A prospective evaluation of plastibell® circumcision in older children.
OBJECTIVE
Circumcision is one of the oldest surgical procedures and one of the most frequently performed worldwide. It can be done by many different techniques. This prospective series presents the results of Plastibell® circumcision in children older than 2 years of age, evaluating surgical duration, immediate and late complications, time for plastic device separation and factors associated with it.


METHODS
We prospectively analyzed 119 children submitted to Plastic Device Circumcision with Plastibell® by only one surgeon from December 2009 to June 2011. In all cases the surgery was done under general anesthesia associated with dorsal penile nerve block. Before surgery length of the penis and latero-lateral diameter of the glans were measured. Surgical duration, time of Plastibell® separation and use of analgesic medication in the post-operative period were evaluated. Patients were followed on days 15, 45, 90 and 120 after surgery.


RESULTS
Age at surgery varied from 2 to 12.5 (5.9 ± 2.9) years old. Mean surgical time was 3.7 ± 2.0 minutes (1.9 to 9 minutes). Time for plastic device separation ranged from 6 to 26 days (mean: 16 ± 4.2 days), being 14.8 days for children younger than 5 years of age and 17.4 days for those older than 5 years of age (p < 0.0001). The diameter of the Plastibell® does not interfered in separations time (p = 0,484). Late complications occurred in 32 (26.8%) subjects, being the great majority of low clinical significance, especially prepucial adherences, edema of the mucosa and discrete hypertrophy of the scar, all resolving with clinical treatment. One patient still using diaper had meatus stenosis and in one case the Plastibell® device stayed between the glans and the prepuce and needed to be removed manually.


CONCLUSIONS
Circumcision using a plastic device is a safe, quick and an easy technique with low complications, that when occur are of low clinical importance and of easy resolution. The mean time for the device to fall is shorter in children under 6 years of age and it is not influenced by the diameter of the device.
Division of Urology, Department of Surgery Federal University of Juiz de Fora, Juiz de Fora, MG.
José Murillo
JM
Bastos Netto
José
J
Gonçalves de Araújo
Marcos Flávio de Almeida
MF
Noronha
Bruno Rezende
BR
Passos
Humberto Elias
HE
Lopes
José de
Jd
Bessa
André Avarese
AA
Figueiredo
D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design / Q000009:adverse effects; D006801:Humans; D008297:Male; D061646:Operative Time; D009929:Organ Size; D010413:Penis / Q000033:anatomy & histology / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome