Jump to content

User:Geckomating/sandbox

From Wikipedia, the free encyclopedia
ShangRing
The image shows a simple illustation of the ShangRing.
Overview
The ShangRing is a medical device used for male circumcision, designed to simplify the procedure and reduce complications.
Inventor
Jianzhong Shang
Year Introduced
2005
Materials
Polycarbonate plastic
Website
[1]
See also: Circumcision

The ShangRing is a disposable medical device designed for male circumcision, characterised by its elimination of traditional need for suturing in circumcision and its simplicity in operating using the two-clamp system.[1][2][3][4]

Consisted of two concentric plastic rings that clamp the foreskin for removal, the ShangRing features several unique design elements and comes in 32 sizes[1] to accommodate various anatomical needs. It can be used with two techniques: the flip and no-flip methods[5], depending on the patient's age and anatomy. Local anaesthesia needs to be applied before the procedures.[6][7]

There are potential risks and complications associated with the use of ShangRing.[2][8][9] Compared with the traditional and laser circumcision methods, there are some major differences that the ShangRing may be used as an alternative method for some individuals. [3][10][11][12][13][14]

Basic Information

[edit]

Intended Use

[edit]

The ShangRing is designed for male circumcision, which is defined as the removal or excision of the foreskin or prepuce[15]. The ShangRing is approved for use in both adolescent and adult males.[1][5] For adolescent and adult males aged 13 years and older, either the flip technique or the no-flip technique can be used with the ShangRing. For boys aged 10 to 12 years, only the no-flip technique is advised.[1][5]

Design and Features

[edit]

The ShangRing consists of one inner and one outer concentric plastic ring.[2] They work together to clamp the foreskin before its surgical removal.

Frenulum attaching foreskin to glans penis, which is preferably preserved during circumcision.

The device incorporates several innovative design features. Firstly, the collar-shaped design includes self-locking ratchets that provide physicians with improved visibility during the circumcision procedure[2], allowing for a precise removal of the foreskin while preserving the frenulum.[16] The cascade ratchet mechanism enables precise adjustments to accommodate different anatomical needs. Secondly, the inner ring is lined with a silicone rubber cushion that ensures a uniform, tight clamp on the foreskin without exposing the wound.[2] It facilitates easier wound cleaning, reduces the risk of infection, and promotes faster recovery.[17] Thirdly, projections along the outer ring prevent the device from dislocating during use.[1] These projections also allow for the flow of interstitial fluid, which helps reduce the risk of postoperative edema and other complications.[18]

With these unique designs, the ShangRing has become the first medical device to standardise circumcision surgery.[19][3]

First introduced in China in 2005[20], The ShangRing is used worldwide today.[4] It is recognised for its innovative design and has received international certifications, including FDA clearance in the United States and the CE Mark from the European Union.[2]

Sizes

[edit]

The ShangRing is available in 32 sizes, ranging from A4 to Z2, with inside diameters varying from 9 mm to 40 mm.[2] The wide size range it provides can accommodate patients with different anatomical needs.[1]

ShangRing Size Table[1]
Shang Ring size Inner diameter of inner ring (mm)
A4 40
A3 39
A2 38
A1 37
A 36
B 35
C 34
D 33
E 32
F 31
G 30
H 29
I 28
J 27
K 26
L 25
M 24
N 23
O 22
P 21
Q 20
R 19
S 18
T 17
U 16
V 15
W 14
X 13
Y 12
Z 11
Z1 10
Z2 9

Techniques

[edit]

Flip vs. No-Flip[21] [5]

[edit]

The ShangRing procedure can be performed with either the flip technique or the no-flip technique. In the flip technique, the foreskin is flipped over the inner ring before the outer ring is applied. This technique is suitable for older adolescents and adults.[22] In the no-flip technique[23], the foreskin is clamped directly without flipping, which makes it more suitable for younger patients, particularly those aged 10 to 12 years[24], or for patients with specific anatomical considerations.[25][10]

Usage and Procedure

[edit]

Anaesthesia

[edit]
The image shows the phimosis condition. Topical anaesthesia is only used for patients without this medical condition.

The ShangRing procedure requires local anaesthesia, which can be administered topically or via injection.[9] Topical anaesthesia is used only with the no-flip technique and is suitable solely for patients without foreskin adhesions or phimosis[26]. The recommended anaesthetic cream contains 2.5% lidocaine and 2.5% prilocaine.[27][6][28] To apply the cream, it should be liberally distributed both around and inside the foreskin, as well as over the glans, if the foreskin can be retracted. A needle-free syringe can be used to assist the cream application inside the foreskin.[29] Additionally, the anaesthetic cream should also be applied to the external surface of the penis, from the foreskin's tip to the base of the shaft. The cream should remain in place for 25 to 30 minutes to allow sufficient time before testing for anaesthetic effectiveness.[30] After achieving the desired effect, the remaining cream should be wiped off, and the genital area should be thoroughly disinfected with an appropriate antiseptic, such as povidone-iodine, unless contraindicated by an allergy. It is recommended to perform at least three applications of disinfectant, with a two-minute interval before proceeding with the device placement.[25]

Injectable anaesthesia can be used with either the flip or no-flip technique. The anaesthetic solution may consist of either lidocaine alone or a mixture of lidocaine and bupivacaine.[31][32][33] After administering the anaesthetic, the base of the penis should be massaged to facilitate the spread of the solution. A waiting period of 3 to 5 minutes is required before testing all four quadrants of the penis to ensure effective anaesthesia is achieved. Two primary techniques are used for injectable anaesthesia.[7] The dorsal penile nerve block involves injecting the anaesthetic at the one o’clock and eleven o’clock positions along the dorsal penile nerves.[34][35][36] The circumferential ring block involves injecting the anaesthetic circumferentially around the base of the penis between the superficial (dartos) and deep (Buck’s) fascia to achieve a complete block.[25][37][38][39]

Procedure

[edit]
Various scalpels, which are used to create slits in the foreskin.

The ShangRing circumcision procedure begins by measuring the penis to select the appropriate device size.[24] After the suitable size is determined, local anaesthesia is administered, and the surgical site is prepared with an antiseptic[40].[9] The inner ring is positioned below or proximal to the level of the coronal sulcus.[41] Clamps are then used at the 3, 6, 9 and 12 o’clock positions to evert, or turn inside out, the foreskin over the inner ring.[1] Next, the outer ring is placed over the inner ring, securely clamping the foreskin between the two rings. The foreskin is then removed beneath the device using surgical scissors. In some cases, eight to ten small slits are made in the foreskin on the underside of the ring using a scalpel. These slits facilitate healing during erections[11] and allow the scab to expand. The procedure is completed by leaving the ShangRing device in place for seven days to support proper healing.[20][42]

Benefits & Drawbacks

[edit]

Benefits

[edit]

The ShangRing circumcision technique is acclaimed by both medical professionals and patients for its simplicity and ease of use. This method can be used without suture[2][43], meaning that stitches are not used in the procedure which reduces the risk of complications like infection and scarring is avoided.[44] Its sutureless design enhances patient comfort during healing.[45] In addition, the ShangRing is cost-effective, requiring minimal specialised equipment and the procedure is straightforward.[20][2] It, therefore, benefits individual patients as well as publicly-funded healthcare systems, especially in poverty-stricken countries.[19]

Another advantage is the speed of the procedure. Most of the time, the procedure takes 3 to 5 minutes[2], which is significantly shorter than most circumcision procedures which typically take at least 30 minutes.[2][15][46] This efficiency allows healthcare providers to redirect time and resources to other purposes. In addition, patients can shower immediately after surgery, ensuring hygiene and comfort.[2][47] This immediacy in maintaining personal hygiene is particularly important for healing and preventing infections. The simplicity, speed, and ease of use of the ShangRing make it a viable option for individuals considering circumcision.

The ShangRing method also supports smooth recovery with minimal disruption to daily life. Patients are advised to avoid heavy activities and some physical exertions for a few days following the procedure, but walking around and light activities are permitted without significantly disrupting daily life.[48] The same applies to early return to work for most patients whose jobs do not involve much physical exertion.[47] This implies that life after the procedure is minimally affected, which is important especially for people have busy schedules or when they live in countries where healthcare services access is limited.[19]

Drawbacks

[edit]

One primary drawback is post-operative pain, particularly during erections in the first week.[20][49] Increased sensitivity can cause discomfort and may require additional pain management measures.[50] Although pain is an expected outcome of most surgeries, its impact on circumcision will prove to be more difficult for some patients.[51]

Another aspect of the possible problems with the ShangRing method is that the healing time might be longer than the traditional circumcision techniques.[20][49] This is because the healing process involves secondary intention, where the wound closes up naturally without the aid of a suture.[12] Though in some cases this may lead to less scarring, there is a greater chance that it may prolong recovery time. Therefore, patients should prepare for the possibility of a longer time-span for rest and recuperation.

There is a risk of ring placement failure with the ShangRing method. This occurs if the ring slips off or there is damage to the foreskin at the time of ring placement.[20][52] Additional surgery might be needed in such instances to correct the problem. Though small, the risk should not be overlooked and patients would be counselled on post-procedure instructions to minimise complications after the procedure.[3]

More follow-up visits will be needed for ShangRing removal compared to traditional method, which further adds to the logistical burden of the procedure.[52][46] These visits will not only establish if the circumcision heals as desired but also remove the ring once it serves its purpose.[53] The inconvenience can be significant in places where sufficient healthcare services are not accessible or patients have a busy schedule. This, however, helps prevent potential complications and promoting a successful outcome.[54]

Potential Risks and Complications

[edit]
A patient suffering from penile edema, which is a serious potential post-operation complication. The swelling is usually the most significant between the line of the circumcision and the ridge of the head of the penis.

The ShangRing procedure also involves the possible risks and complications that must be considered. For at least two to three days, the patient should rest at home after the procedure and refrain from vigorous activities, heavy sweating, swimming, sex, and masturbation for at least four weeks or until the wound is completely healed.[46] In most cases, light work or any activity that does not strain the body can be resumed within a few days[55], but these instructions ought to be followed to ensure proper healing and minimise the risk of complications.

Some serious post-operative complications include significant penile edema, bleeding, difficulty in urination, increased pain and redness, bruising, fever, and other signs of infection (for example, pus or discharge), which require immediate medical care to avert bad outcomes.[1][8] Patient should be informed of the associated risks and monitor their recovery closely. Should any unusual symptoms develop, he should seek medical advice to aid his successful and safe recovery.

Comparisons

[edit]

ShangRing vs. Traditional Circumcision[11]

[edit]
Traditional circumcision

The ShangRing method for circumcision has some differences over conventional techniques of circumcision. One key difference is procedure time.[56] ShangRing circumcision typically takes about 3 to 5 minutes, significantly faster than traditional methods, which often take 30 minutes to an hour.[2][15][46] This shorter procedure time saves both time and costs for both patient and provider.

The ShangRing method is less invasive, involving minimal tissue manipulation and no sutures[2], which reduces the risk of infection and promotes rapid healing.[44][57] In contrast, traditional circumcision involves a lot more tissue manipulation and sutures, increasing the likelihood of complicated by bleeding and infection.[58]

Relating to pain and complications, The ShangRing method has a lower risk of bleeding and infection compared to traditional circumcision[56] but has been found to results in more pain during erections after the procedure.[20][49][59] Traditional circumcision has a higher risk of bleeding and infection due to the use of sutures and greater manipulation of tissues.[44][58]

Another notable difference is the healing time. In general, traditional circumcision heals faster than ShangRing because the latter does secondary healing after the ring is removed.[56] Despite this, the ShangRing method is associated with fewer complications and tends to have a smoother healing process because of the sutureless method.

ShangRing vs. Laser Circumcision

[edit]
Illustration of Laser Circumcision

The ShangRing method and laser circumcision differ in several aspects. The time taken for the procedure is one of the major differences: ShangRing circumcision takes 3 to 5 minutes,[2] [46][15]while laser circumcision takes 15 to 30 minutes.[56][13]

Both of the procedures may be regarded as minimally invasive when compared with conventional surgery; however, the ShangRing method "does less manipulation of tissue" and therefore has fewer complications.[20][56] Although laser circumcision also considered non-invasive compared to the traditional method[14][60], it does not significantly reduce the risk of bleeding and infection.

The ShangRing technique is used alternatively due to lower pain and fewer complications compared to laser circumcision, which carries a higher risk of complications and bleeding.[61] This is due to the fact that the ShangRing provides hemostasis and reduces postoperative bleeding and risk of infection.[62]

References

[edit]
  1. ^ a b c d e f g h i "WHO PQMC Public Report" (PDF). WHO PQMC Public Report (5). October 2019.
  2. ^ a b c d e f g h i j k l m n o "China Circumcision Shang Ring Suppliers, Manufacturers, Factory - Made in China - SHANGRING". www.circumcision.cn. Retrieved 2025-04-01.
  3. ^ a b c d Peng, Yi-Feng; Yang, Ben-Hai; Jia, Chao; Jiang, Jian (2010). "[Standardized male circumcision with Shang Ring reduces postoperative complications: a report of 351 cases]". Zhonghua Nan Ke Xue = National Journal of Andrology. 16 (11): 963–966. ISSN 1009-3591. PMID 21218635.
  4. ^ a b Masson, Puneet; Li, Philip S.; Barone, Mark A.; Goldstein, Marc (2010). "The ShangRing device for simplified adult circumcision". Nature Reviews Urology. 7 (11): 638–642. doi:10.1038/nrurol.2010.167. ISSN 1759-4820.
  5. ^ a b c d Yang, Ben-Hai; Jia, Chao; Liu, Tao; Peng, Yi-Feng (2014). "[Novel no-flip Shang Ring circumcision for adult males: a clinical application study of 528 cases]". Zhonghua Nan Ke Xue = National Journal of Andrology. 20 (8): 709–714. ISSN 1009-3591. PMID 25195367.
  6. ^ a b World Health Organisation (April 2018). Manual for male circumcision under local anaesthesia and HIV prevention services for adolescent boys and men. ISBN 978-92-4-151359-3.
  7. ^ a b Awori, Quentin; Li, Philip S.; Lee, Richard K.; Ouma, Daniel; Oundo, Millicent; Barasa, Mukhaye; Obura, Nereah; Mwamkita, David; Simba, Raymond; Oketch, Jairus; Nyangweso, Nixon; Maina, Mary; Kiswi, Nicholas; Kirui, Michael; Chirchir, Betty (2019-08-14). "Use of topical versus injectable anaesthesia for ShangRing circumcisions in men and boys in Kenya: Results from a randomized controlled trial". PLOS ONE. 14 (8): e0218066. doi:10.1371/journal.pone.0218066. ISSN 1932-6203. PMC 6693766. PMID 31412032.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  8. ^ a b Wang, Hui; Huang, Zhenyu; Zhou, Jun; Zhang, Xiansheng; Liang, Chaozhao (2019). "Clinical Outcomes And Risk Factors In Patients Circumcised By Chinese Shang Ring: A Prospective Study Based On Age And Types Of Penile Disease". Therapeutics and Clinical Risk Management. 15: 1233–1241. doi:10.2147/TCRM.S215471. ISSN 1176-6336. PMC 6814311. PMID 31695396.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  9. ^ a b c Ogle, Orrett E.; Mahjoubi, Ghazal (2012-01-01). "Local Anesthesia: Agents, Techniques, and Complications". Dental Clinics. 56 (1): 133–148. doi:10.1016/j.cden.2011.08.003. ISSN 0011-8532. PMID 22117947.
  10. ^ a b Weiss, Helen A.; Larke, Natasha; Halperin, Daniel; Schenker, Inon (2010-02-16). "Complications of circumcision in male neonates, infants and children: a systematic review". BMC urology. 10: 2. doi:10.1186/1471-2490-10-2. ISSN 1471-2490. PMC 2835667. PMID 20158883.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  11. ^ a b c Li, Hui-Ning; Xu, Jun; Qu, Li-Ming (2010). "[Shang Ring circumcision versus conventional surgical procedures: comparison of clinical effectiveness]". Zhonghua Nan Ke Xue = National Journal of Andrology. 16 (4): 325–327. ISSN 1009-3591. PMID 20626160.
  12. ^ a b Wang, Daya; Li, Zhijia; Chen, Ximeng; Wang, Haibo (2023). "Wound healing rates and wound problems of conventional circumcision compared with ring circumcision: A meta-analysis". International Wound Journal. 20 (9): 3699–3707. doi:10.1111/iwj.14262. ISSN 1742-481X. PMC 10588352. PMID 37303303.
  13. ^ a b "Laser Circumcision - Treatment Procedure, Benefits & Recovery". www.pristyncare.com. Archived from the original on 2025-01-15. Retrieved 2025-04-01.
  14. ^ a b Ronchi, Piero (2020-07-16). "Technology Meets Tradition: CO2 Laser Circumcision versus Conventional Surgical Technique". Research and Reports in Urology. 12: 255–260. doi:10.2147/RRU.S260636. PMC 7371603. PMID 32766172.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  15. ^ a b c d American Academy of Pediatrics Task Force on Circumcision (2012). "Male circumcision". Pediatrics. 130 (3): e756–785. doi:10.1542/peds.2012-1990. ISSN 1098-4275. PMID 22926175.
  16. ^ Liu, Guang-Ming; Xu, Zi-Qiang (2021-10-14), The Morphological Classification of the Penile Frenulum in Chinese's People and its Clinical Application Value in the Frenulum Malposition of Circumcision with the Disposable Circumcision Suture Device (DCSD), doi:10.21203/rs.3.rs-900176/v1, retrieved 2025-04-11
  17. ^ Cheng, Yue; Wu, Kerong; Yan, Zejun; Yang, Shuwei; Li, Fang; Su, Xinjun (2014-05-20). "Long-term follow-up for Shang Ring male circumcision". Chinese Medical Journal. 127 (10): 1879. doi:10.3760/cma.j.issn.0366-6999.20133135. ISSN 0366-6999.
  18. ^ Guyton, A. C.; Granger, H. J.; Taylor, A. E. (1971). "Interstitial fluid pressure". Physiological Reviews. 51 (3): 527–563. doi:10.1152/physrev.1971.51.3.527. ISSN 0031-9333.
  19. ^ a b c Barone, Mark A.; Ndede, Frederick; Li, Philip S.; Masson, Puneet; Awori, Quentin; Okech, Jairus; Cherutich, Peter; Muraguri, Nicholas; Perchal, Paul; Lee, Richard; Kim, Howard H.; Goldstein, Marc (2011-05-01). "The Shang Ring device for adult male circumcision: a proof of concept study in Kenya". Journal of Acquired Immune Deficiency Syndromes (1999). 57 (1): e7–12. doi:10.1097/QAI.0b013e3182158967. ISSN 1944-7884. PMID 21346586.
  20. ^ a b c d e f g h Barone, Mark A.; Li, Philip S.; Awori, Quentin D.; Lee, Richard; Goldstein, Marc (2014). "Clinical trials using the Shang Ring device for male circumcision in Africa: a review". Translational Andrology and Urology. 3 (1): 113–124. doi:10.3978/j.issn.2223-4683.2014.01.09. ISSN 2223-4691. PMC 4708291. PMID 26816759.
  21. ^ "Adult Circumcision - Shangring technique | Harley Medical Circumcision Clinic | East London". Harley Medical Circumcision Clinic. Retrieved 2025-04-01.
  22. ^ Barone, Mark A.; Li, Philip S.; Lee, Richard K.; Ouma, Daniel; Oundo, Millicent; Barasa, Mukhaye; Oketch, Jairus; Otiende, Patrick; Nyangweso, Nixon; Maina, Mary; Kiswi, Nicholas; Chirchir, Betty; Goldstein, Marc; Awori, Quentin D. (2019). "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". Asian Journal of Andrology. 21 (4): 324. doi:10.4103/aja.aja_91_18. ISSN 1008-682X.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  23. ^ Barone, Mark A.; Li, Philip S.; Lee, Richard K.; Ouma, Daniel; Oundo, Millicent; Barasa, Mukhaye; Oketch, Jairus; Otiende, Patrick; Nyangweso, Nixon; Maina, Mary; Kiswi, Nicholas; Chirchir, Betty; Goldstein, Marc; Awori, Quentin D. (2019). "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". Asian Journal of Andrology. 21 (4): 324–331. doi:10.4103/aja.aja_91_18. ISSN 1745-7262. PMC 6628734. PMID 30520424.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  24. ^ a b Fang, Li; Zhu, Weichao; Xie, Zhongfei; Wu, Kerong; Wang, Guoyao; Yan, Zejun; Zheng, Zhong; Ma, Qi; Cheng, Yue (2018). "Choosing the appropriate ShangRing size for paediatric circumcision using the no-flip technique". Journal of Paediatrics and Child Health. 54 (1): 42–48. doi:10.1111/jpc.13660. ISSN 1440-1754.
  25. ^ a b c "China Shang Ring Circumcision Suppliers, Manufacturers, Factory - Made in China - SHANGRING". www.circumcision.cn. Retrieved 2025-04-01.
  26. ^ McGregor, Thomas B.; Pike, John G.; Leonard, Michael P. (2007-03-01). "Pathologic and physiologic phimosis: Approach to the phimotic foreskin". Canadian Family Physician. 53 (3): 445–448. ISSN 0008-350X. PMID 17872680.
  27. ^ Lehr, Victoria Tutag; Cepeda, Eugene; Frattarelli, Daniel A. C.; Thomas, Ron; LaMothe, Jennifer; Aranda, J. V. (2005). "Lidocaine 4% Cream Compared with Lidocaine 2.5% and Prilocaine 2.5% or Dorsal Penile Block for Circumcision". American Journal of Perinatology. 22 (5): 231–237. doi:10.1055/s-2005-871655. ISSN 0735-1631.
  28. ^ Buckley, Micaela M.; Benfield, Paul (1993-07-01). "Eutectic Lidocaine/Prilocaine Cream". Drugs. 46 (1): 126–151. doi:10.2165/00003495-199346010-00008. ISSN 1179-1950.
  29. ^ Taddio, Anna; Stevens, Bonnie; Craig, Kenneth; Rastogi, Pratap; Ben-David, Shlomit; Shennan, Andrew; Mulligan, Peggy; Koren, Gideon (1997-04-24). "Efficacy and Safety of Lidocaine–Prilocaine Cream for Pain during Circumcision". New England Journal of Medicine. 336 (17): 1197–1201. doi:10.1056/NEJM199704243361701. ISSN 0028-4793.
  30. ^ Zhao, Shimeng; Jia, Pengyu; Chai, Hongchao; Qi, Can; Xin, Chaojun; Zhou, Yun (2025-03-30). "A modified Shang Ring circumcision surgical technique under local anesthesia for penile torsion in children". Translational Andrology and Urology. 14 (3): 60209–60609. doi:10.21037/tau-2024-698. ISSN 2223-4691.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  31. ^ Stolik-Dollberg, Orit C.; Dollberg, Shaul (2005-05-22). "Bupivacaine versus lidocaine analgesia for neonatal circumcision". BMC Pediatrics. 5 (1): 12. doi:10.1186/1471-2431-5-12. ISSN 1471-2431. PMC 1164419. PMID 15907216.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  32. ^ Kigozi, Godfrey; Musoke, Richard; Anyokorit, Margaret; Nkale, James; Kighoma, Nehemiah; Ssebanenya, William; Mwinike, Joshua; Watya, Stephen; Nalugoda, Fred; Kagaayi, Joseph; Nalwoga, Grace; Nakigozi, Gertrude; Kiwanuka, Noah; Makumbi, Frederick; Lutalo, Tom (2012). "Use of a mixture of lignocaine and bupivacaine vs lignocaine alone for male circumcision under local anaesthesia in Rakai, Uganda". BJU International. 109 (7): 1068–1071. doi:10.1111/j.1464-410X.2011.10505.x. ISSN 1464-410X.
  33. ^ Galukande, M.; Hodges, S.; Duffy, K.; Coutinho, A.; Kaggwa, S. (2016). "The Use of Lidocaine and Bupivacaine Mix in Adult Safe Male Circumcision: Less Is More". Advances in Anesthesiology. 2016 (1): 2861217. doi:10.1155/2016/2861217. ISSN 2314-7555.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  34. ^ Butler-O'Hara, Meggan; LeMoine, Christine; Guillet, Ronnie (1998-04-01). "Analgesia for Neonatal Circumcision: A Randomized Controlled Trial of EMLA Cream Versus Dorsal Penile Nerve Block". Pediatrics. 101 (4): e5. doi:10.1542/peds.101.4.e5. ISSN 0031-4005.
  35. ^ Wang, Jiamin; Zhao, Shankun; Luo, Lianmin; Liu, Yangzhou; Zhu, Zhiguo; Li, Ermao; Zhao, ZhiGang (2018-09-06). "Dorsal penile nerve block versus eutectic mixture of local anesthetics cream for pain relief in infants during circumcision: A meta-analysis". PLOS ONE. 13 (9): e0203439. doi:10.1371/journal.pone.0203439. ISSN 1932-6203. PMC 6126851. PMID 30188927.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  36. ^ Teunkens, An; Van de Velde, Marc; Vermeulen, Kristien; Van Loon, Philippe; Bogaert, Guy; Fieuws, Steffen; Rex, Steffen (2018). "Dorsal penile nerve block for circumcision in pediatric patients: A prospective, observer-blinded, randomized controlled clinical trial for the comparison of ultrasound-guided vs landmark technique". Pediatric Anesthesia. 28 (8): 703–709. doi:10.1111/pan.13429. ISSN 1460-9592.
  37. ^ Howard, Cynthia R.; Howard, Fred M.; Fortune, Karen; Generelli, Patricia; Zolnoun, Denniz; tenHoopen, Cynthia; deBlieck, Elisabeth (1999-12-01). "A randomized, controlled trial of a eutectic mixture of local anesthetic cream (lidocaine and prilocaine) versus penile nerve block for pain relief during circumcision". American Journal of Obstetrics and Gynecology. 181 (6): 1506–1511. doi:10.1016/S0002-9378(99)70397-2. ISSN 0002-9378.
  38. ^ Lander, Janice; Brady-Fryer, Barbara; Metcalfe, James B.; Nazarali, Shemin; Muttitt, Sarah (1997-12-24). "Comparison of Ring Block, Dorsal Penile Nerve Block, and Topical Anesthesia for Neonatal Circumcision: A Randomized Controlled Trial". JAMA. 278 (24): 2157–2162. doi:10.1001/jama.1997.03550240047032. ISSN 0098-7484.
  39. ^ Naja, Z.; Al-Tannir, M. A.; Faysal, W.; Daoud, N.; Ziade, F.; El-Rajab, M. (2011). "A comparison of pudendal block vs dorsal penile nerve block for circumcision in children: a randomised controlled trial". Anaesthesia. 66 (9): 802–807. doi:10.1111/j.1365-2044.2011.06753.x. ISSN 1365-2044.
  40. ^ WOLBARST, ABRAHAM L. (1914-01-10). "UNIVERSAL CIRCUMCISION AS A SANITARY MEASURE". Journal of the American Medical Association. LXII (2): 92–97. doi:10.1001/jama.1914.02560270008003. ISSN 0002-9955.
  41. ^ Skrodzka, M.; Ayers, J.; Rea, A.; Britnell, W.; Hadway, P.; Muneer, A.; Malone, P.R. (2018-07-01). "122 How to do a Circumcision, When the Foreskin is Welded to the Glans. The ROLOCS (Restoration Of the Lost Obscured Coronal Sulcus) Procedure". The Journal of Sexual Medicine. 15 (Supplement_3): S179 – S180. doi:10.1016/j.jsxm.2018.04.124. ISSN 1743-6095.
  42. ^ Lü, Nian-qing; Li, Philip S.; Sokal, David; Cheng, Yue; Peng, Yi-feng; Barone, Mark; Huang, Yi-ran; Goldstein, Marc (2011). "[Progress in the clinical studies of male circumcision using the Shang Ring]". Zhonghua Nan Ke Xue = National Journal of Andrology. 17 (3): 195–202. ISSN 1009-3591. PMID 21485538.
  43. ^ Peng, Yi-Feng; Cheng, Yue; Wang, Guo-Yao; Wang, Suo-Qun; Jia, Chao; Yang, Ben-Hai; Zhu, Ru; Jian, Shu-Chuan; Li, Qing-Wen; Geng, Da-Wei (2008). "Clinical application of a new device for minimally invasive circumcision". Asian Journal of Andrology. 10 (3): 447–454. doi:10.1111/j.1745-7262.2008.00411.x. ISSN 1008-682X. PMID 18385906.
  44. ^ a b c Brook, Itzhak (2016-10-01). "Infectious Complications of Circumcision and Their Prevention". European Urology Focus. 2 (4): 453–459. doi:10.1016/j.euf.2016.01.013. ISSN 2405-4569.
  45. ^ Malone, Padraig; Steinbrecher, Henrik (2007-12-06). "Medical aspects of male circumcision". BMJ. 335 (7631): 1206–1290. doi:10.1136/bmj.39385.382708.AD. ISSN 0959-8138. PMID 18063645.
  46. ^ a b c d e "What You Need to Know about the Shang Ring Circumcision". RMDY Clinic: Health, Wellness, Preventive Care. Retrieved 2025-04-01.
  47. ^ a b Feldblum, Paul J.; Zulu, Robert; Linyama, David; Long, Sarah; Nonde, Thikazi Jere; Lai, Jaim Jou; Kashitala, Joshua; Veena, Valentine; Kasonde, Prisca (2016-06-01). "Randomized Controlled Trial of the ShangRing for Adult Medical Male Circumcision: Safety, Effectiveness, and Acceptability of Using 7 Versus 14 Device Sizes". Journal of Acquired Immune Deficiency Syndromes (1999). 72 Suppl 1 (Suppl 1): S30–35. doi:10.1097/QAI.0000000000001015. ISSN 1944-7884. PMC 4936423. PMID 27331587.
  48. ^ Cheng, Yue; Peng, Yi-Feng; Liu, Yi-Dong; Tian, Long; Lü, Nian-Qing; Su, Xin-Jun; Yan, Ze-Jun; Hu, Jia-Sheng; Lee, Richard; Kim, Howard H.; Sokal, David C.; Li, Philip S. (2009). "[A recommendable standard protocol of adult male circumcision with the Chinese Shang Ring: outcomes of 328 cases in China]". Zhonghua Nan Ke Xue = National Journal of Andrology. 15 (7): 584–592. ISSN 1009-3591. PMID 19694369.
  49. ^ a b c Han, Hu; Xie, Da-wei; Zhou, Xiao-guang; Zhang, Xiao-dong (2017). "Novel penile circumcision suturing devices versus the shang ring for adult male circumcision: a prospective study". International braz j urol. 43: 736–745. doi:10.1590/S1677-5538.IBJU.2016.0204. ISSN 1677-5538.
  50. ^ Rossi, Serena; Buonocore, Giuseppe; Bellieni, Carlo Valerio (2021-01-01). "Management of pain in newborn circumcision: a systematic review". European Journal of Pediatrics. 180 (1): 13–20. doi:10.1007/s00431-020-03758-6. ISSN 1432-1076. PMC 7782363. PMID 32748017.
  51. ^ US President's Emergency Plan for AIDS Relief. Evaluation of the acceptability and safety of the ShangRing device for male circumcision in Shinyanga, Tanzania.
  52. ^ a b Kigozi, Godfrey; Musoke, Richard; Watya, Stephen; Kighoma, Nehemiah; Ssebbowa, Paschal; Serwadda, David; Nalugoda, Fred; Makumbi, Frederick; Li, Philip; Lee, Richard; Goldstein, Marc; Wawer, Maria; Sewankambo, Nelson; Gray, Ronald H. (2013-08-15). "The acceptability and safety of the Shang Ring for adult male circumcision in Rakai, Uganda". Journal of Acquired Immune Deficiency Syndromes (1999). 63 (5): 617–621. doi:10.1097/QAI.0b013e3182968dda. ISSN 1944-7884. PMC 3805675. PMID 23614991.
  53. ^ Barone, Mark A.; Awori, Quentin D.; Li, Philip S.; Simba, Raymond O.; Weaver, Mark A.; Okech, Jairus O.; Aduda, Alex O.; Cherutich, Peter; Muraguri, Nicholas; Wekesa, John Masasabi; Nyanchoka, Jared; Perchal, Paul; Masson, Puneet; Lee, Richard; Goldstein, Marc (2012-07-01). "Randomized trial of the Shang Ring for adult male circumcision with removal at one to three weeks: delayed removal leads to detachment". Journal of Acquired Immune Deficiency Syndromes (1999). 60 (3): e82–89. doi:10.1097/QAI.0b013e31824ea1f2. ISSN 1944-7884. PMID 22343180.
  54. ^ Cheng, Yue; Wu, Kerong; Yan, Zejun; Yang, Shuwei; Li, Fang; Su, Xinjun (2014). "Long-term follow-up for Shang Ring male circumcision". Chinese Medical Journal. 127 (10): 1879–1883. ISSN 2542-5641. PMID 24824249.
  55. ^ Alawamlh*, Omar Al Hussein; Punjani, Nahid; Barone, Mark A.; Awori, Quentin D.; Goldstein, Marc; Li, Philip S.; Lee, Richard K. (2020). "MP04-16 THE EXPERIENCE OF A WHO TARGETED AGE GROUP (10-29 YEARS) FOR HIV PREVENTION WITH THE SHANGRING MALE CIRCUMCISION DEVICE". Journal of Urology. 203: e38. doi:10.1097/JU.0000000000000818.016.
  56. ^ a b c d e "Shang Ring Circumcision in Singapore". The Clifford Clinic. Retrieved 2025-04-01.
  57. ^ Sokal, David C.; Li, Philip S.; Zulu, Robert; Awori, Quentin D.; Combes, Stephanie L.; Simba, Raymond O.; Lee, Richard; Hart, Catherine; Perchal, Paul; Hawry, Hayden J.; Bowa, Kasonde; Goldstein, Marc; Barone, Mark A. (2014-04-01). "Randomized Controlled Trial of the Shang Ring Versus Conventional Surgical Techniques for Adult Male Circumcision: Safety and Acceptability". JAIDS Journal of Acquired Immune Deficiency Syndromes. 65 (4): 447. doi:10.1097/QAI.0000000000000061. ISSN 1525-4135.
  58. ^ a b Manakijsirisuthi, Wanchai (2005-12-30). "Circumcisor: An Instrument for Circumcision". The Thai Journal of Surgery. 26 (4): 123–126. ISSN 2697-5858.
  59. ^ Senel, F.; Misirlioglu, F. (2012-10-01). "1623 Pain after Circumcision: Comparison of Conventional and Plastic Clamp Circumcisions". Archives of Disease in Childhood. 97 (Suppl 2): A459 – A459. doi:10.1136/archdischild-2012-302724.1623. ISSN 0003-9888.
  60. ^ Vaos, George (2004). "Circumcision with the Nd:YAG Laser Contact Technique Compared with Conventional Surgery". Photomedicine and Laser Surgery. 22 (4): 318–322. doi:10.1089/pho.2004.22.318. ISSN 1549-5418.
  61. ^ "Laser Circumcision surgery : Procedure, Recovery & Benefits". Medfin. Retrieved 2025-04-01.
  62. ^ Li, Hui-Ning; Xu, Jun; Qu, Li-Ming (2010). "[Shang Ring circumcision versus conventional surgical procedures: comparison of clinical effectiveness]". Zhonghua Nan Ke Xue = National Journal of Andrology. 16 (4): 325–327. ISSN 1009-3591. PMID 20626160.
Retrieved from "https://en.wikipedia.org/w/index.php?title=User:Geckomating/sandbox&oldid=1285589547"