Complication from plastibell circumcision ring

doi:10.1016/0090-4295(77)90286-2

Urology

Volume 9, Issue 1, January 1977, Pages 57-58

https://doi.org/10.1016/0090-4295(77)90286-2 Get rights and content

Abstract

We describe the cases of 4 neonates with retained Plastibell rings and discuss the potential seriousness of this problem. Removal of the rings was accomplished by use of wire cutters. Local wound care resulted in perfect healing in 3 and slight scarring with ventral curvature in 1. None of these patients required skin grafting.

References (2)

G. Jonas
Retention of a Plastibell circumcision ring
Obstet. Gynecol.
(1964)
M.M. Rubenstein et al.
Complication of circumcision done with a plastic bell clamp
Am. J. Dis. Child.
(1968)

Cited by (18)

Neonatal plastibell circumcision: does the thread type matter? a prospective randomized study
2019, Journal of Pediatric Urology
Citation Excerpt :
The commonly available Plastibell is packed with a cotton thread to be tied around the ring to induce ischemia of the foreskin at the intended site of circumcision. The reported cases of complications of Plastibell, such as bleeding or a retained ring with subsequent penile edema and ischemia, are due to either the technique or the device [2,4–9]. Utilizing a safe technique with careful selection of Plastibell size reduces the complications [2,5,10].
Plastibell is one of the most common disposable devices used for circumcision. The study aims to determine whether changing the thread type from cotton to polypropylene to tie around the Plastibell in neonatal circumcision would result in faster separation of the ring.
Prospective, randomized, clinical and biomechanical studies were performed. All circumcisions were performed by a single surgeon. Data collected included anthropometric measures, demographic data, procedure time, complications, parent satisfaction, follow-up, and outcomes. The biomechanical study measured the tensile properties of both threads using a universal testing machine (4465; Instron, Norwood, MA).
Two hundred full-term, male neonates aged between 24 and 48 h were circumcised using Plastibell. Both groups were similar in gestational age, age at circumcision, body weight, height, head circumference, Apgar score at 1 and 5 min, procedure time, Plastibell size, and parent satisfaction. The subjects were randomized into two groups of 100 neonates each: group I where Plastibell was tied by a cotton thread supplied by the manufacturer and group II where Plastibell was tied by Polypropylene 0. The mean duration for Plastibell fall-off was 8.98 days and 7.74 days in cotton thread and Polypropylene 0, respectively (P-value < 0.001). There was no difference regarding the complications for both groups. The diameters of the cotton and Polypropylene 0 threads were 0.68 mm and 0.35 mm, respectively. The measured tensile strengths of cotton and Polypropylene thread were 180 MPa and 457 MPa, respectively.
Plastibell tied by Polypropylene 0 fell off faster than that tied by cotton thread, with no significant differences in adverse effects or complications. This finding might be relevant for anxious parents and caregivers. Further studies are needed to examine other types and sizes of threads to investigate whether this separation period can be reduced further.
A report of 918 cases of circumcision with the shang ring: Comparison between children and adults
2013, Urology
Citation Excerpt :
The Plastibell technique, which was reported in 1965, was the first circumcision using a clinical device. The procedure involves placing a ring around the corona of glans penis and ligation using elastic thread, which would stop the blood supply to the foreskin.10-12 However, in this procedure, the ring is placed around the corona of glans penis without flipping the foreskin and the tension of the elastic thread is hard to adjust appropriately; therefore, the procedure can cause complications, such as glans necrosis.13
To compare the clinical outcome and surgical complications in circumcision using the Shang Ring between children and adults.
Circumcision using the Shang Ring was performed on 702 adults and 216 children. Comparative analysis on indices including operative time, healing time, postoperative edema, postoperative bleeding, postoperative pain, and postoperative infection was conducted.
When the ring was removed after surgery, the pain was tolerable in the adult group, but more substantial in the child group. The optimal time for removing the ring was 2 weeks after surgery.
Special attention to the pain management is needed when using the Shang Ring to treat redundant foreskin or phimosis in children. The timing of the ring removal is critical to avoiding complications. Surgeons' knowledge in urology is also critical to the clinical outcome.
Prospective randomized trial comparing dissection with Plastibell <sup>®</sup> circumcision
2010, Journal of Pediatric Urology
Citation Excerpt :
In our study, we chose the double-incision (sleeve) technique for the dissection circumcision group because it is used in our service, even for adolescents and adults. As only three studies [13–15] have compared these techniques, and the most recent published reported a group of infants only, and there are many reports on complications with the Plastibell® device [22–26], a comparison of the two techniques was considered important. To make sure that the groups were balanced we included in both only boys with penis and glans sizes that could fit a Plastibell® device.
To compare and evaluate dissection and Plastibell^® circumcision techniques for the treatment of phimosis.
In 2006–2007, 125 children were submitted to circumcision by the same surgeon. The children were randomly divided into two groups (PD: Plastibell^® and DC: dissection). In both groups the surgery was performed under general anesthesia and dorsal penile block. The dissection circumcision used the double circular incision technique. Follow-up was done on days 15, 45 and 90 after surgery.
Sixty-eight patients were included in DC and 57 in PD. The mean age at surgery was 71.76 ± 31.56 months for DC and 70.95 ± 31.73 months for PD. There was no difference in Kayaba's classification for phimosis or indication for surgery between the groups. Surgical time for DC was 14.64 ± 1.93 min and for PD 3.29 ± 1.48 min (P < 0.001). The incidence of immediate complications was similar, but late complications, especially adhesions, were greater in DC (P < 0.01). The use of pain medication (paracetamol) was similar during the first 2 days after surgery, but was greater in PD from the 3rd day after surgery (P < 0.05).
Plastibell^® circumcision has a shorter surgical duration with fewer late complications, but requires more analgesic medication after the 3rd day post surgery.
Pediatric Urology: Newborn Penile Glans Amputation During Circumcision and Successful Reattachment
1995, The Journal of Urology
Penile denudation injuries after circumcision
1985, Journal of Urology
Tourniquet syndrome caused by metallic bands: A new tool for removal
1982, Annals of Emergency Medicine
Reported are two cases of metallic constricting devices presenting to our emergency department. A 40-year-old man was unable to remove a steel ring from his engorged penile shaft after autostimulation, and a 22-year-old man riveted a metallic nut onto his right index finger proximal to his distal interphalangeal joint. Both metallic devices were successfully removed by a new, easily managed, and readily available tool called the “Dremel MotoTool Kit” Cat. #280. Constricting devices around digits or the penis are not uncommon problems. Because of the inherent dangers and sequelae of delay in treatment, it is imperative that the removal of these devices is expedited.

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^☆: Presented at the Annual Meeting of Western Section, American Urological Association, Portland, Oregon, April 13–17, 1975.

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Case reportComplication from plastibell circumcision ring☆

Abstract

Retention of a Plastibell circumcision ring

Obstet. Gynecol.

Complication of circumcision done with a plastic bell clamp

Am. J. Dis. Child.

Case report
Complication from plastibell circumcision ring☆