The Experts below are selected from a list of 1086 Experts worldwide ranked by ideXlab platform

Yu-chun Zhu - One of the best experts on this subject based on the ideXlab platform.

  • circumcision with no flip shang ring and Dorsal Slit methods for adult males a single centered prospective clinical study
    Asian Journal of Andrology, 2016
    Co-Authors: Jun-hao Lei, Liang-ren Liu, Qiang Wei, Wen-ben Xue, Tu-run Song, Shi-bing Yan, Lu Yang, Ping Han, Yu-chun Zhu
    Abstract:

    This paper was aimed to compare the clinical effectiveness and safety of adult male circumcision using the Shang Ring™ (SR) with the no-flip technique compared with Dorsal Slit (DS) surgical method. A single-centered, prospective study was conducted at the West China Hospital, where patients were circumcised using the no-flip SR (n = 408) or the DS (n = 94) procedure. The adverse events (AEs) and satisfaction were recorded for both groups, and ring-removal time and percentage of delayed removals were recorded for the SR group. Finally, complete follow-up data were collected for 76.1% of patients (SR: n = 306; DS: n = 76). The average ring-removal time for the SR group was 17.62 ± 6.30 days. The operation time (P < 0.001), pain scores during the procedure (P < 0.001) and at 24 h postoperatively (P < 0.001), bleeding (P = 0.001), infection (P = 0.034), and satisfaction with penile appearance (P < 0.001) in the SR group were superior to those in the DS group. After two postoperative weeks, the percentage of patients with edema in the SR group (P = 0.029) was higher but no differences were found at 4 weeks (P = 0.185) between the two groups. In conclusions, the no-flip SR method was found to be superior to the DS method for its short operation time (<5 min), involving less pain, bleeding, infection, and resulting in a satisfactory appearance. However, the time for recovery from edema took longer, and patients may wear device for 2-3 weeks after the procedure.

  • Circumcision with "no-flip Shang Ring" and "Dorsal Slit" methods for adult males: a single-centered, prospective, clinical study
    Wolters Kluwer Medknow Publications, 2016
    Co-Authors: Jun-hao Lei, Liang-ren Liu, Qiang Wei, Wen-ben Xue, Tu-run Song, Shi-bing Yan, Lu Yang, Ping Han, Yu-chun Zhu
    Abstract:

    This paper was aimed to compare the clinical effectiveness and safety of adult male circumcision using the Shang Ring™ (SR) with the no-flip technique compared with Dorsal Slit (DS) surgical method. A single-centered, prospective study was conducted at the West China Hospital, where patients were circumcised using the no-flip SR (n = 408) or the DS (n = 94) procedure. The adverse events (AEs) and satisfaction were recorded for both groups, and ring-removal time and percentage of delayed removals were recorded for the SR group. Finally, complete follow-up data were collected for 76.1% of patients (SR: n = 306; DS: n = 76). The average ring-removal time for the SR group was 17.62 ± 6.30 days. The operation time (P < 0.001), pain scores during the procedure (P < 0.001) and at 24 h postoperatively (P < 0.001), bleeding (P = 0.001), infection (P = 0.034), and satisfaction with penile appearance (P < 0.001) in the SR group were superior to those in the DS group. After two postoperative weeks, the percentage of patients with edema in the SR group (P = 0.029) was higher but no differences were found at 4 weeks (P = 0.185) between the two groups. In conclusions, the no-flip SR method was found to be superior to the DS method for its short operation time (

Godfrey Kigozi - One of the best experts on this subject based on the ideXlab platform.

  • The Safety and Acceptance of the PrePex Device for Non- Surgical Adult Male Circumcision in Rakai, Uganda. A Non-Randomized Observational Study
    2016
    Co-Authors: Godfrey Kigozi, Richard Musoke, Stephen Watya, Nehemia Kighoma, James Nkale, Mary Nakafeero, Dan Namuguzi, David Serwada, Fred Nalugoda, Nelson Sewankambo
    Abstract:

    Objectives: To assess the safety and acceptance of the PrePex device for medical male circumcision (MMC) in rural Uganda. Methods: In an observational study, HIV-uninfected, uncircumcised men aged 18 and older who requested elective MMC were informed about the PrePex and Dorsal Slit methods and offered a free choice of their preferred procedure. 100 men received PrePex to assess preliminary safety (aim 1). An additional 329 men, 250 chose PrePex and 79 chose Dorsal Slit, were enrolled following approval by the Safety Monitoring Committee (aim 2). Men were followed up at 7 days to assess adverse events (AEs) and to remove the PrePex device. Wound healing was assessed at 4 weeks, with subsequent weekly follow up until completed healing. Results: The PrePex device was contraindicated in 5.7 % of men due to a tight prepuce or phimosis/adhesions. Among 429 enrolled men 350 (82.0%) got the PrePex device and 79 (18.0%) the Dorsal Slit procedure. 250 of 329 men (76.0%) who were invited to choose between the 2 procedures chose Prepex. There were 9 AEs (2.6%) with the PrePex, of which 5 (1.4%) were severe complications, 4 due to patient self-removal of the device leading to edema and urinary obstruction requiring emergency surgical circumcision, and one due to wound dehiscence following device removal. 71.8 % of men reported an unpleasant odor prior to PrePex removal. Cumulative rates of completed wound healing with the PrePex were 56.7 % a

  • the safety and acceptance of the prepex device for non surgical adult male circumcision in rakai uganda a non randomized observational study
    PLOS ONE, 2014
    Co-Authors: Godfrey Kigozi, Richard Musoke, Stephen Watya, Nehemia Kighoma, James Nkale, Mary Nakafeero, Dan Namuguzi, David Serwada, Fred Nalugoda, Nelson K Sewankambo
    Abstract:

    Objectives To assess the safety and acceptance of the PrePex device for medical male circumcision (MMC) in rural Uganda. Methods In an observational study, HIV-uninfected, uncircumcised men aged 18 and older who requested elective MMC were informed about the PrePex and Dorsal Slit methods and offered a free choice of their preferred procedure. 100 men received PrePex to assess preliminary safety (aim 1). An additional 329 men, 250 chose PrePex and 79 chose Dorsal Slit, were enrolled following approval by the Safety Monitoring Committee (aim 2). Men were followed up at 7 days to assess adverse events (AEs) and to remove the PrePex device. Wound healing was assessed at 4 weeks, with subsequent weekly follow up until completed healing. Results The PrePex device was contraindicated in 5.7% of men due to a tight prepuce or phimosis/adhesions. Among 429 enrolled men 350 (82.0%) got the PrePex device and 79 (18.0%) the Dorsal Slit procedure. 250 of 329 men (76.0%) who were invited to choose between the 2 procedures chose Prepex. There were 9 AEs (2.6%) with the PrePex, of which 5 (1.4%) were severe complications, 4 due to patient self-removal of the device leading to edema and urinary obstruction requiring emergency surgical circumcision, and one due to wound dehiscence following device removal. 71.8% of men reported an unpleasant odor prior to PrePex removal. Cumulative rates of completed wound healing with the PrePex were 56.7% at week 4, 84.8% week 5, 97.6% week 6 and 98.6% week 7, compared to 98.7% at week 4 with Dorsal Slit (p<0.0001). Conclusion The PrePex device was well accepted, but healing was slower than with Dorsal Slit surgery. Severe complications, primarily following PrePex self-removal, required rapid access to emergency surgical facilities. The need to return for removal and delayed healing may increase Program cost and client burden.

  • Characteristics and behaviors of men who received the PrePex or Dorsal Slit circumcision.
    2014
    Co-Authors: Godfrey Kigozi, Richard Musoke, Stephen Watya, Nehemia Kighoma, James Nkale, Mary Nakafeero, Dan Namuguzi, David Serwada, Fred Nalugoda, Nelson Sewankambo
    Abstract:

    Characteristics and behaviors of men who received the PrePex or Dorsal Slit circumcision.

  • male circumcision wound healing in human immunodeficiency virus hiv negative and hiv positive men in rakai uganda
    BJUI, 2014
    Co-Authors: Godfrey Kigozi, Richard Musoke, Stephen Watya, James Nkale, Fred Nalugoda, David Serwadda, Nehemiah Kighoma, Noah Kiwanuka, Fred Wabwiremangen, Frederick Makumbi
    Abstract:

    OBJECTIVE: To assess completed wound healing after medical male circumcision (MMC) among human immunodeficiency virus (HIV)-negative and HIV-positive men with cluster of differentiation 4 (CD4) counts of /=350 cells/mm(3) as minimal data are available on the safety of MMC among HIV-positive men with low CD4 counts. PATIENTS AND METHODS: In all 262 HIV-negative and 177 HIV-positive consenting males aged >/=12 years accepted MMC using the Dorsal Slit procedure and were enrolled in the study. Socio-demographic and behavioural data and blood for HIV testing and CD4 counts were collected at baseline. Participants were followed weekly to collect information on resumption of sex condom use and both self-reported and clinically assessed wound healing. The proportions healed among HIV-positive men were compared with HIV-negative men. Time to complete wound healing was assessed by Kaplan-Meier survival analysis. RESULTS: There were no statistically significant differences in the proportion of men healed by HIV status. At 4 weeks the proportions healed were 85.9% in HIV-negative men 77.4% in HIV-positive men with a CD4 count of >/=350 cells/mm(3) and 87.1% in HIV-positive men with a CD4 count of /=350 cells/mm(3) (P = 0.052) and 7.8% (P = 0.081) among HIV-negative men. CONCLUSION: Inclusion of HIV-positive men with low CD4 counts in MMC services is not deleterious to postoperative wound healing. (c) 2013 The Authors. BJU International (c) 2013 BJU International.

  • the acceptability and safety of the shang ring for adult male circumcision in rakai uganda
    Journal of Acquired Immune Deficiency Syndromes, 2013
    Co-Authors: Godfrey Kigozi, Richard Musoke, Stephen Watya, Fred Nalugoda, David Serwadda, Nehemiah Kighoma, Paschal Ssebbowa, Frederick Makumbi, Richard K Lee, Marc Goldstein
    Abstract:

    OBJECTIVES Medical male circumcision (MMC) is recommended for HIV prevention in men. We assessed the acceptability and safety of the Shang Ring device compared with those of the Dorsal Slit method. METHODS HIV-negative, uncircumcised men aged 18 years or older who requested free MMC services in rural Rakai, Uganda, were informed about the Shang Ring and Dorsal Slit procedures and offered a free choice of procedure. Men were followed at 7 days postoperatively to assess adverse events related to surgery and to remove the Shang Ring. Wound healing was assessed at 4 weeks postoperatively. RESULTS Six hundred twenty-one men were enrolled, of whom 508 (81.8%) chose the Shang Ring and 113 the Dorsal Slit. The Shang Ring was provided to 504 men, among whom there were 4 failures of Ring placement (0.8%) that required surgical hemostasis and wound closure. Five hundred men received the Shang Ring and postoperative surgery-related moderate adverse events were 1.0%, compared with 0.8% among Dorsal Slit recipients. Complete wound healing at 4 weeks was 84% with the Ring and 100% with the Dorsal Slit (P < 0001). Resumption of intercourse before 4 weeks was 7.0% with the Ring and 15.0% with the Dorsal Slit (P = 0.01.) The mean time for surgery was 6.1 minutes with the Ring and 17.7 minutes with the Dorsal Slit. The mean time for Ring removal was 2.2 minutes. CONCLUSIONS The Shang Ring is highly acceptable and safe in this setting, and could improve the efficiency of MMC services. However, back-up surgical services are needed in cases of Ring placement failures.

Jun-hao Lei - One of the best experts on this subject based on the ideXlab platform.

  • circumcision with no flip shang ring and Dorsal Slit methods for adult males a single centered prospective clinical study
    Asian Journal of Andrology, 2016
    Co-Authors: Jun-hao Lei, Liang-ren Liu, Qiang Wei, Wen-ben Xue, Tu-run Song, Shi-bing Yan, Lu Yang, Ping Han, Yu-chun Zhu
    Abstract:

    This paper was aimed to compare the clinical effectiveness and safety of adult male circumcision using the Shang Ring™ (SR) with the no-flip technique compared with Dorsal Slit (DS) surgical method. A single-centered, prospective study was conducted at the West China Hospital, where patients were circumcised using the no-flip SR (n = 408) or the DS (n = 94) procedure. The adverse events (AEs) and satisfaction were recorded for both groups, and ring-removal time and percentage of delayed removals were recorded for the SR group. Finally, complete follow-up data were collected for 76.1% of patients (SR: n = 306; DS: n = 76). The average ring-removal time for the SR group was 17.62 ± 6.30 days. The operation time (P < 0.001), pain scores during the procedure (P < 0.001) and at 24 h postoperatively (P < 0.001), bleeding (P = 0.001), infection (P = 0.034), and satisfaction with penile appearance (P < 0.001) in the SR group were superior to those in the DS group. After two postoperative weeks, the percentage of patients with edema in the SR group (P = 0.029) was higher but no differences were found at 4 weeks (P = 0.185) between the two groups. In conclusions, the no-flip SR method was found to be superior to the DS method for its short operation time (<5 min), involving less pain, bleeding, infection, and resulting in a satisfactory appearance. However, the time for recovery from edema took longer, and patients may wear device for 2-3 weeks after the procedure.

  • Circumcision with "no-flip Shang Ring" and "Dorsal Slit" methods for adult males: a single-centered, prospective, clinical study
    Wolters Kluwer Medknow Publications, 2016
    Co-Authors: Jun-hao Lei, Liang-ren Liu, Qiang Wei, Wen-ben Xue, Tu-run Song, Shi-bing Yan, Lu Yang, Ping Han, Yu-chun Zhu
    Abstract:

    This paper was aimed to compare the clinical effectiveness and safety of adult male circumcision using the Shang Ring™ (SR) with the no-flip technique compared with Dorsal Slit (DS) surgical method. A single-centered, prospective study was conducted at the West China Hospital, where patients were circumcised using the no-flip SR (n = 408) or the DS (n = 94) procedure. The adverse events (AEs) and satisfaction were recorded for both groups, and ring-removal time and percentage of delayed removals were recorded for the SR group. Finally, complete follow-up data were collected for 76.1% of patients (SR: n = 306; DS: n = 76). The average ring-removal time for the SR group was 17.62 ± 6.30 days. The operation time (P < 0.001), pain scores during the procedure (P < 0.001) and at 24 h postoperatively (P < 0.001), bleeding (P = 0.001), infection (P = 0.034), and satisfaction with penile appearance (P < 0.001) in the SR group were superior to those in the DS group. After two postoperative weeks, the percentage of patients with edema in the SR group (P = 0.029) was higher but no differences were found at 4 weeks (P = 0.185) between the two groups. In conclusions, the no-flip SR method was found to be superior to the DS method for its short operation time (

Richard Musoke - One of the best experts on this subject based on the ideXlab platform.

  • The Safety and Acceptance of the PrePex Device for Non- Surgical Adult Male Circumcision in Rakai, Uganda. A Non-Randomized Observational Study
    2016
    Co-Authors: Godfrey Kigozi, Richard Musoke, Stephen Watya, Nehemia Kighoma, James Nkale, Mary Nakafeero, Dan Namuguzi, David Serwada, Fred Nalugoda, Nelson Sewankambo
    Abstract:

    Objectives: To assess the safety and acceptance of the PrePex device for medical male circumcision (MMC) in rural Uganda. Methods: In an observational study, HIV-uninfected, uncircumcised men aged 18 and older who requested elective MMC were informed about the PrePex and Dorsal Slit methods and offered a free choice of their preferred procedure. 100 men received PrePex to assess preliminary safety (aim 1). An additional 329 men, 250 chose PrePex and 79 chose Dorsal Slit, were enrolled following approval by the Safety Monitoring Committee (aim 2). Men were followed up at 7 days to assess adverse events (AEs) and to remove the PrePex device. Wound healing was assessed at 4 weeks, with subsequent weekly follow up until completed healing. Results: The PrePex device was contraindicated in 5.7 % of men due to a tight prepuce or phimosis/adhesions. Among 429 enrolled men 350 (82.0%) got the PrePex device and 79 (18.0%) the Dorsal Slit procedure. 250 of 329 men (76.0%) who were invited to choose between the 2 procedures chose Prepex. There were 9 AEs (2.6%) with the PrePex, of which 5 (1.4%) were severe complications, 4 due to patient self-removal of the device leading to edema and urinary obstruction requiring emergency surgical circumcision, and one due to wound dehiscence following device removal. 71.8 % of men reported an unpleasant odor prior to PrePex removal. Cumulative rates of completed wound healing with the PrePex were 56.7 % a

  • the safety and acceptance of the prepex device for non surgical adult male circumcision in rakai uganda a non randomized observational study
    PLOS ONE, 2014
    Co-Authors: Godfrey Kigozi, Richard Musoke, Stephen Watya, Nehemia Kighoma, James Nkale, Mary Nakafeero, Dan Namuguzi, David Serwada, Fred Nalugoda, Nelson K Sewankambo
    Abstract:

    Objectives To assess the safety and acceptance of the PrePex device for medical male circumcision (MMC) in rural Uganda. Methods In an observational study, HIV-uninfected, uncircumcised men aged 18 and older who requested elective MMC were informed about the PrePex and Dorsal Slit methods and offered a free choice of their preferred procedure. 100 men received PrePex to assess preliminary safety (aim 1). An additional 329 men, 250 chose PrePex and 79 chose Dorsal Slit, were enrolled following approval by the Safety Monitoring Committee (aim 2). Men were followed up at 7 days to assess adverse events (AEs) and to remove the PrePex device. Wound healing was assessed at 4 weeks, with subsequent weekly follow up until completed healing. Results The PrePex device was contraindicated in 5.7% of men due to a tight prepuce or phimosis/adhesions. Among 429 enrolled men 350 (82.0%) got the PrePex device and 79 (18.0%) the Dorsal Slit procedure. 250 of 329 men (76.0%) who were invited to choose between the 2 procedures chose Prepex. There were 9 AEs (2.6%) with the PrePex, of which 5 (1.4%) were severe complications, 4 due to patient self-removal of the device leading to edema and urinary obstruction requiring emergency surgical circumcision, and one due to wound dehiscence following device removal. 71.8% of men reported an unpleasant odor prior to PrePex removal. Cumulative rates of completed wound healing with the PrePex were 56.7% at week 4, 84.8% week 5, 97.6% week 6 and 98.6% week 7, compared to 98.7% at week 4 with Dorsal Slit (p<0.0001). Conclusion The PrePex device was well accepted, but healing was slower than with Dorsal Slit surgery. Severe complications, primarily following PrePex self-removal, required rapid access to emergency surgical facilities. The need to return for removal and delayed healing may increase Program cost and client burden.

  • Characteristics and behaviors of men who received the PrePex or Dorsal Slit circumcision.
    2014
    Co-Authors: Godfrey Kigozi, Richard Musoke, Stephen Watya, Nehemia Kighoma, James Nkale, Mary Nakafeero, Dan Namuguzi, David Serwada, Fred Nalugoda, Nelson Sewankambo
    Abstract:

    Characteristics and behaviors of men who received the PrePex or Dorsal Slit circumcision.

  • male circumcision wound healing in human immunodeficiency virus hiv negative and hiv positive men in rakai uganda
    BJUI, 2014
    Co-Authors: Godfrey Kigozi, Richard Musoke, Stephen Watya, James Nkale, Fred Nalugoda, David Serwadda, Nehemiah Kighoma, Noah Kiwanuka, Fred Wabwiremangen, Frederick Makumbi
    Abstract:

    OBJECTIVE: To assess completed wound healing after medical male circumcision (MMC) among human immunodeficiency virus (HIV)-negative and HIV-positive men with cluster of differentiation 4 (CD4) counts of /=350 cells/mm(3) as minimal data are available on the safety of MMC among HIV-positive men with low CD4 counts. PATIENTS AND METHODS: In all 262 HIV-negative and 177 HIV-positive consenting males aged >/=12 years accepted MMC using the Dorsal Slit procedure and were enrolled in the study. Socio-demographic and behavioural data and blood for HIV testing and CD4 counts were collected at baseline. Participants were followed weekly to collect information on resumption of sex condom use and both self-reported and clinically assessed wound healing. The proportions healed among HIV-positive men were compared with HIV-negative men. Time to complete wound healing was assessed by Kaplan-Meier survival analysis. RESULTS: There were no statistically significant differences in the proportion of men healed by HIV status. At 4 weeks the proportions healed were 85.9% in HIV-negative men 77.4% in HIV-positive men with a CD4 count of >/=350 cells/mm(3) and 87.1% in HIV-positive men with a CD4 count of /=350 cells/mm(3) (P = 0.052) and 7.8% (P = 0.081) among HIV-negative men. CONCLUSION: Inclusion of HIV-positive men with low CD4 counts in MMC services is not deleterious to postoperative wound healing. (c) 2013 The Authors. BJU International (c) 2013 BJU International.

  • the acceptability and safety of the shang ring for adult male circumcision in rakai uganda
    Journal of Acquired Immune Deficiency Syndromes, 2013
    Co-Authors: Godfrey Kigozi, Richard Musoke, Stephen Watya, Fred Nalugoda, David Serwadda, Nehemiah Kighoma, Paschal Ssebbowa, Frederick Makumbi, Richard K Lee, Marc Goldstein
    Abstract:

    OBJECTIVES Medical male circumcision (MMC) is recommended for HIV prevention in men. We assessed the acceptability and safety of the Shang Ring device compared with those of the Dorsal Slit method. METHODS HIV-negative, uncircumcised men aged 18 years or older who requested free MMC services in rural Rakai, Uganda, were informed about the Shang Ring and Dorsal Slit procedures and offered a free choice of procedure. Men were followed at 7 days postoperatively to assess adverse events related to surgery and to remove the Shang Ring. Wound healing was assessed at 4 weeks postoperatively. RESULTS Six hundred twenty-one men were enrolled, of whom 508 (81.8%) chose the Shang Ring and 113 the Dorsal Slit. The Shang Ring was provided to 504 men, among whom there were 4 failures of Ring placement (0.8%) that required surgical hemostasis and wound closure. Five hundred men received the Shang Ring and postoperative surgery-related moderate adverse events were 1.0%, compared with 0.8% among Dorsal Slit recipients. Complete wound healing at 4 weeks was 84% with the Ring and 100% with the Dorsal Slit (P < 0001). Resumption of intercourse before 4 weeks was 7.0% with the Ring and 15.0% with the Dorsal Slit (P = 0.01.) The mean time for surgery was 6.1 minutes with the Ring and 17.7 minutes with the Dorsal Slit. The mean time for Ring removal was 2.2 minutes. CONCLUSIONS The Shang Ring is highly acceptable and safe in this setting, and could improve the efficiency of MMC services. However, back-up surgical services are needed in cases of Ring placement failures.

Stephen Watya - One of the best experts on this subject based on the ideXlab platform.

  • The Safety and Acceptance of the PrePex Device for Non- Surgical Adult Male Circumcision in Rakai, Uganda. A Non-Randomized Observational Study
    2016
    Co-Authors: Godfrey Kigozi, Richard Musoke, Stephen Watya, Nehemia Kighoma, James Nkale, Mary Nakafeero, Dan Namuguzi, David Serwada, Fred Nalugoda, Nelson Sewankambo
    Abstract:

    Objectives: To assess the safety and acceptance of the PrePex device for medical male circumcision (MMC) in rural Uganda. Methods: In an observational study, HIV-uninfected, uncircumcised men aged 18 and older who requested elective MMC were informed about the PrePex and Dorsal Slit methods and offered a free choice of their preferred procedure. 100 men received PrePex to assess preliminary safety (aim 1). An additional 329 men, 250 chose PrePex and 79 chose Dorsal Slit, were enrolled following approval by the Safety Monitoring Committee (aim 2). Men were followed up at 7 days to assess adverse events (AEs) and to remove the PrePex device. Wound healing was assessed at 4 weeks, with subsequent weekly follow up until completed healing. Results: The PrePex device was contraindicated in 5.7 % of men due to a tight prepuce or phimosis/adhesions. Among 429 enrolled men 350 (82.0%) got the PrePex device and 79 (18.0%) the Dorsal Slit procedure. 250 of 329 men (76.0%) who were invited to choose between the 2 procedures chose Prepex. There were 9 AEs (2.6%) with the PrePex, of which 5 (1.4%) were severe complications, 4 due to patient self-removal of the device leading to edema and urinary obstruction requiring emergency surgical circumcision, and one due to wound dehiscence following device removal. 71.8 % of men reported an unpleasant odor prior to PrePex removal. Cumulative rates of completed wound healing with the PrePex were 56.7 % a

  • the safety and acceptance of the prepex device for non surgical adult male circumcision in rakai uganda a non randomized observational study
    PLOS ONE, 2014
    Co-Authors: Godfrey Kigozi, Richard Musoke, Stephen Watya, Nehemia Kighoma, James Nkale, Mary Nakafeero, Dan Namuguzi, David Serwada, Fred Nalugoda, Nelson K Sewankambo
    Abstract:

    Objectives To assess the safety and acceptance of the PrePex device for medical male circumcision (MMC) in rural Uganda. Methods In an observational study, HIV-uninfected, uncircumcised men aged 18 and older who requested elective MMC were informed about the PrePex and Dorsal Slit methods and offered a free choice of their preferred procedure. 100 men received PrePex to assess preliminary safety (aim 1). An additional 329 men, 250 chose PrePex and 79 chose Dorsal Slit, were enrolled following approval by the Safety Monitoring Committee (aim 2). Men were followed up at 7 days to assess adverse events (AEs) and to remove the PrePex device. Wound healing was assessed at 4 weeks, with subsequent weekly follow up until completed healing. Results The PrePex device was contraindicated in 5.7% of men due to a tight prepuce or phimosis/adhesions. Among 429 enrolled men 350 (82.0%) got the PrePex device and 79 (18.0%) the Dorsal Slit procedure. 250 of 329 men (76.0%) who were invited to choose between the 2 procedures chose Prepex. There were 9 AEs (2.6%) with the PrePex, of which 5 (1.4%) were severe complications, 4 due to patient self-removal of the device leading to edema and urinary obstruction requiring emergency surgical circumcision, and one due to wound dehiscence following device removal. 71.8% of men reported an unpleasant odor prior to PrePex removal. Cumulative rates of completed wound healing with the PrePex were 56.7% at week 4, 84.8% week 5, 97.6% week 6 and 98.6% week 7, compared to 98.7% at week 4 with Dorsal Slit (p<0.0001). Conclusion The PrePex device was well accepted, but healing was slower than with Dorsal Slit surgery. Severe complications, primarily following PrePex self-removal, required rapid access to emergency surgical facilities. The need to return for removal and delayed healing may increase Program cost and client burden.

  • Characteristics and behaviors of men who received the PrePex or Dorsal Slit circumcision.
    2014
    Co-Authors: Godfrey Kigozi, Richard Musoke, Stephen Watya, Nehemia Kighoma, James Nkale, Mary Nakafeero, Dan Namuguzi, David Serwada, Fred Nalugoda, Nelson Sewankambo
    Abstract:

    Characteristics and behaviors of men who received the PrePex or Dorsal Slit circumcision.

  • male circumcision wound healing in human immunodeficiency virus hiv negative and hiv positive men in rakai uganda
    BJUI, 2014
    Co-Authors: Godfrey Kigozi, Richard Musoke, Stephen Watya, James Nkale, Fred Nalugoda, David Serwadda, Nehemiah Kighoma, Noah Kiwanuka, Fred Wabwiremangen, Frederick Makumbi
    Abstract:

    OBJECTIVE: To assess completed wound healing after medical male circumcision (MMC) among human immunodeficiency virus (HIV)-negative and HIV-positive men with cluster of differentiation 4 (CD4) counts of /=350 cells/mm(3) as minimal data are available on the safety of MMC among HIV-positive men with low CD4 counts. PATIENTS AND METHODS: In all 262 HIV-negative and 177 HIV-positive consenting males aged >/=12 years accepted MMC using the Dorsal Slit procedure and were enrolled in the study. Socio-demographic and behavioural data and blood for HIV testing and CD4 counts were collected at baseline. Participants were followed weekly to collect information on resumption of sex condom use and both self-reported and clinically assessed wound healing. The proportions healed among HIV-positive men were compared with HIV-negative men. Time to complete wound healing was assessed by Kaplan-Meier survival analysis. RESULTS: There were no statistically significant differences in the proportion of men healed by HIV status. At 4 weeks the proportions healed were 85.9% in HIV-negative men 77.4% in HIV-positive men with a CD4 count of >/=350 cells/mm(3) and 87.1% in HIV-positive men with a CD4 count of /=350 cells/mm(3) (P = 0.052) and 7.8% (P = 0.081) among HIV-negative men. CONCLUSION: Inclusion of HIV-positive men with low CD4 counts in MMC services is not deleterious to postoperative wound healing. (c) 2013 The Authors. BJU International (c) 2013 BJU International.

  • the acceptability and safety of the shang ring for adult male circumcision in rakai uganda
    Journal of Acquired Immune Deficiency Syndromes, 2013
    Co-Authors: Godfrey Kigozi, Richard Musoke, Stephen Watya, Fred Nalugoda, David Serwadda, Nehemiah Kighoma, Paschal Ssebbowa, Frederick Makumbi, Richard K Lee, Marc Goldstein
    Abstract:

    OBJECTIVES Medical male circumcision (MMC) is recommended for HIV prevention in men. We assessed the acceptability and safety of the Shang Ring device compared with those of the Dorsal Slit method. METHODS HIV-negative, uncircumcised men aged 18 years or older who requested free MMC services in rural Rakai, Uganda, were informed about the Shang Ring and Dorsal Slit procedures and offered a free choice of procedure. Men were followed at 7 days postoperatively to assess adverse events related to surgery and to remove the Shang Ring. Wound healing was assessed at 4 weeks postoperatively. RESULTS Six hundred twenty-one men were enrolled, of whom 508 (81.8%) chose the Shang Ring and 113 the Dorsal Slit. The Shang Ring was provided to 504 men, among whom there were 4 failures of Ring placement (0.8%) that required surgical hemostasis and wound closure. Five hundred men received the Shang Ring and postoperative surgery-related moderate adverse events were 1.0%, compared with 0.8% among Dorsal Slit recipients. Complete wound healing at 4 weeks was 84% with the Ring and 100% with the Dorsal Slit (P < 0001). Resumption of intercourse before 4 weeks was 7.0% with the Ring and 15.0% with the Dorsal Slit (P = 0.01.) The mean time for surgery was 6.1 minutes with the Ring and 17.7 minutes with the Dorsal Slit. The mean time for Ring removal was 2.2 minutes. CONCLUSIONS The Shang Ring is highly acceptable and safe in this setting, and could improve the efficiency of MMC services. However, back-up surgical services are needed in cases of Ring placement failures.