ReviewComparative efficacy and safety of different circumcisions for patients with redundant prepuce or phimosis: A network meta-analysis

- The effect of three circumcisions (CC, SRC and DCSD) on redundant prepuce or phimosis has not been conclusively studied in previous researches.
- The study had collected high-quality RCTs in order to conduct an overall NMA for comparative safety and efficacy in three treatments.
- The analysis shows a significant increase in the satisfaction of postoperative penile appearance after the therapy of novel circumcisions (SRC, DCSD), comparing with CC.
- The network meta-analysis confirmed that the disposable circumcision suture device could be the best choice for patients with phimosis or redundant prepuce.

BackgroundPhimosis 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.Material and methodsElectronic 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.ResultsEighteen 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).ConclusionsBased 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.