Buwembo DR, Musoke R, Kigozi G, Ssempijja V, Serwadda D, Makumbi F, Watya S, Namuguzi D, Nalugoda F, Kiwanuka N, Sewankambo NK, Wabwire-Mangen F, Kiggundu V, Wawer MJ, Gray RH
BJU Int. 2011 May 31. doi: 10.1111/j.1464-410X.2011.10259.x. [Epub ahead of print] PMID: 21627752
Abstract
Objective:
To assess the safety and efficiency of the dorsal slit and sleeve male circumcision (MC) procedures performed by physicians and clinical officers (COs).
Patients and methods:
We evaluated the time required for the MC procedure (efficiency) and moderate/severe adverse events (AEs) for MC (safety) by trained physicians and COs using the sleeve and dorsal slit MC methods in a service programme. Univariate and multiple regressions with robust variance estimation were used to assess factors associated with operative duration (linear) and AEs (logistic).
Results:
Six physicians and eight COs conducted 1934 and 3218 MCs, respectively; there were 2471 dorsal slit and 2681 sleeve MC procedures. The overall mean operative duration was 33 min for newly trained providers, which decreased to ≈20 min after ≈100 MCs. The adjusted mean operative duration for dorsal slit MC was significantly shorter than that for the sleeve MC method (Δ - 2.7 min, P < 0.001). The operative duration was longer for COs than physicians for the sleeve procedure, but not the dorsal slit procedure; however this difference reduced with increasing numbers of MCs completed. The unadjusted AE rates were 0.6% for dorsal slit MC and 1.4% for the sleeve method (P = 0.006) and 1.5% for physicians and 0.68% for COs (P = 0.003); however, there were no significant differences after multivariate adjustment. Use of bipolar cautery significantly reduced operative duration (Δ - 4.0 min, P = 0.008), but was associated with higher AE rates (adjusted odds ratio 2.13, 95% confidence interval 1.26-3.61, P = 0.005).
Conclusion:
The dorsal slit MC method is faster than sleeve resection and can be safely performed by non-physicians; however, use of bipolar cautery may be inadvisable in this setting.