05 October 2012

Ring device helps in adult circumcision

A new device that men wear on the penis for a week to produce ischemic necrosis of the foreskin compared favourably to conventional surgical circumcision in a recent trial.


A new device that men wear on the penis for a week to produce ischemic necrosis of the foreskin compared favourably to conventional surgical circumcision in a recent trial, according to researchers from China.

Those researchers and others have said the Shang Ring could vastly increase access to male circumcision in countries hard-hit by the HIV epidemic.

The device consists of two rings and comes in 13 sizes. "The uniform force of the two outer rings created by this device can result in ischemic necrosis of the tissues clamped between the inner and outer rings," according to Dr Cheng Yue of the Medical College of Ningbo University and colleagues.

Research hints device is safe

Earlier this year in the Journal of AIDS, researchers from the US and Kenya reported that the Shang Ring is safe to use and that if men exceeded the recommended timing for removing the device, there are no serious consequences.

The Chinese team, reporting online in The Journal of Urology, said the Shang Ring has been used in "thousands" of patients - but without a direct comparison of the approach and conventional methods.

To compare the Shang Ring and conventional circumcision, the researchers analysed data on 479 men who had been randomised to use of the ring and 354 who had standard sleeve resection circumcision, and for whom they had one-month follow-up data. Both groups were of comparable age (roughly 31 years old, on average) and foreskin status.

'Pleased with results'

Mean procedure time was less in the ring group (4.65 vs 27.29 minutes), as was mean blood loss (0.98 vs 8.30 mL). The intraoperative pain score was also significantly lower.

The complication rate was significantly less with the Shang Ring (6.89% vs 13.28%). The only apparent disadvantage was that wound healing took significantly longer in the ring group (19.86 vs 13.42 days).

Patients were pleased with the results overall, as were the investigators, but given the extended healing time; they propose "that further investigations are needed to improve the specifics of Shang Ring male circumcision."

Dr Mark Barone of EngenderHealth, New York, said that his organisation "has been doing research on the device in Africa, but have no commercially or financial interest/stake in the product." The African studies also had positive results.

Commenting on the findings of the Chinese study, Dr Barone said in an email, "The Shang Ring is not available commercially outside of China at the present time. However, recently it did receive FDA clearance."

Patents for the device are pending in a total of 85 countries.

Dr Yue did not respond to requests for comments. The study was supported by the Ningbo Rural Innovation and Development Fund.

(Reuters Health, October 2012)

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