumcision. Data were exported to Stata® 17 statistical software. Univariate, bivariate, and multivariate regression analyses were done at a statistical level of significance P value < 0.05. Results. Our 556 study participants had an age range of 21-25 years. The majority (81.29%) of the respondents knew that safe medical circumcision reduces the risk of acquiring HIV. However, the perception is that close to 3 in 4 (74.46%) of the students were unsure if they would opt for safe medical circumcision as risk reduction measure against HIV. The practice of safe medical circumcision was 64.8% among the study participants. Conclusions. More than three in four of the undergraduate students have knowledge on safe medical circumcision as risk reduction measure for HIV infection. And close to 3 in 4 (74.46%) of the student's perception were unsure if they would opt for safe medical circumcision as risk reduction measure against HIV. The practice of safe medical circumcision was 64.8% among the study participants. Therefore, in an effort to increase SMC's adoption for HIV/AIDS prevention, the Ministry of Health of Uganda and related stakeholders in health should work hand in hand with university study bodies in order to optimize SMC uptake among university students. [ABSTRACT FROM AUTHOR]

Purpose: In children, circumcision is a procedure associated with perioperative pain and parental satisfaction is an important parameter in the evaluation of anesthesia procedures. Inadequate dorsal penile nerve block (DPNB) for the ventral shaft of the penis might impact parental satisfaction negatively. To evaluate this hypothesis, we compared the effects of penile ring block (RB) and dorsal penile nerve block (DPNB) on parental satisfaction. Postoperative pain, need for additional analgesia, intraoperative hemodynamic data, recovery status, side effects, and postoperative complications were evaluated as secondary outcomes between the blocks. Methods: Parental satisfaction and anesthetic effectiveness of RB and DPNB for circumcision in children were compared. 86 patients were randomized 1:1 to Group RB and Group DPNB, which were administered the same dose of anesthesia. Parental satisfaction was evaluated with the Pediatric Anesthesia Parental Satisfaction Questionnaire (PAPS). Postoperative pain evaluations were made with the Face, Legs, Activity, Crying, Consolability Pain Scale (FLACC). Results: In terms of parent satisfaction, no differences were detected between the groups in the pre-anesthesia, pre-anesthesia and post-anesthesia, post-anesthesia, hospital team, and anesthesia team parameters (p > 0.05). The scores of Group DPNB patients were higher only in the "Q11" subparameter in the "anesthesia team" parameter, and this difference was significant (0.024). Conclusion: RB and DPNB were compared in circumcision, which is the most common surgical procedure for children. Parental satisfaction, anesthesia, and analgesic effects of both blocks were found to be similar. Clinical trials: ACTRN12622001211752. [ABSTRACT FROM AUTHOR]

The numerous testaments on papyrus provide a valuable basis for an investigation of legal language around διαθήκη in the Pauline letters. Of particular importance is the ancient practice of revoking wills, which I consider to be the legal frame of reference for the recipients of the Pauline letters to grasp expressions like καινὴ/παλαιὰ διαθήκη. In the Corinthian correspondence the conformity to the current legal practice is evident, but in Galatians Paul turns the whole procedure upside down, manipulating in the construction of his argument not only the practice of testamentary cancellation, but also the traditional connection of Abraham with circumcision. We are compelled to a text-internal solution of the problem in Gal 3.15–17 by the fact that the papyrological evidence shows clearly that no other type of document than the ordinary revocable διαθήκαι can be taken into consideration. This approach is not compilatory, as it is often the case when dealing with documentary papyri applied to New Testament texts, but heuristic, with the purpose of elaborating new exegetical insights in old controversies. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) pandemic has rapidly spread worldwide and affected the healthcare system, including the deferral of surgical practice. There are various reactions regarding delayed surgeries, but parental viewpoints towards circumcision remain scarce. In light of the pandemic, this study aimed to evaluate how parents feel about circumcision and the probable determining variables. Materials and Methods: This study is a cross-sectional study based on an online questionnaire available from March to April 2022. The factors affecting the decision were analysed using logistic regression. Results: Of 1,218 (26.28%) parents who completed the survey, 879 (18.96%) met the inclusion criteria and were included in this study. Among them, 615 (70.00%) parents agreed to delay circumcision during the COVID-19 pandemic. These respondents were more likely to be non-Muslim (P = 0.01), have no relatives whose work is related to medicine or paramedicine (P = 0.02) and have monthly income equal to or below the regional minimum wage (P = 0.03). After adjusting the potential confounder, non-Muslim religion (odds ratios, 2.87; 95% confidence interval, 1.27-6.49; P = 0.012) was found to be the only independent predictor for agreeing to the deferral of circumcision amid the pandemic. Conclusion: Most parents agreed to postpone circumcision due to the fear of COVID-19 exposure. In order to help them feel less apprehensive about this matter, it is important to educate them about the medical benefits of circumcision and the safety of this procedure. [ABSTRACT FROM AUTHOR]

Introduction: Following HIV testing services (HTS), the World Health Organization recommends prompt linkage to prevention and treatment. Scale‐up of effective linkage strategies is essential to achieving the global 95‐95‐95 goals for maintaining low HIV incidence by 2030 and reducing HIV‐related morbidity and mortality. Whereas linkage to care including same‐day antiretroviral therapy (ART) initiation for all people with HIV is now routinely implemented in testing programmes, linkage to HIV prevention interventions including behavioural or biomedical strategies, for HIV‐negative individuals remains sub‐optimal. This review aims to evaluate effective post‐HTS linkage strategies for HIV overall, and highlight gaps specifically in linkage to prevention. Methods: Using the five‐step Arksey and O'Malley framework, we conducted a scoping review searching existing published and grey literature. We searched PubMed, Cochrane Library, CINAHL, Web of Science and EMBASE databases for English‐language studies published between 1 January 2010 and 30 November 2023. Linkage interventions included as streamlined interventions—involving same‐day HIV testing, ART initiation and point‐of‐care CD4 cell count/viral load, case management—involving linkage coordinators developing personalized HIV care and risk reduction plans, incentives—financial and non‐financial, partner services—including contact tracing, virtual—like social media, quality improvement—like use of score cards, and peer‐based interventions. Outcomes of interest were linkage to any form of HIV prevention and/or care including ART initiation. Results: Of 2358 articles screened, 66 research studies met the inclusion criteria. Only nine linkage to prevention studies were identified (n = 9/66, 14%)—involving pre‐exposure prophylaxis, voluntary medical male circumcision, sexually transmitted infection and cervical cancer screening. Linkage to care studies (n = 57/66, 86%) focused on streamlined interventions in the general population and on case management among key populations. Discussion: Despite a wide range of HIV prevention interventions available, there was a dearth of literature on HIV prevention programmes and on the use of messaging on treatment as prevention strategy. Linkage to care studies were comparatively numerous except those evaluating virtual interventions, incentives and quality improvement. Conclusions: The findings give insights into linkage strategies but more understanding of how to provide these effectively for maximum prevention impact is needed. [ABSTRACT FROM AUTHOR]

In the personal credo that prefaces his Decem libri historiarum , Gregory of Tours states his belief in an Antichrist who would impose circumcision upon his subjects. While Gregory did not invent this theme of a circumcising Antichrist, it nevertheless closely mirrored his own eschatological anxieties. Physical circumcision was, for Gregory, an unmistakable indicator of Judaism and the Old Law. The Bishop of Tours was deeply concerned about the Jews of his own time, whose obstinate refusal to acknowledge Christian truth he perceived as an obstacle to his socio-religious ideal of a unified Christian society. While Gregory did not necessarily believe that the End Times would arrive during his own lifetime, he saw signa of its inevitability everywhere, and consequently encouraged readiness on the part of his contemporaries. The Antichrist's imposition of compulsory circumcision thus implied for Gregory the culmination of an ongoing effort by Jews to inhibit Christian unity. [ABSTRACT FROM AUTHOR]

Male circumcision is a protective HIV prevention strategy. However, uncircumcised Zambian men are reluctant to undergo voluntary medical male circumcision (VMMC). Tailored interventions are necessary to stimulate the uptake of early infant male circumcision (EIMC) and VMMC in Zambia. This feasibility study presents the formative process of utilising the PRECEDE framework in the development of a family-centred EIMC/VMMC intervention, Like Father Like Son, and its application in an existing VMMC intervention, Spear & Shield. We found that fear of the pain associated with EIMC procedures, foreskin disposal, beliefs in children's autonomy and rights, and men's dominance in health decision-making were factors affecting EIMC uptake. Perceived benefits for infants included improved hygiene, protection from HIV infection, and faster recovery. Reinforcing factors included female partners and fathers' MC status. The availability and access to EIMC services and information, skill and experience of health workers, and engagement and belief in traditional circumcision practices were factors enabling EIMC uptake. These individual, interpersonal, and structural factors positively and negatively influencing EIMC uptake in the Zambian clinic context were integrated into the intervention for expecting parents. Feedback from community advisory boards suggested the process was effective in developing a culturally tailored and acceptable EIMC/VMMC promotion intervention. [ABSTRACT FROM AUTHOR]

Two features of the Shechem story present challenges for reading: the story's ambiguities and its relationship to the law. The two features are mutually implicating. Through their words and their actions, particular characters allude to particular laws, revealing that they hold divergent points of view on the crisis instigated by Prince Shechem. Disclosing this conflict of perspectives clarifies many of the story's ambiguities and maximizes others. In this way, Genesis 34 reveals itself as a legal riddle. All the legal actions proposed and taken by different characters correspond with biblical laws, but all are wrongly applied. One possibility after another is tested and discarded, until all the options are discounted. [ABSTRACT FROM AUTHOR]

Background: Male circumcision (MC) is a key part of the package of interventions to prevent HIV, the biggest health challenge in sub-Saharan Africa. Objective: To estimate the male circumcision prevalence and to evaluate the progress towards meeting WHO targets in sub-Saharan Africa during the period 2010–2023. Methods: We carried out a systematic review and meta-analysis of studies published during the period 2010–2023. We searched PubMed, Scopus, Cochrane CENTRAL, Google Scholar, WHO and the Demographic and Health Survey for reports on MC prevalence in sub-Saharan Africa. MC prevalence was synthesized using inverse-variance heterogeneity models, heterogeneity using I2 statistics and publication bias using funnel plots. Results: A total of 53 studies were included. The overall prevalence during the study period was 45.9% (95% CI 32.3–59.8), with a higher MC prevalence in Eastern (69.9%, 95%CI 49.9–86.8) compared to Southern African (33.3%, 95%CI 21.7–46.2). The overall prevalence was higher in urban (45.3%, 95%CI 27.7–63.4) compared to rural settings (42.6%, 95% 26.5–59.5). Male circumcision prevalence increased from 40.2% (95% CI 25.0–56.3) during 2010–2015 to 56.2% (95% CI 31.5–79.5) during 2016–2023. Three countries exceeded 80% MC coverage, namely, Ethiopia, Kenya and Tanzania. Conclusion: Overall, the current MC prevalence is below 50%, with higher prevalence in Eastern African countries and substantially lower prevalence in Southern Africa. Most of the priority countries need to do more to scale up medical male circumcision programs. [ABSTRACT FROM AUTHOR]

In this article, I set out to study Foreskin Quarterly, which was the Official Publication of the Uncircumcised Society of America (USA). Over the course of its history, it changed editorial hands and publishers hands several times, and with each change the magazine shifted direction that influenced and affected its original goals of foreskin activism. I argue that this magazine braided together pornography and activism in a way that was novel and important because in arguing against circumcision, it also sought to reclaim and eroticize the foreskin in a culture where the foreskin was anomalous and rare. Unfortunately, this magazine has largely gone unread by scholars, not just of pornography, but also of circumcision, and men's bodies more generally. This article, thus, contributes to a growing body of scholarship on anti-circumcision activism, while also arguing for the importance of pornography in that activist milieu. [ABSTRACT FROM AUTHOR]

Many African states including South Africa practice cultural activities including Male Circumcision (MC) to instil principles in young boys. MC is regarded as the transition from boy to manhood. However, this practice has been associated with many forbidden activities such as risky sexual behaviours, and drug abuse as compared to the previous years. This forbidden activity has many debates about the relevance of MC in current generation. This study sought to explore the relevance of male circumcision in Xhosa tribe in the 21st century. The qualitative research approach, through unstructured interviews, was employed in the paper and the participants were approached purposely. The collected data was analysed using a thematic approach. The findings revealed that MC is relevant for the prevention of sexually transmitted diseases such as STIs or HIV and the enhancement of sexual pleasure, however, the study also found that the tradition is relevant for preserving the Xhosa cultural customs, instilling good principles and ensuring human dignity. It further states that MC is irrelevant in the 21st century as it no longer serves its initial purpose and there are now more safer health practices for circumcision. The study thus recommended that the tradition must be preserved but subjected to health regulations. The MC needs to ensure that it suits the environment, is done by experienced people and it must not be compulsory. [ABSTRACT FROM AUTHOR]

Keloid is the maximum expression of pathological fibroproliferative skin wound healing, whose pathophysiology is not yet fully understood. Its occurrence in the perineum and genitalia is uncommon. A systematic review was carried out regarding the occurrence and treatment of keloids on the penis. An illustrative case was also reported. The review used the PRISMA checklist and was registered in PROSPERO. The entire literature period up to April 2023 was searched in the EMBASE/Elsevier, Cochrane, Scopus, Medline, BVS, SciELO, and Lilacs databases. The inclusion criteria embraced primary studies, clinical trials, prospective or retrospective cohorts, case series, case–control studies and case reports. Three hundred and sixty‐one studies were found and 12 of them were included, consisting of 9 case reports and 3 case series. The most common triggering factor for keloid formation was circumcision, in 11 of the cases, of which more than half occurred in prepubescent children. Several therapies, associated or isolated, were used to treat the cases. Only one of the reported patients had scar recurrence after surgical treatment. Studies with better scientific evidence are needed to understand the involvement of keloids in male genitalia. However, keloid formation in this topography is rare, making it difficult to carry out more elaborate studies. [ABSTRACT FROM AUTHOR]

Background To address knowledge gaps, this study examined social determinants, such as education attainment and HIV prevention, among sexually active men (SAM), with a focus on voluntary medical male circumcision (VMMC). Methods Two nationally representative surveys, the Eswatini Demographic and Health Survey 2006 and the Eswatini HIV Incidence Measurement Survey 2016, were used to estimate whether or not VMMC at the individual and community levels contributes to HIV disparities to any meaningful extent. Multilevel logistic regression models further explored the educational gradient in HIV infection for 2006–2007 and 2016 with regard to VMMC among SAM, while adjusting for household poverty, sexual practices and individual characteristics. Results Among SAM with tertiary education, HIV prevalence declined from 25.0% in 2006–2007 to 10.5% in 2016. A 51% decrease in HIV prevalence was found to be associated with an increase in VMMC (adjusted odds ratio 0.49; 95% CI 0.40 to 0.60). Compared with SAM with tertiary education, those who had a lower level of education were more likely to have HIV infection and this education gradient effect had become particularly profound in 2016. Conclusions VMMC began to be promoted in 2008 in Eswatini and results suggest its effect, along with the education attainment effect, significantly resulted in a meaningful reduction in HIV prevalence among SAM by 2016. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to perform a detailed analysis of the clinical characteristics of megameatus with intact prepuce (MIP) and to audit our results of reconstructive surgeries on MIP. Materials and Methods: Design: Retrospective analysis. Setting: Pediatric surgery department of tertiary level. Subjects, methods: Hospital records and pictures of MIP operated over a 9-year period. Age, size of penis, circumcised or not, shape of glans, external urethral meatus (EUM), urethral plate (UP), chordee, distal urethra, reconstructive surgery, and complications were analyzed. Postoperative result was objectively assessed by Hypospadias Objective Scoring Evaluation (HOSE). Results: Twelve of 254 hypospadias were MIP (incidence = 4.72%). The mean age at operation was 38.25 months (12--87 m). Patients sought circumcision or surgical correction of anomaly. Two patients were precircumcised. MIP was coronal 7, subcoronal 3, and glanular 2. Meatus was wide in 10 and normal in 2. Glans penis was wide in 9 and conical in 3. UP was wide (9), moderately wide (2), or narrow and shallow (1). In two cases of wide deep UP, distal septum was present. Distal urethra was nondilated in all but 1, which had megalourethra. Reconstructive surgery was Tubularized Urethral Plate Urethroplasty (7 cases) or classical Snodgrass (Tubularised incised plate urethroplasty (TIPU), with superimposed vascular dartos flap (5 cases). The megalourethra underwent partial excision and TIPU. Distal UP-septum was incised. Urethral injury (2 cases) and UP injury (1 case) were intraoperative complications. One postoperative complication (ventral glans necrosis) resulted. The mean follow-up period was 4.79 months (1--12 m). In the postoperative follow-up, 11 (92%) had HOSE score 14--16, whereas one had HOSE 13. Conclusion: Some hypospadias cases which have intact prepuce have no megameatus; hence, they cannot be termed MIP. All cases of hypospadias having intact prepuce can be covered by the umbrella term "Hypospadias with Intact Prepuce (HIP);" MIP is a large subgroup under HIP. HIP presents with a spectrum of anomalies of glans, EUM, and UP. Repair by tubularization of UP without or with midline incision gives excellent results. [ABSTRACT FROM AUTHOR]

Purpose: To compare the physician and parental satisfactions between the two types of circumcision maneuvers used in our units, Gomco and Plastibell circumcision. Methodology: This study was performed from 2019 to 2021. A total of 190 children were circumcised either by Gomco or Plastibell procedure. Each child was evaluated during the procedure, immediately after the operation, and 1, 2, and 3 weeks after the procedure. Data were collected, statistically analyzed using SPSS version 25. Results: A total of 190 children underwent circumcision from 2019 to 2021. Of the total 190, 98 children (51.6%) underwent circumcision by Gomco, while 92 (48.4%) underwent circumcision by Plastibell. Bleeding was significantly higher in Plastibell method, while excess skin was significantly higher in Gomco method (p value 0.048). Physician evaluation results show no significant difference between both methods in late physician evaluation. 23/92 (28%) of parents were not satisfied after Plastibell circumcision, compared to 8/98 (8.2%) of parents who were not satisfied with the results of Gomco circumcision (p value 0.002). Conclusion: Gomco needs a longer operative time, and Plastibell circumcision is less preferable by parents. There is no significant difference in physician satisfaction between the two procedures, but parents are less satisfied with Plastibell circumcision. [ABSTRACT FROM AUTHOR]

This article examines why Paul uses self-praise, or periautology, in Phil 3:2–14 to respond to Christians who boasted of their Jewish origin. It shows the importance and relevance of this type of rhetoric, clarifies its purpose, and examines the way Paul uses it. Paul does not only use periautology in Phil 3, but it is in this passage that it has the most force and originality. As, until now, very few monographs and articles have shown the existence of periautology in the Pauline letters, this article invites exegetes to be more sensitive to the existence of literary models and their importance for better interpreting the apostle's thought. [ABSTRACT FROM AUTHOR]

Background: Phimosis is the inability to completely retract the foreskin and expose the glans. The treatment of phimosis varies depending on the age of the patient and the severity of the disease; a great number of conservative or surgical treatments are currently available. Aim: To provide the first review summarizing the available options for the treatment of adult phimosis. Methods: A PubMed, Cochrane and Embase search for peer-reviewed studies, published between January 2001 and December 2022 was performed using the search terms "phimosis AND treatment". Results: A total of 288 publications were initially identified through database searching. Thirty manuscripts were ultimately eligible for inclusion in this review. Conservative treatment is an option. and it includes topical steroid application and the new medical silicon tubes (Phimostop™) application for gentle prepuce dilation. Concerning the surgical approach, the gold-standard treatment is represented by circumcision in which tissue synthesis after prepuce removal can be also obtained with barbed sutures, fibrin glues or staples. Laser circumcision seems to be providing superior outcomes in terms of operative time and postoperative complication rate when compared to the traditional one. Several techniques of preputioplasty and use of in situ devices (which crush the foreskin and simultaneously create haemostasis) have been also described. These in situ devices seem feasible, safe and effective in treating phimosis while they also reduce the operative time when compared to traditional circumcision. Patient satisfaction rates, complications and impact on sexual function of the main surgical treatments are presented. Conclusion: Many conservative and surgical treatments are available for the treatment of adult phimosis. The choice of the right treatment depends on the grade of phimosis, results, complications, and cost-effectiveness. [ABSTRACT FROM AUTHOR]

In 2015, the international community agreed to end Female Genital Mutilation/Cutting (FGM/C) by 2030. However, the target is unlikely to be met as changes in practice, including medicalized female genital mutilation/cutting (mFGM/C), challenge abandonment strategies. This paper critically reviews the current World Health Organization (WHO) definition of mFGM/C to demonstrate that mFGM/C, as currently defined, lacks detail and clarity, and may serve as an obstacle to the collection of credible, reliable, and comparable data relevant to targeted FGM/C prevention policies and programs. The paper argues that it is necessary to initiate a discussion on the revision of the current WHO definition of mFGM/C, where different components (who-how-where-what) should be taken into account. This is argued by discussing different scenarios that compare the current WHO definition of mFGM/C with the actual practice of FGM/C on the ground. The cases discussed within these scenarios are based on existing published research and the research experience of the authors. The scenarios focus on countries where mFGM/C is prevalent among girls under 18 years, using data from Demographic Health Surveys and/or Multiple Indicator Cluster Surveys, and thus the focus is on the Global South. The paper places its arguments in relation to wider debates concerning female genital cosmetic surgery, male genital circumcision and consent. It calls for more research on these topics to ensure that definitions of FGM/C and mFGM/C reflect the real-world contexts and ensure that the human rights of girls and women are protected. [ABSTRACT FROM AUTHOR]

To characterize changes in the proportion of newborn circumcisions performed by pediatric urologists and advanced practiced providers (APPs) in the United States over the last decade. The Merative MarketScan Commercial Database was queried for newborn circumcision private health insurance claims (Common Procedural Terminology 54150) between 2010 and 2021. Setting (inpatient/outpatient), US Census Bureau region, clinician specialty, and patient age (days) were determined for the full study time period, and by study year. Simple linear regression assessed growth in proportion of newborn circumcisions performed by pediatric urologists and APPs (nurse practitioner/physician assistant/midwife), over time. In total, 1,006,748 newborn circumcisions (59% inpatient) were identified; while most were performed by obstetricians (45%) or pediatricians (33%); APPs performed 0.9%, and pediatric urologists performed 0.7%. From 2010-2021, the proportion of newborn circumcisions performed by pediatric urologists increased from 0.3% to 2.0% and by APPs in from 0.5% to 2.9% (P <.001 for both). Growth for both pediatric urologists and APPs occurred APPs predominantly from 2016 to 2021. Trends in proportion of newborn circumcision performed by pediatricians was stable [31.5% (2010) and 32.5% (2021)], but decreased for obstetricians [48.8% (2014) and 38.1% (2021)]. The proportion of newborn circumcisions performed by pediatric urologists and APPs increased more than 6-fold between 2010 and 2021, though both specialties still perform a minority of newborn circumcisions. These data provide important baseline information for newborn circumcision workforce planning, including evaluating collaborative care models where pediatric urologists train APPs to perform circumcision. [ABSTRACT FROM AUTHOR]

AbstractDid young Freud face the horrors of little girls’ circumcision in pediatric wards? Did Freud refuse to have his sons ritually circumcised? Did Emma Eckstein, Freud’s main female patient in the course of the foundation of psychoanalysis, endure a circumcision when she was a girl? The author discusses these three controversial issues and suggests how they can help to rethink the origins of psychoanalysis. Erasing Emma Eckstein’s circumcision as a traumatic life event, Freud uprooted the birth of psychoanalysis from the ground of history, jeopardizing the possibility of Freud’s biographers and scholars providing a consistent account of his early discoveries. Yet, despite all distortions, it is still possible to restore significant connections between key historical events, from which an intrinsic legitimacy of psychoanalysis emerges, jointly with a different narration. [ABSTRACT FROM AUTHOR]

Objective: Management of emergency care Background: Circumcision is commonly performed in males, especially in Jewish and Muslim cultures, and is considered a safe surgical procedure with a low complication rate. Major complications, such as partial and total penile amputation, can occur, but those are rare complications. However, high replantation success rates have been reported and reviewed. Case Report: We describe the case of an 8-year-old boy who experienced total penile amputation during ritual circumcision performed by a layperson outside the hospital setting. Microsurgical penile replantation was performed after an ischemic period of 16 hours 43 minutes, with successful outcomes and without any major complications. In our technique, we repaired both dorsal and deep cavernosal vessels. At 1-year postoperative period, the results of two-point discrimination test were 4 mm, 7 mm, and 7 mm on the dorsal part, ventral part, and glans, respectively. After a follow-up period of 4 years, there were no late complications such as penile deformity, urethral fistula, urethral stenosis, absence of penile sensation, or erectile dysfunction. The results of two-point discrimination test were 3 mm, 5 mm, and 5 mm on the dorsal part, ventral part, and glans, respectively. The patient also experienced good penile sensation, morning erection, satisfaction with the cosmetic outcome, and a peak urine flow rate of 21 mL/s with a consistently strong void stream and a low postvoid residual urine volume of 20 mL. Conclusions: Our experience suggests that a short ischemic time, prompt surgical correction, microscopic technique of replantation, and intensive postoperative care can result in good functional outcomes. [ABSTRACT FROM AUTHOR]

Background: Female genital mutilation has many sexual, physical, and psychological consequences. The present study aimed to examine the relationship between Female Genital Mutilation/Cutting (FGM/C), and Sexual Function among circumcised women in Sardasht City, Iran." Methods: In this present cross-sectional study, 197 women who were mutilated entered the study by simple random sampling from two healthcare centers in Sardasht, Iran. A gynecologist first performed a genital examination to identify the type of female genital mutilation of participants. Subsequently, Socio-demographic and FGM/C-related characteristics checklist and the female sexual function index questionnaire were completed by interview method. Data were analyzed using SPSS 23 software. Results: Type I and II of female genital mutilation were performed in 73.1 and 26.9% of the participants, respectively. The age range of performing female genital mutilation in type I and II of female genital mutilation was 4–10 years old in 67.4% and 71.1% respectively. Traditional practitioners/local women carried out the circumcision in all of the participants, and Sunnah/tradition was reported as the most common reason for doing this procedure. The average total score of FSFI index in type I and II of female genital mutilation was 23.5 ± 2.0 and 17.4 ± 2.39, respectively. In all domains of FSFI, women with type II of female genital mutilation obtained lower scores than women with type I. Conclusion: Circumcised women have reduced scores in all domains of FSFI, and the severity of sexual dysfunction is related to the type of FGM/C. Considering the prevalence of female genital mutilation and its adverse effects, it is imperative to initiate cultural improvements through education and awareness. By educating and raising awareness among individuals about this issue, we can foster positive changes and address the problem effectively. [ABSTRACT FROM AUTHOR]

Objective: Over half of infant boys born in the United States undergo newborn circumcision. However, available data indicate that boys who are publicly insured, or Black/African American, have less access to desired newborn circumcision, thus concentrating riskier, more costly operative circumcision among these populations. This study ascertains perinatal physician perspectives about barriers and facilitators to providing newborn circumcisions, with a goal of informing future strategies to ensure more equitable access. Methods: Qualitative interviews about newborn circumcision care were conducted from April–June 2020 at eleven Chicago-Area hospitals. Physicians that provide perinatal care (pediatricians, family medicine physicians, and obstetricians) participated in qualitative interviews about newborn circumcision. Inductive and deductive qualitative coding was performed to identify themes related to barriers and facilitators of newborn circumcision care. Results: The 23 participating physicians (78% female, 74% white, median 16 years since medical school graduation [range 5–38 years], 52% hospital leadership role, 78% currently perform circumcisions) reported multiple barriers including difficulty with procedural logistics and inconsistent clinician availability and training; corresponding suggestions for operational improvements were also provided. Regarding newborn circumcision insurance coverage and reimbursement, physicians reported limited knowledge, but noted that some insurance reimbursement policies financially disincentivize clinicians and hospitals from offering inpatient newborn circumcision. Conclusions: Physicians identified logistical/operational, and reimbursement-related barriers to providing newborn circumcision for desirous families. Future studies and advocacy work should focus on developing clinical strategies and healthcare policies to ensure equitable access, and incentivize clinicians/hospitals to perform newborn circumcisions. Significance: What is already known on this subject? Access to desired newborn circumcision is inconsistent in the United States. Boys who are publicly insured, or Black/African American typically have less access, resulting in higher rates of riskier elective, operative circumcision procedures in these groups. What this study adds? Reasons for observed differences in access to desired newborn circumcision include hospital-level operational and logistical challenges, and an insurance reimbursement structure that often disincentivizes newborn circumcision. [ABSTRACT FROM AUTHOR]

Objective: Management of emergency care Background: Circumcision is commonly performed in males, especially in Jewish and Muslim cultures, and is considered a safe surgical procedure with a low complication rate. Major complications, such as partial and total penile amputation, can occur, but those are rare complications. However, high replantation success rates have been reported and reviewed. Case Report: We describe the case of an 8-year-old boy who experienced total penile amputation during ritual circumcision performed by a layperson outside the hospital setting. Microsurgical penile replantation was performed after an ischemic period of 16 hours 43 minutes, with successful outcomes and without any major complications. In our technique, we repaired both dorsal and deep cavernosal vessels. At 1-year postoperative period, the results of two-point discrimination test were 4 mm, 7 mm, and 7 mm on the dorsal part, ventral part, and glans, respectively. After a follow-up period of 4 years, there were no late complications such as penile deformity, urethral fistula, urethral stenosis, absence of penile sensation, or erectile dysfunction. The results of two-point discrimination test were 3 mm, 5 mm, and 5 mm on the dorsal part, ventral part, and glans, respectively. The patient also experienced good penile sensation, morning erection, satisfaction with the cosmetic outcome, and a peak urine flow rate of 21 mL/s with a consistently strong void stream and a low postvoid residual urine volume of 20 mL. Conclusions: Our experience suggests that a short ischemic time, prompt surgical correction, microscopic technique of replantation, and intensive postoperative care can result in good functional outcomes. [ABSTRACT FROM AUTHOR]

Background: There is paucity of hepatitis B virus (HBV) data among student populations although Ghana is HBV endemic. Screening and identification of factors associated with HBV transmission in schools will support the intervention in the elimination of the virus by 2030. This study assessed the seroprevalence and factors associated with HBV among students in two Senior High Schools in the Krachi Nchumuru District in Ghana. Methods: Through cross-sectional design and simple random sampling technique, 300 first-year students were enrolled from selected Senior High Schools. Structured questionnaires were used to collect data on demographic and exposure factors while rapid test kit was used to detect HBV infections. Chi-square/Fisher exact test and multivariable logistic regression were performed to determine the association between the variables at a 95% confidence interval and 0.05 significant level. Results: Seroprevalence of HBV was 14% (42/300) among the students. The prevalence was significantly (p = 0.001) higher in males 19.4% (34/175) than females 6.4% (8/125). 77.7% (233/300) were aware of HBV infection. Males who were circumcised were 4 times more likely to be infected with HBV (AOR = 4.09, 95%CI = 1.82–9.19) (p = 0.001) compared with those uncircumcised. Conclusion: HBV screening and education on hygienic genital circumcision practices must be prioritized in endemic countries. [ABSTRACT FROM AUTHOR]

This research explores the interpretation of nomos in Galatians 2:11–21 within the light of Greco-Roman associations and Palestinian chavurot. As such, it proposes a reading of the text and conflict as a localized issue of conflicting association by-laws between Jews and Gentiles. The members of Jacob's association in Jerusalem demonstrated Pharisaic behavior in requiring circumcision for membership in the association and requiring the additional observance of purity and tithing regulations as interpreted by the association as crucial elements of its by-laws. Paul chastises Peter for breaking the by-laws of the Jewish assembly when eating with the Gentiles but then "separating himself" from them and requiring the Gentiles to observe the by-laws that he had just broken. Paul then explains how the Jewish association's by-laws are not required for his Gentile followers and redirects them to the faithfulness of Christ as their means of being set right and the means of acquiring justice. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of frenulum protection technique of the disposable circumcision suture device (DCSD) in adult males. Materials and Methods: Atotal of 53 adult males were diagnosed with redundant prepuce and underwent circum- cision with DCSD using frenulum protection technique. The main preoperative and postoperative measure of the length of penile frenulum was evaluated. Other data such as edema rate, intraoperative blood loss, operation time, postoperative pain, staple falling off time, incision infection rate, and evaluation of satisfaction rate with penis appearance were documented in the study. Results: There was no significant difference in preoperative and postoperative frenulum length for each patient. The mean length of the penile frenulum before and after surgery was 2.25 ± 0.36 cm and 2.23 ± 0.39 cm, respectively (p = .31). The rate of frenulum length preservation was 100%. All the patients had no excessive resection of the frenulum and no serious complication happened after surgery. The satisfaction rate of postoperative penis appearance from patients’ evaluation was 98.1% (52/53). Conclusion: The frenulum protection technique was simple and operable, which could help the operator to accu- rately identify the most distal position of the frenulum and retain a sufficient length of frenulum during DCSD circumcision. [ABSTRACT FROM AUTHOR]

South Africa's 2016 medical male circumcision (MMC) guidelines ("the guidelines") provide direction for the MMC programme's implementation in South Africa. The aim of our document analysis was to assess the guidelines, particularly in lieu of changing guidance from WHO and PEPFAR. We then assessed how the guidelines might be applied to infant and child male circumcision (ICMC). The analysis was performed by reviewing South Africa's guidelines, along with international documents used in developing those guidelines, to identify the historical development of the guidelines, as well as the implications for MMC and ICMC decision-making within the South African context. The following principles were analysed within the context of South Africa's guidelines: (1) quality and safety; (2) informed consent; (3) confidentiality; (4) human rights; and (5) accessibility of services. Tthe document analysis also identified ambiguities that exist in the guidelines, particularly regarding consent, recognising religious or cultural exemptions, and guaranteeing the best interests of the child. South Africa's MMC guidelines could benefit from incorporating common definitions to assist with interpretation and understanding, thus preventing confusion and controversy among programme planners, parents and boys. The guidelines were made available in 2016 and recommendations for circumcision have evolved as new research and information has become available. South Africa's National Department of Health should review and update these guidelines, with a focus on both MMC and ICMC issues, so that they reflect the most up-to-date, accurate information available, to avoid inconsistent practices, risks, and litigation in the management of the programme. This study was situated within a qualitative paradigm and applied a social choice theory perspective to make sense of the MMC guidelines. The study concludes that future policy revisions should develop a broader understanding of the complex medical male circumcision decision-making process, particularly faced by parents. [ABSTRACT FROM AUTHOR]

In the article, the author discusses issues like circumcision, nudism and anti-circumcision activism, particularly in the U.S., by analyzing an article published in the nudist magazine "Clothed in the Sun." Also cited are neonatal circumcision as a key component of American culture, the relationship between nudism and naturism, and Nacktkultur as a German concept of nudism.

Introduction: Voluntary medical male circumcision (VMMC) clients are required to attend multiple post-operative follow-up visits in South Africa. However, with demonstrated VMMC safety, stretched clinic staff in SA may conduct more than 400,000 unnecessary reviews for males without complications, annually. Embedded into a randomized controlled trial (RCT) to test safety of two-way, text-based (2wT) follow-up as compared to routine in-person visits among adult clients, the objective of this study was to compare 2wT and routine post-VMMC care costs in rural and urban South African settings. Methods: Activity-based costing (ABC) estimated the costs of post-VMMC care, including counselling, follow-ups, and tracing in $US dollars. Transportation for VMMC and follow-up was provided for rural clients in outreach settings but not for urban clients in static sites. Data were collected from National Department of Health VMMC forms, RCT databases, and time-and-motion surveys. Sensitivity analysis presents different follow-up scenarios. We hypothesized that 2wT would save per-client costs overall, with higher savings in rural settings. Results: VMMC program costs were estimated from 1,084 RCT clients: 537 in routine care and 547 in 2wT. On average, 2wT saved $3.56 per client as compared to routine care. By location, 2wT saved $7.73 per rural client and increased urban costs by $0.59 per client. 2wT would save $2.16 and $7.02 in follow-up program costs if men attended one or two post-VMMC visits, respectively. Conclusion: Quality 2wT follow-up care reduces overall post-VMMC care costs by supporting most men to heal at home while triaging clients with potential complications to timely, in-person care. 2wT saves more in rural areas where 2wT offsets transportation costs. Minimal additional 2wT costs in urban areas reflect high care quality and client engagement, a worthy investment for improved VMMC service delivery. 2wT scale-up in South Africa could significantly reduce overall VMMC costs while maintaining service quality. [ABSTRACT FROM AUTHOR]

Circumcision has traditionally been practiced through most of Africa, much of Asia, most of Australia, Polynesia and Melanesia, large parts of South and Central America, and smaller areas of North America. No other cultural practice, except the use of fire and the manufacture of stone tools, has such a global distribution. All the patients were personally subjected to detailed history regarding name, age, occupation, socioeconomic status and general physical examination. Patients with active infection like balanoposthitis were administered antibiotics and circumcision was done on a later date. Patients with diabetes mellitus were evaluated and if not under control, appropriate glycemic control was achieved and were later posted for circumcision. It is evident that majority of patients underwent circumcision on grounds of phimosis, i.e. 45% of patients followed by circumcision on grounds of religious/cultural reasons, i.e. 20%. One of the patients had attempted self-circumcision using a blade at his residence, and hence completion circumcision was done. [ABSTRACT FROM AUTHOR]

Circumcision is a commonly performed surgery. Surgeons have become increasingly interested in the use of adhesive bonds. Recent advances have been made in the use of tissue glue in circumcision. In this study, we used Isoamyl 2 cyanoacrylate for closing circumcision wounds and we have reported our experience. This was a prospective non-comparative observational study involving 40 patients where 2-octyl cyanoacrylate was used as a tissue adhesive for wound closure after formal circumcision at surgery department. A total of 40 patients were enrolled in our study. In this study, the mean time taken for skin closure by Isoamyl-2-cyanoacrylate is much faster in last year of study. There is significant less pain. Bleeding and excessive swelling was seen in 1 patient each. 3 patients had serous exudates, 2 patients had erythema, 1 patient had purulent discharge and 4 patients had minor wound separation. The wound cosmesis score on 3rd month is optimal except in 2 patients of wound separation, and perfect score was seen in all patients by the end of 6th month. Hence use of adhesive glue, isoamyl-2-cyanoacrylate can be considered as an alternative to sutures for skin closure after circumcision. [ABSTRACT FROM AUTHOR]

Introduction: Topical analgesics, caudal block, and ring block of the penis are a few examples of regional anesthesia that have been utilized during circumcision and have varying degrees of effectiveness. Transient motor block has been linked to caudal block. The dorsal penile nerve block is a successful anesthetic technique, with extended postoperative analgesia, according to earlier investigations [4]. However, it has a 4-6.7% failure rate that has been documented [6]. To compare the analgesic and anesthetic efficacy of bilateral nerve stimulator-guided pudendal nerve block with that of dorsal nerve block for perioperative and postoperative analgesia in children undergoing circumcision, we conducted a prospective randomized controlled clinical trial based on this background. Methods: A prospective, single-blinded, randomized investigation was carried out from March 2020 to February 2023 with the approval of the institutional review board and the signed agreement of the parents. 50 ASA-1 male children between the ages of 3 and 5 who were scheduled for elective circumcision were included in the study. A pre-existing coagulopathy, an infection at the injection site, and a known allergy to local anesthetic were among the exclusion criteria. One group received a pudendal nerve block, while the other group received a dorsal nerve block. For the first day, pain ratings were taken at various intervals (0, 6 and 12 h, and once per day for the next 5 days). It was measured using the Objective Pain Scale as modified by Hannallah et al. [9]. Age, hemodynamic stability, and duration of surgery were comparable across the two groups (Table 1). In the group of patients who had their pudendal nerves blocked, every patient underwent circumcision as planned without requiring any analgesics. 3 patients (12%) in the dorsal nerve block group experienced an incomplete block, necessitating further local infiltration. In the dorsal nerve block group, one patient (4%) had total block failure and underwent general anesthesia (Table 2). In conclusion, as compared to the dorsal nerve block, the guided pudendal nerve block method has been shown to be more precise and successful in circumcising children. [ABSTRACT FROM AUTHOR]

Objective: To compare sleeve dissection vs plastibell circumcision. Study Design: Randomized Control Trial. Setting: Department of Surgical Outpatient, Gulab Devi Hospital, Lahore. Period: Between July 2021 and July 2022. Material & Methods: This study was conducted on 110 children of different ages who presented with uncircumcised phallus for circumcision. They were divided randomly for any of two methods: Sleeve dissection and Plastibell circumcision. The complications which were observed were: bleeding, incomplete circumcision, meatal stenosis and plastibell slippage. Results: A total of 110 boys (55 in each group) were operated for circumcision during the study period and were subjected to analysis. The mean age group of babies with plastibell was 2.25 ± 1.32 months as compared to sleeve dissection 2.87 ± 1.67 months and P-Value was found to be (0.034). The mean procedural time of babies with plastibell was 9.94 ± 3.22 minutes as compared to sleeve dissection 13.1 ± 3.07 minutes and P-Value was obtained as (0.000). Overall complication rate was 10.9% in plastibell technique while 14.5% complication rate was present in sleeve dissection technique with a P-value (0.388). Conclusion: As Plastibell circumcision has less rate of complication so Plastibell circumcision is considered safer and less time consuming as compared to Sleeve dissection circumcision. [ABSTRACT FROM AUTHOR]

The study investigates the statistical relationship between male circumcision and HIV prevalence in Africa, in the context of the Voluntary Medical Male Circumcision (VMMC) campaigns in place since 2008. Data from the Population-based HIV Impact Assessment (PHIA) surveys conducted in African countries in 2017-2018 were utilized. Six countries with high HIV prevalence, low traditional circumcision and large VMMC programs were selected: Eswatini, Lesotho, Malawi, Namibia, Zambia, Zimbabwe. The statistical analysis investigated the relative risk (RR) of HIV prevalence by circumcision status (circumcised vs intact) among men age 20-59, and the age-incidence of HIV in the two groups among men age 20-49, defined as the linear-logistic slope of the relationship between prevalence and age. Results show that the standardized RR was not different from 1 at older ages (50-59): RR = 0.923, 95% CI = 0.769-1.108, P = 0.390. Furthermore, the age-incidence was at least as high or higher among the circumcised groups than among the intact groups. The standardized RR was lower than 1 at younger ages, and this could be explained by selection biases. HIV prevalence at age 40-59 (27.3%) was also the same in the four groups of circumcision status (intact, traditional, medical, unknown). Results matched earlier observations made in South Africa that circumcised and intact men had similar levels of HIV infection. The study questions the current strategy of large scale VMMC campaigns to control the HIV epidemic. These campaigns also raise a number of ethical issues. [ABSTRACT FROM AUTHOR]

Diphallia (penile duplication) is a rare congenital malformation with an incidence of about 1 per 5–6 million newborns. The severity of diphallia varies from a small accessory penile-like tissue to complete true penile duplication with other deformities, usually involving the urogenital, gastrointestinal, and musculoskeletal systems. Pseudodiphallia, as a rare kind of diphallia, is characterized by a small accessory penile-like tissue without a normal penile anatomy structure. A 5.5-year-old male child was brought to the pediatric surgery outpatient department by the parents with complaint of difficulty in retracting the prepucial foreskin and the presence of some growth near the glans. There were no other complaints in specific. Clinical examination revealed foreskin retractable with difficulty and small conical lump smaller than the original glans approximately size ~1 cm diameter at the base attached horizontally at the left side of the original glans at the coronal sulcus and visible incomplete clefting in between the 2 glans visible from the aerial view. After approval from anesthetist, the patient was operated under general anesthesia by excision of pseudodiphallia. Urethral catheterization and circumcision of the penis after taking informed parental consent. Postoperatively, the period was uneventful. The patient responded well to the symptomatic treatment and was orally allowed on the same day evening. Urinary catheter was removed on 5th postoperative day. The patient was discharged on oral symptomatic medication and was advice for follow-up. [ABSTRACT FROM AUTHOR]

Studies have shown the possibility of using the part of the foreskin removed after circumcision in the field of scientific and therapeutic research. Donations of tissues and organs are always associated with ethical challenges posed by bioethicists and societies to ensure the appropriate use of these tissues/organs. The purpose of this study was to understand the attitudes and awareness of parents/guardians regarding donation of excised foreskin to research and medical use. The study was based on a questionnaire and included 133 parents/guardians who visited Uhud Children's Hospital in Madinah, Saudi Arabia for newborn male circumcision. The results showed a high willingness (61.7%) to donate the extracted foreskin to research. The willingness to donate the extracted foreskin to research associated with undergraduate degree (P = 0.018), male sex (P = 0.011), high income (P = 0.029), and participation in previous research studies (P = 0.002). About 41.8% were convinced that written informed consent should be obtained before circumcision surgery, 38.1% (n = 51) were convinced that written informed consent should be taken after surgery, while the remaining 19.4% reported that the timing of written informed consent is unimportant. Finally, fear of excision of excess tissue (74.5%), lack of confidence in the research (68.6%), and potential for commercial use (64.7%) were the main barriers to unwillingness to donate the excised foreskin for research. In conclusion, a reasonable portion of Saudis agreed to donate their foreskin for research purposes. There is an urgent need to enhance awareness and attitudes towards tissue donation for research and therapeutic use. [ABSTRACT FROM AUTHOR]

Background: There is limited data on client preferences for different HIV self-testing (HIVST) and provider-delivered testing options and associated factors. We explored client preferences for oral-fluid-based self-testing (OFBST), blood-based self-testing (BBST) and provider-delivered blood-based testing (PDBBT) among different populations. Methods: At clinics providing HIV testing services to general populations (1 urban, 1 rural clinic), men seeking voluntary medical male circumcision (VMMC, 1 clinic), and female sex workers (FSW, 1 clinic), clients had the option to test using OFBST, BBST or PDBBT. A pre-test questionnaire collected information on demographics and testing history. Two weeks after collecting a self-test kit, participants responded to a questionnaire. We used logistic regression to determine predictors of choices. We also conducted 20 in-depth interviews to contextualise quantitative findings. Results: May to June 2019, we recruited 1244 participants of whom 249 (20%), 251 (20%), 244 (20%) and 500 (40%) were attending urban general, rural, VMMC and FSW clinics, respectively. Half (n = 619, 50%) chose OFBST, 440 (35%) and 185 (15%) chose BBST and PDBBT, respectively. In multivariable analysis comparing those choosing HIVST (OFBST and BBST combined) versus not, those who had never married aOR 0.57 (95% CI 0.34–0.93) and those previously married aOR0.56 (0.34–0.93) were less likely versus married participants to choose HIVST. HIVST preference increased with education, aOR 2.00 (1.28–3.13), 2.55 (1.28–5.07), 2.76 (1.48–5.14) for ordinary, advanced and tertiary education, respectively versus none/primary education. HIVST preference decreased with age aOR 0.97 (0.96–0.99). Urban participants were more likely than rural ones to choose HIVST, aOR 9.77 (5.47–17.41), 3.38 (2.03–5.62) and 2.23 (1.38–3.61) for FSW, urban general and VMMC clients, respectively. Comparing those choosing OFBST with those choosing BBST, less literate participants were less likely to choose oral fluid tests, aOR 0.29 (0.09–0.92). Conclusions: Most testing clients opted for OFBST, followed by BBST and lastly, PDBBT. Those who self-assessed as less healthy were more likely to opt for PDBBT which likely facilitated linkage. Results show importance of continued provision of all strategies in order to meet needs of different populations, and may be useful to inform both HIVST kit stock projections and tailoring of HIVST programs to meet the needs of different populations. [ABSTRACT FROM AUTHOR]

Unlike female genital mutilation, the alteration of male genitals has not received much attention. Circumcision is the most common and oldest surgical procedure being performed. When performed by surgeons or well-trained personal the procedure is safe, but most of the times it is being performed by untrained people with no or little medical background. This has led to many complications. Total skin loss is an uncommon but serious complication. There is an ongoing debate regarding the management of this complication. Here, we present a case of total penile skin loss which had resulted from penile mutilation in the name of ritual circumcision. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the relation of maternal pain catastrophizing score with children who underwent circumcision postoperative pain. This prospective cohort study was performed between March 2022 and March 2023 at Samsun University, Turkey. Demographic characteristics of mothers and children, mothers' education level, presence of chronic pain, and Beck Depression Inventory scores were recorded preoperatively. Pain catastrophizing was assessed by applying the pain catastrophizing scale (PCS) to the mothers of children who experienced postoperative circumcision pain. The mothers were divided into low-pain catastrophizing (Group 1) and high-pain catastrophizing (Group 2) group. A total of 197 mothers and sons participated in the study, with 86 (43.6%) in Group 1 and 111 (56.4%) in Group 2. Significant differences were found between the two groups in terms of the mothers' PCS scores (p < 0.001), education levels (p = 0.004), chronic pain scores (p = 0.022), and Beck Depression Inventory scores (p < 0.001). Our findings showed that children with high pain catastrophizing mothers experience greater postoperative pain than those with low pain catastrophizing mothers. This may be attributable to a mother's specific cognitive style for coping with pain, which is associated with the child's responses to painful experiences. [ABSTRACT FROM AUTHOR]

Objective. Circumcision is one of the most common surgical procedures in pediatric surgery. Even though manual suture (MANS) is regarded as the gold standard technique, easy-to-use mechanical suture (MECS) devices have been recently developed, with better postoperative results in the adult population. The objective of our study was to compare the operating time and incidence of postoperative complications between both techniques in our environment. Materials and methods. A retrospective study of patients undergoing circumcision in our institution from October 2021 to December 2022 was carried out. Operating time and complications observed in the first 14 postoperative days (edema, hematoma, dehiscence) were analyzed according to the technique used (MANS vs. MECS) and patient age (< 12 and ≥ 12 years old). Results. 173 patients (147 MANS, 26 MECS) were included. Mean operating time was significantly lower in MECS patients, both in patients < 12 years old (16 min vs. 10 min, p= 0.002) and in patients ≥ 12 years old (23 min vs. 12 min, p< 0.001). Regarding complications, MECS patients ≥ 12 years old had a lower rate of suture dehiscence (23.5% vs. 0%, p< 0.001), with no significant differences in the younger group. Conclusions. MECS circumcision is a simple and effective technique involving shorter operating times than MANS circumcision, regardless of age. It has a lower rate of complications in older children (≥ 12 years), which means it stands as a valid alternative to the conventional technique. [ABSTRACT FROM AUTHOR]

Objective To evaluate resource allocation and costs associated with delivery of human immunodeficiency virus (HIV) services in Uganda and the United Republic of Tanzania. Methods We used time-driven activity-based costing to determine the resources consumed and costs of providing five HIV services in Uganda and the United Republic of Tanzania: antiretroviral therapy (ART); HIV testing and counselling; prevention of mother-to-child transmission; voluntary male medical circumcision; and pre-exposure prophylaxis. Findings Country-based teams undertook time-driven activity-based costing with 1119 adults in Uganda and 886 adults in the United Republic of Tanzania. In Uganda, service delivery costs ranged from 8.18 United States dollars (US$) per visit for HIV testing and counselling to US$ 43.43 for ART (for clients in whom HIV was suppressed). In the United Republic of Tanzania, these costs ranged from US$ 3.67 per visit for HIV testing and counselling to US$ 28.00 for voluntary male medical circumcision. In both countries, consumables were the main cost driver, accounting for more than 60% of expenditure. Process maps showed that in both countries, registration, measurement of vital signs, consultation and medication dispensing were the steps that occurred most frequently for ART clients. Conclusion Establishing a rigorous, longitudinal system for tracking investments in HIV services that includes thousands of clients and numerous facilities is achievable in different settings with a high HIV burden. Consistent engagement of implementation partners and standardized training and data collection instruments proved essential for the success of these exercises. [ABSTRACT FROM AUTHOR]

Background: Circumcision, a religious obligation for Male Muslims in Indonesia, is conducted at a high cost using health facilities. Meanwhile, while wanting to circumcise their children the pandemic situation reduces the economic capacity of the people. Therefore, it is necessary to conduct community service activities in the form of free circumcision performed en masse to help the poor. However, due to the coronavirus pandemic which has spread rapidly since the beginning of 2020, it is necessary to adhere to health protocols. Mass circumcision during a pandemic requires a health protocol strategy to ensure that activities are performed in a safe, comfortable, and satisfying state. East Jakarta has 2,937,859 people, with 486,110 people being children of age 0-19 years. The majority of residents in this city, about 96%, are Muslims. Meanwhile 3% percent of them, or 91,610 people, are considered poor. There is still a high need for the people of East Jakarta to conduct circumcision for their children during the pandemic, even though there is a decrease in their income. Methods: A free, safe, and comfortable mass circumcision is required with the implementation of health protocols. Out of 170 participants registered for the circumcision, 163 of them passed the Covid-19 screening, while two did not fulfill the indications for circumcision; hence only 161 children were circumcised using the smart clamp. Furthermore, the youngest, oldest, and most circumcised participants were 1, 15, and 5 - 9 years old (60 %), respectively. Results: The commonly used smart clamps were 13 in numbers, and the average circumcision time for each participant was 6 minutes. Furthermore, there were mild complications among 7 participants (4%). The participants' parents were satisfied and advised their relatives to partake in mass circumcision in the future. Conclusion: Meanwhile, there were no reports of participants, parents, health workers, and committee members being infected with the coronavirus after completing the activity. The health protocol implementation strategy was successfully conducted during the free mass circumcision in East Jakarta, which took place safely, comfortably, and satisfactorily. [ABSTRACT FROM AUTHOR]