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• W2155123831 abstract "No AccessJournal of UrologyAdult Urology1 Sep 2010No-Needle Local Anesthesia for Adult Male Circumcision Yifeng Peng, Puneet Masson, Philip S. Li, Yue Chang, Long Tian, Richard Lee, Howard Kim, David C. Sokal, and Marc Goldstein Yifeng PengYifeng Peng Department of Sexual Medicine, Yijishan Hospital-Wannan Medical College, Wuhu, People's Republic of China Equal study contribution. More articles by this author , Puneet MassonPuneet Masson Center for Male Reproductive Medicine and Microsurgery, Department of Urology and Institute of Reproductive Medicine, Weill Cornell Medical Center and The Population Council, Center for Biomedical Research, New York, New York Equal study contribution. More articles by this author , Philip S. LiPhilip S. Li Center for Male Reproductive Medicine and Microsurgery, Department of Urology and Institute of Reproductive Medicine, Weill Cornell Medical Center and The Population Council, Center for Biomedical Research, New York, New York More articles by this author , Yue ChangYue Chang Department of Urology, First Hospital of Ningbo, Ningbo University School of Medicine, Ningbo, People's Republic of China More articles by this author , Long TianLong Tian Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China More articles by this author , Richard LeeRichard Lee Center for Male Reproductive Medicine and Microsurgery, Department of Urology and Institute of Reproductive Medicine, Weill Cornell Medical Center and The Population Council, Center for Biomedical Research, New York, New York More articles by this author , Howard KimHoward Kim Center for Male Reproductive Medicine and Microsurgery, Department of Urology and Institute of Reproductive Medicine, Weill Cornell Medical Center and The Population Council, Center for Biomedical Research, New York, New York More articles by this author , David C. SokalDavid C. Sokal Family Health International, Research Triangle Park, North Carolina More articles by this author , and Marc GoldsteinMarc Goldstein Center for Male Reproductive Medicine and Microsurgery, Department of Urology and Institute of Reproductive Medicine, Weill Cornell Medical Center and The Population Council, Center for Biomedical Research, New York, New York More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.04.080AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We used a local anesthetic jet injection technique for adult male circumcision. This method eliminates needle use and may decrease the fear of local anesthetic injection used for male circumcision. Materials and Methods: We recruited 60 men seeking voluntary adult male circumcision into the study from June to September 2009. We used a MadaJet® Medical Injector to deliver a high pressure spray of 0.1 ml 2% plain lidocaine solution directly through the penile skin circumferentially around the proximal third of the penis. All men underwent circumcision using the Shang Ring™ and were evaluated for anesthetic safety, efficacy and acceptability. Pain was measured on a visual analog scale. Results: The average volume of 2% lidocaine anesthetic solution delivered by jet injection was 0.1 ml with a mean total of 0.9 ml per circumcision procedure. More than 85% of men did not require supplemental anesthesia. Anesthetic onset required approximately 45 seconds from the time that injections were completed. Mean pain scores for immediate postoperative, 24-hour postoperative, ring removal and post-ring removal events were 0.1, 6.8, 2.2 and 0.9, respectively. In 4 patients (6.67%) mild urethral bleeding resolved with pressure, resulting in technique modification. Conclusions: No-needle jet injection is safe and effective for adult MC. The technique efficiently delivers local anesthesia with rapid onset in men undergoing circumcision. This needle-free approach may enhance the popularity of adult male circumcision. References 1 : Complications of circumcision. Br J Surg1993; 80: 1231. Crossref, Medline, Google Scholar 2 : Circumcision: a consideration of some of the controversy. J Child Health Care2002; 6. Google Scholar 3 Male circumcision: global trends and determinants of prevalence, safety and acceptability: World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2007. http://data.unaids.org/pub/Report/2007/jc1360_male_circumcision_en.pdf. Accessed on March 4, 2009. Google Scholar 4 : Male circumcision and HIV infection: ten years and counting. Lancet1999; 354: 1813. 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Google Scholar 11 : High complication rates challenge the implementation of male circumcision for HIV prevention in Africa. Nat Clin Pract Urol2009; 6: 64. Google Scholar 12 : Adult circumcision. Am Fam Physician1999; 59: 1514. Google Scholar 13 Manual for male circumcision under local anesthesia version 2.5c: World Health Organization 2008. http://www.who.int/hiv/pub/malecircumcision/who_mc_local_anaesthesia.pdf. Accessed January 2008. Google Scholar 14 : Clinical application of a new device for minimally invasive circumcision. Asian J Androl2008; 10: 447. Google Scholar 15 : Adult circumcision under local anaesthetic. Br J Urol1995; 75: 96. Google Scholar 16 : Anesthesia for genitourinary surgery. In: Clinical Anesthesia. Edited by . Philadelphia: Lippincott1992: 1157. Google Scholar 17 : No-needle jet anesthetic technique for no-scalpel vasectomy. J Urol2005; 173: 1677. Link, Google Scholar 18 : A recommendable standard protocol of adult male circumcision with the Chinese Shang Ring: outcomes of 328 cases in China. Zhonghua Nan Ke Xue2009; 15: 584. Google Scholar 19 : The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain1983; 17: 45. Google Scholar 20 : Validity and sensitivity of visual analogue scales in young and older healthy subjects. Age Ageing1998; 27: 63. Google Scholar 21 : The efficacy and acceptability of using a jet injector in performing digital blocks. Am J Emerg Med1993; 11: 648. Google Scholar 22 : Painless intravenous catheterization by intradermal jet injection of lidocaine: a randomized trial. J Clin Anesth1999; 11: 87. Google Scholar 23 : Evaluation of a needle-free injection system for local anesthesia prior to venous cannulation. Anaesthesia2000; 55: 247. Google Scholar 24 : No-scalpel, no-needle vasectomy. Urology2006; 68: 9. Google Scholar © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 184Issue 3September 2010Page: 978-983 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Keywordsequipment and supplieslidocainepeniscircumcision, maleinjections, jetAcknowledgmentsAn English translation of a standardized surgical protocol for SR application is available.18MetricsAuthor Information Yifeng Peng Department of Sexual Medicine, Yijishan Hospital-Wannan Medical College, Wuhu, People's Republic of China Equal study contribution. More articles by this author Puneet Masson Center for Male Reproductive Medicine and Microsurgery, Department of Urology and Institute of Reproductive Medicine, Weill Cornell Medical Center and The Population Council, Center for Biomedical Research, New York, New York Equal study contribution. More articles by this author Philip S. Li Center for Male Reproductive Medicine and Microsurgery, Department of Urology and Institute of Reproductive Medicine, Weill Cornell Medical Center and The Population Council, Center for Biomedical Research, New York, New York More articles by this author Yue Chang Department of Urology, First Hospital of Ningbo, Ningbo University School of Medicine, Ningbo, People's Republic of China More articles by this author Long Tian Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China More articles by this author Richard Lee Center for Male Reproductive Medicine and Microsurgery, Department of Urology and Institute of Reproductive Medicine, Weill Cornell Medical Center and The Population Council, Center for Biomedical Research, New York, New York More articles by this author Howard Kim Center for Male Reproductive Medicine and Microsurgery, Department of Urology and Institute of Reproductive Medicine, Weill Cornell Medical Center and The Population Council, Center for Biomedical Research, New York, New York More articles by this author David C. Sokal Family Health International, Research Triangle Park, North Carolina More articles by this author Marc Goldstein Center for Male Reproductive Medicine and Microsurgery, Department of Urology and Institute of Reproductive Medicine, Weill Cornell Medical Center and The Population Council, Center for Biomedical Research, New York, New York More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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