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A modified Shang Ring circumcision surgical technique under local anesthesia for penile torsion in children.

作者信息

Zhao Shimeng, Jia Pengyu, Chai Hongchao, Qi Can, Xin Chaojun, Zhou Yun

机构信息

Department of Urology, Hebei Children's Hospital, Shijiazhuang, China.

Medical Records Room, Hebei Children's Hospital, Shijiazhuang, China.

出版信息

Transl Androl Urol. 2025 Mar 30;14(3):602-609. doi: 10.21037/tau-2024-698. Epub 2025 Mar 26.


DOI:10.21037/tau-2024-698
PMID:40226052
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11986521/
Abstract

BACKGROUND: Penile torsion is a congenital condition characterized by the rotation of the penis along its longitudinal axis. This study aimed to describe a modified Shang Ring circumcision (SRC) surgical technique as a simple and effective approach for correcting penile torsion in children under local anesthesia. METHODS: From July 2018 to August 2023, 20 male children with penile torsion underwent the modified SRC technique under local anesthesia, performed by the same surgeon (S.Z.). In our technique, the inner ring of the Shang Ring is placed over the glans penis, while the outer ring is positioned over the outer layer of the foreskin and secured by the first notch of the outer ring. The foreskin is held in place in a semi-locked state between the inner and outer rings. The frenulum is adjusted to achieve mild overcorrection, positioning the urethral opening between the 6 and 7 o'clock positions to correct penile torsion. A good surgical outcome is defined as a postoperative penile torsion angle of less than 30 degrees, while a poor surgical outcome is one with a postoperative penile torsion angle greater than 30 degrees. RESULTS: All cases involved counterclockwise penile torsion, and surgeries, performed under local anesthesia, with an average surgical time of 8.55±1.61 minutes. The preoperative median angle of penile torsion was 45 [45, 60] degrees, with a maximum torsion angle of 60 degrees. The average time for the Shang Ring to fall off was 23.10±6.38 days. Three cases of the Shang Ring did not naturally fall off and were manually removed 30 days post-surgery. After the Shang Ring removal, the median penile torsion angle at follow-up was 10 [0, 10] degrees, with a median correction angle of 42.5 [35, 48.75] degrees. The average follow-up time was 2.06±0.74 years. At the last follow-up, the median penile torsion angle was 10 [0, 10] degrees, with a median correction angle of 42.5 [35, 50] degrees. No significant difference was observed in the postoperative torsion angle between the mild and moderate torsion patients, both after Shang Ring removal and at the last follow-up (P>0.05). All patients had good surgical outcomes. CONCLUSIONS: The modified SRC technique is feasible, safe, and effective for correcting mild to moderate penile torsion under local anesthesia, offering a new surgical option for children.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/06db/11986521/3655dd6c85b1/tau-14-03-602-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/06db/11986521/0451df2fa1d6/tau-14-03-602-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/06db/11986521/3655dd6c85b1/tau-14-03-602-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/06db/11986521/0451df2fa1d6/tau-14-03-602-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/06db/11986521/3655dd6c85b1/tau-14-03-602-f2.jpg

相似文献

[1]
A modified Shang Ring circumcision surgical technique under local anesthesia for penile torsion in children.

Transl Androl Urol. 2025-3-30

[2]
[Shang Ring circumcision by transverse incision in the distal penis foreskin and pull-up of the interior board for short frenulum praeputii].

Zhonghua Nan Ke Xue. 2014-4

[3]
[Application of disposable oval circumcision anastomat in pediatric urology].

Zhonghua Yi Xue Za Zhi. 2019-1-8

[4]
Correction of penile torsion and chordee by mobilization of urethra with spongiosum in chordee without hypospadias.

J Pediatr Urol. 2014-7-22

[5]
[Novel no-flip Shang Ring circumcision for adult males: a clinical application study of 528 cases].

Zhonghua Nan Ke Xue. 2014-8

[6]
Isolated penile torsion in newborns.

Can Urol Assoc J. 2015

[7]
Is The Dorsal Dartos Flap Rotation Technique Successful in Children with Isolated Penile Torsion?

Urol J. 2024-8-18

[8]
Single-Stage Pedicle Preputial Tube Substitution Urethroplasty with Corpora Cavernosa Augmentation Using Buccal Mucosa Graft for Primary Peno-Scrotal Hypospadias Re-pair in Adults.

Int Braz J Urol. 2025

[9]
The Fisher Technique for Correction of Penile Torsion in Children: Who Are the Candidates?

Urology. 2017-6

[10]
[Circumcision with no-flip Shang Ring technique for adult males: analysis of 168 cases].

Zhonghua Nan Ke Xue. 2014-4

本文引用的文献

[1]
The Effect of Different Doses of Ropivacaine for Caudal Block in School-aged Children Undergoing Shang Ring Circumcision.

J Perianesth Nurs. 2025-4

[2]
Is The Dorsal Dartos Flap Rotation Technique Successful in Children with Isolated Penile Torsion?

Urol J. 2024-8-18

[3]
Isolated Severe Congenital Penile Torsion of 180 Degrees.

Indian Pediatr. 2024-4-15

[4]
Association between male circumcision and human papillomavirus infection in males and females: a systematic review, meta-analysis, and meta-regression.

Clin Microbiol Infect. 2023-8

[5]
Voluntary Medical Male Circumcisions for HIV Prevention - 13 Countries in Eastern and Southern Africa, 2017-2021.

MMWR Morb Mortal Wkly Rep. 2023-3-10

[6]
Cost-effectiveness of voluntary medical male circumcision for HIV prevention across sub-Saharan Africa: results from five independent models.

Lancet Glob Health. 2023-2

[7]
Comparative analysis on the outcomes in circumcising children using modified Chinese ShangRing and conventional surgical circumcision.

Pediatr Surg Int. 2022-12-23

[8]
Effects of COVID-19 Pandemic on Voluntary Medical Male Circumcision Services for HIV Prevention, Sub-Saharan Africa, 2020.

Emerg Infect Dis. 2022-12

[9]
ShangRing versus Mogen clamp for early infant male circumcision in eastern sub-Saharan Africa: a multicentre, non-inferiority, adaptive, randomised controlled trial.

Lancet Glob Health. 2022-10

[10]
Adolescent male genitalia dissatisfaction: a surgical perspective.

Asian J Androl. 2022

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