A Simplified No-Flip Shang Ring Circumcision Technique with Topical (EMLA) Anesthesia

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A SIMPLIFIED NO-FLIP SHANG RING CIRCUMCISION TECHNIQUE WITH TOPICAL (EMLA) ANESTHESIA IN ADOLESCENTS AND ADULTS. A. M. Bernie,Y. Peng, P. S. Li, R. Lee, C. Jia,B. Yang, Q. Awori, N. LU, M. A. Barone, M. Goldstein;
1 Urology, New York Presbyterian-Weill Cornell, New York, NY, 2Urology, Wuhu, China, 3Weill Cornell Medical College, New York, NY, 4Reproductive Medicine, Wuhu, China, 5EngenderHealth, Kilifi, Kenya, 6Jiangsu Family Planning Research Institute, Nanjing, China, 7EngenderHealth, New York, NY, 8Weill Cornell Medical College, New York Presbyterian, New York, NY.

(ShangRing received FDA 510K in 2012 and WHO-PQ in June 2015)
Introduction and Objective: The Shang Ring provides a very safe and simple method for performing male circumcision and has been used in highly populous areas to decrease transmission of sexually transmitted diseases and rates of genital cancer. The advent of the no-flip Shang Ring procedure provided several advantages over the standard Shang Ring, such as negating the need to evert the foreskin over the inner ring. Despite this, previous Shang Ring procedures have required local injectable anesthesia, which has deterred some men from proceeding with circumcision.
Methods: The no-flip Shang Ring circumcision was performed on 183 men (142 adults, 41 adolescents) with topical EMLA anesthesia used prior to the procedure. Topical anesthesia was applied inside and around the foreskin and allowed to remain in place for 25-30 minutes prior to performing circumcision. After completion of the circumcision, patients were asked to provide their level of discomfort both during the procedure as well as 24 hours after the procedure with a scale from 0-10 that included faces that precluded the need to read any survey data.
Results: The no-flip Shang Ring circumcision is able to be performed on average in under 4 minutes. Adolescents reported low pain scores during the Shang Ring circumcision with a score of 2.3 out of 10, despite 21 of 41 patients having a tight phimosis. 24 hour post-procedural pain remained low in these patients with a score of 2.7. Adult patients also reported low pain scores, with a 1.6 out of 10 during the circumcision and a 2.2 out of 10 24 hours post procedure. Infection rates after no-flip Shang Ring circumcision remain low at less than 2%.
Conclusions: The no-flip Shang Ring circumcision can be successfully performed with topical EMLA anesthesia. Men undergoing this procedure had little pain during the procedure and minimal post-procedural pain.
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