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Meatal stenosis following three types of circumcision with frenular artery preservation (FAP), the Plastibell device (PD), and frenular artery ligation (FAL): a long-term follow-up

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Abstract

Background

Despite the simplicity of male circumcision, complications occur frequently. Post-circumcision meatal stenosis is a concerning complication that might require several interventions.

Aim

This study aims to evaluate the incidence of meatal stenosis in long-term follow-up, following three common circumcision methods: frenular artery preservation, frenular ligation, and the Plastibell device.

Methods

This study is the continuation of the previous randomized clinical trial, the preliminary abstract of which has been accepted in the annual meeting of the American Urological Association in 2011. However, in this paper, we only included the patients with results of long-term follow-up. Patients were followed for a median of 11 years (range, 7–17). Follow-ups were recorded by evaluation of meatus and signs and symptoms of meatal stenosis.

Results

Two hundred six boys (80 neonates and 126 non-neonates) at the time of procedure were included in this study. The circumcision was conducted on 23.3% (48/206) of boys with the Plastibell device (PD) and 39.3% (81/206) of cases with frenular artery preservation (FAP) and 37.4% (77/206) of cases with frenular artery ligation (FAL). Meatal stenosis presented in 13 children during follow-up. Considering the three methods of circumcision, a significant difference in the incidence of meatal stenosis among the types of circumcisions was observed (6.3% in PD and 1.2% in FAP, 11.7% in FAL, P = 0.026).

Conclusion

The present study revealed that the technique preserving the frenular artery is associated with a significantly lower incidence of meatal stenosis. Hence, the FAP is the recommended technique for circumcision as compared to two other methods.

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Data availability

All data generated or analyzed during this study are included in this article and its table and figures. Further enquiries can be directed to the corresponding author.

Abbreviations

FAP:

Frenular artery preservation

PD:

Plastibell device

FAL:

Frenular artery ligation

MC:

Male circumcision

MS:

Meatal stenosis

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Acknowledgements

We highly appreciate S. Lotfi for their continuous support. We would like to show our sincere gratitude to the cooperation of all the participants at the Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science.

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Authors and Affiliations

  1. Department of Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran

    Zahra Shokri Varniab, Ashkan Pourabhari Langroudi, Afarin Neishabouri, Parham Torabinavid, Mona Arbab, Firouzeh Heidari, Seyed Mohammad Milani, Sahar Eftekharzadeh, Shabnam Sabetkish & Abdol-Mohammad Kajbafzadeh

  2. Department of Radiation Oncology, Indiana University, Indianapolis, IN, USA

    Mona Arbab

Authors
  1. Zahra Shokri Varniab
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  2. Ashkan Pourabhari Langroudi
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  10. Abdol-Mohammad Kajbafzadeh
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Contributions

Study conception and design, Abdol-Mohammad Kajbafzadeh and Seyed Mohammad Milani. Data acquisition, Abdol-Mohammad Kajbafzadeh, Seyed Mohammad Milani, Firouzeh Heidari, and Mona Arbab. Analysis and data interpretation, Zahra Shokri Varniab, Ashkan Pourabhari Langroudi, and Afarin Neishabouri. Drafting of the manuscript, Zahra Shokri Varniab, Ashkan Pourabhari Langroudi, and Sahar Eftekharzadeh. Critical revision, Zahra Shokri Varniab, Ashkan Pourabhari Langroudi, Afarin Neishabouri, Abdol-Mohammad Kajbafzadeh, Sahar Eftekharzadeh, Mona Arbab, and Parham Torabinavid.

Corresponding author

Correspondence to Abdol-Mohammad Kajbafzadeh.

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Ethics approval

We followed the principles of the Helsinki Declaration at all stages. After explaining the goals of the study, informed consent was obtained from the children’s parents or their legal guardians. This study was approved by the ethics committee of the affiliated medical school.

Competing interests

The authors declare no competing interests.

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Shokri Varniab, Z., Pourabhari Langroudi, A., Neishabouri, A. et al. Meatal stenosis following three types of circumcision with frenular artery preservation (FAP), the Plastibell device (PD), and frenular artery ligation (FAL): a long-term follow-up. Ir J Med Sci 192, 707–711 (2023). https://doi.org/10.1007/s11845-022-03040-8

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