Department of Urology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Int J Surg. 2017 Jul;43:17-25. doi: 10.1016/j.ijsu.2017.04.060. Epub 2017 May 15.
Phimosis and redundant prepuce are defined as the inability of the foreskin to be retracted behind the glans penis in uncircumcised males. To synthesize the evidence and provide the hierarchies of different circumcisions for phimosis and redundant prepuce, we performed an overall network meta-analysis (NMA) based on their comparative efficacy and safety.
Electronic databases including PubMed, Embase, Wan Fang, VIP, CNKI and CBM database were researched from randomized controlled trials (RCTs) for redundant prepuce or phimosis. We conducted the direct and indirect comparisons by aggregate data drug information system (ADDIS) software. Moreover, consistency models were applied to assess the differences among the male circumcision practices, and the ranks based on probabilities of intervention for the different endpoints were performed. Node-splitting analysis was used to test inconsistency.
Eighteen RCTs were included with 6179 participants. Compared with the conventional circumcision(CC), two new styles of circumcisions, the disposable circumcision suture device(DCSD) and Shang Ring circumcision(SRC), provided significantly shorter operation time[DCSD: standardized mean difference (SMD) = -20.60, 95% credible interval(CI) (-23.38, -17.82); SRC: SMD = -19.16, 95%CI (-21.86, -16.52)], shorter wound healing time [DCSD:SMD = -4.19, 95%CI (-8.24,-0.04); SRC: SMD = 4.55, 95%CI (1.62, 7.57); ] and better postoperative penile appearance [DCSD: odds ratios odds ratios (OR) = 11.42, 95%CI (3.60, 37.68); SRC: OR = 3.85,95%CI (1.29, 12.79)]. Additionally, DCSD showed a lower adverse events rate than other two treatments. However, no significant difference was shown in all surgeries for 24 h postoperative pain score. Node-splitting analysis showed that no significant inconsistency was existed (P > 0.05).
Based on the results of NMA, DCSD may be a most effective and safest choice for phimosis and redundant prepuce. DCSD has the advantages of a shorter operation time, better postoperative penile appearance, fewer complication and shorter wound healing time. However, with the limitations of our study, additional multi-center RCTs are needed to evaluate the outcomes.
包茎和多余包皮是指未行环切术的男性包皮无法向后退缩至龟头。为了综合评估各种环切术治疗包茎和多余包皮的疗效和安全性，我们进行了一项网状荟萃分析（NMA）。
检索PubMed、Embase、万方、维普、中国知网和中国生物医学文献数据库中关于包茎和多余包皮的随机对照试验（RCT），采用ADDIS 软件进行直接和间接比较。采用一致性模型评估不同男性环切术的差异，并根据不同结局的干预概率进行等级排列。采用节点分裂分析检验异质性。
纳入 18 项 RCT，共 6179 例患者。与传统环切术（CC）相比，一次性环切缝合器（DCSD）和商环环切术（SRC）的手术时间更短[DCSD：标准化均数差（SMD）=-20.60，95%可信区间（CI）（-23.38，-17.82）；SRC：SMD=-19.16，95%CI（-21.86，-16.52）]，伤口愈合时间更短[DCSD：SMD=-4.19，95%CI（-8.24，-0.04）；SRC：SMD=4.55，95%CI（1.62，7.57）]，术后阴茎外观更好[DCSD：比值比（OR）=11.42，95%CI（3.60，37.68）；SRC：OR=3.85，95%CI（1.29，12.79）]。此外，DCSD 的不良反应发生率低于其他两种治疗方法。然而，三种手术方式在 24 小时术后疼痛评分方面差异无统计学意义。节点分裂分析显示无显著异质性（P＞0.05）。
基于 NMA 的结果，DCSD 可能是治疗包茎和多余包皮最有效和最安全的选择。DCSD 具有手术时间短、术后阴茎外观好、并发症少、伤口愈合时间短等优点。然而，由于本研究的局限性，需要更多的多中心 RCT 来评估其结果。
