Circumcision in hemophilia: a cost-effective method using a novel device.
OBJECTIVE
The authors conducted a prospective clinical study to see whether the need for and the cost of factor substitution after circumcision can be reduced using a novel device for bloodless circumcision in boys with hemophilia.


METHODS
Forty-five boys with hemophilia (age range, 1.5 to 25 years; median age, 11; 40 with hemophilia A, 5 with hemophilia B; weight range, 9 to 75 kg; median weight, 30 kg) were circumcised in our department between 1996 and 2001. Severity of the disease was mild in 9 cases, moderate in 11, and severe in 25. After starting systemic prophylaxis including factor substitution and DDAVP (desmopressin acetate) in reduced doses, all patients underwent circumcision under local anesthesia using a modified straight clamp and a battery-operated diathermic knife specially designed for bloodless circumcision. Duration of factor replacement ranged between 7 and 18 days, and the hospitalization period was 2 to 5 days according to severity of the disease. The last 19 patients were given tranexamic acid orally for 7 days after surgery.


RESULTS
Transient minimal bleeding was observed in 5 patients and easily responded to factor administration. Moderate edema and hyperemia along the excision line owing to the diathermic effect of the device lasted for 3 to 4 days. Normal cosmetic appearance was regained within 7 to 21 days. Excellent patient and family satisfaction was reported. The average cost of the operation was calculated as 81 dollars, 144 dollars, and 243 dollars per kilogram in mild, moderate, and severe cases, respectively.


CONCLUSIONS
Bloodless circumcision with "diathermic knife" is a practical and reliable alternative for boys with hemophilia. Enhancement of local hemostasis using such an alternative device may reduce the need for factor substitution and, accordingly, the cost of circumcision in hemophiliacs, down to 50%.
Department of Urology, Haydarpasa Numune Training Hospital, Istanbul, Turkey.
M Ihsan
MI
Karaman
Bulent
B
Zulfikar
Turhan
T
Caskurlu
Erbil
E
Ergenekon
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male / Q000191:economics* / Q000295:instrumentation* / Q000379:methods; D003362:Cost-Benefit Analysis; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D004564:Electrocoagulation / Q000191:economics* / Q000295:instrumentation*; D004867:Equipment Design; D006467:Hemophilia A / Q000150:complications; D006801:Humans; D007223:Infant; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011292:Premedication; D011446:Prospective Studies; D014945:Wound Healing
D003894:Deamino Arginine Vasopressin