V3-08: A Simplified No-Flip Shang Ring Circumcision Technique with Topical (EMLA) Anesthesia in Adolescents and Adults

Video

Introductions and Objectives
Numerous clinical and randomized controlled trials have confirmed that the Shang Ring is a safe, simple, and rapid method for performing adult and adolescent male circumcision. It has the potential to play an important role for reducing human immunodeficiency virus (HIV), human papillomavirus (HPV), and herpes simplex virus 2 (HSV-2) transmission in Africa. The advent of the no-flip Shang Ring circumcision procedure provides several advantages over the standard Shang Ring technique, such as eliminating the need to evert the foreskin over the inner ring and thus simplifying the overall technique. We now introduce the use of topical anesthesia will also eliminate the pain and morbidity associated with injectable anesthesia.

Methods
No-flip Shang Ring circumcision was performed on 183 males (142 adults, 41 adolescents) with topical EMLA anesthesia. Topical anesthesia was applied inside and around the foreskin and with a dwell time of 25 to 30 minutes prior to circumcision. After circumcision, patients were asked to assess their pain both during the procedure as well as 24 hours after the procedure using the visual analog scale (VAS).

Results
Mean no-flip Shang Ring circumcision procedural time was less than 4 minutes. Adolescents reported low pain scores during the Shang Ring circumcision with a mean VAS score of 2.3, despite 51% (n=21) of patients having a tight phimosis. 24 hour post-procedural pain remained low in these patients with a mean score of 2.7. Adult patients also reported low pain scores, with a mean VAS of 1.6 during circumcision and 2.2 24 hours post-procedure.

Conclusions
The no-flip Shang Ring circumcision can be successfully performed in a rapid fashion with topical EMLA anesthesia in adults and adolescents. Men undergoing this procedure experienced little pain during the procedure and minimal post-procedural pain.

Funding: None