{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T02:46:58Z","timestamp":1770778018680,"version":"3.50.0"},"reference-count":46,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2022,10,21]],"date-time":"2022-10-21T00:00:00Z","timestamp":1666310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Traditional approaches for male circumcision are tedious and could lead to complications such as peri-\/postoperative pain, bleeding, and infection. Thus, for the first time, we investigated the surgical outcomes of recently the discovered Disposable Circumcision Anastomat Type A (Dongguan ZSR Biomedical Technology Company Ltd., China), a disposable circumcision suture device (DCSD), in terms of the operation time, surgical complexity, safety, satisfaction, and aesthetic outcomes and most importantly the prognostic factors for postoperative infection. A total of 394 individuals were circumcised, with a mean age, body mass index (BMI), stretched penile length (SPL), and penile circumference of 30.1 \u00b1 7.05 years, 25.47 \u00b1 4.73, 10.12 \u00b1 1.61, and 7 \u00b1 0.73 cm, respectively. Associated comorbidities included diabetes mellitus (6.09%), hypertension (2.03%), gout (1.02%), end-stage renal disease (ESRD, 0.25%), and HIV (0.25%). The mean operation time, average postoperative bleeding, and wound infection rate was 31.4 \u00b1 9.96 min, 2.54%, and 9.39%, respectively. The mean VAS postoperative pain scores at D0 and D1 were 4.4 \u00b1 2.4 and 1.9 \u00b1 1.6, respectively. Moreover, 1.27% of subjects required reoperation, and a 2.03% rate of instrument malfunction was noted. The significant factors associated with the post-operative infection group were age (p = 0.0313), BW (p = 0.0081), BMI (p = 0.0026), penile circumference (p = 0.0343), and DM (p \u2264 0.001). Multivariate analyses revealed only DM as a statistically significant factor (p &lt; 0.001). Our box\u2013whisker plot revealed no significant difference between the HbA1c level of infection (Hb1Ac = 7.77 \u00b1 1.39) and non-infection groups (Hb1Ac = 6.92 \u00b1 1.84). However, a trend of higher glycemic index in the infection group was observed. Conclusively, DSCD could be an effective and safe alternative to performing circumcision. However, in the population with advanced aging, phimosis, elevated BMI, and DM (HbA1C &gt; 9%), users should be highly cautious due to the increased risk of infection, dehiscence, and hematoma.<\/jats:p>","DOI":"10.3390\/jcm11206206","type":"journal-article","created":{"date-parts":[[2022,10,24]],"date-time":"2022-10-24T04:40:36Z","timestamp":1666586436000},"page":"6206","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["A Retrospective Taiwanese-Population-Based Clinical Study on Determining the Efficacy and Safety of Disposable Circumcision Anastomat"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6482-1586","authenticated-orcid":false,"given":"An-Chi","family":"Chou","sequence":"first","affiliation":[{"name":"Department of Urology, Taipei Medical University Hospital, Taipei 11031, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Yo","family":"Laih","sequence":"additional","affiliation":[{"name":"Department of Urology, China Medical University Hospital, Taichung 404327, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fang-Yu","family":"Ku","sequence":"additional","affiliation":[{"name":"Department of Urology, Taipei Medical University Hospital, Taipei 11031, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,21]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2008). Male Circumcision: Global Trends and Determinants of Prevalence, Safety and Acceptability, World Health Organization."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"362","DOI":"10.4103\/1008-682X.174855","article-title":"Use of a disposable circumcision suture device versus conventional circumcision: A systematic review and meta-analysis","volume":"19","author":"Huo","year":"2017","journal-title":"Asian J. Androl."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Jacobs, A.J. (2022). Male circumcision. Assigning Responsibility for Children\u2019s Health When Parents and Authorities Disagree: Whose Child?, Springer.","DOI":"10.1007\/978-3-030-87698-2"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Kennedy, C.E., Yeh, P.T., Atkins, K., Fonner, V.A., Sweat, M.D., O\u2019Reilly, K.R., Rutherford, G.W., Baggaley, R., and Samuelson, J. (2020). Economic compensation interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review and meta-analysis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0227623"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4","DOI":"10.3389\/fpubh.2019.00004","article-title":"Does Male Circumcision Reduce Women\u2019s Risk of Sexually Transmitted Infections, Cervical Cancer, and Associated Conditions?","volume":"7","author":"Morris","year":"2019","journal-title":"Front. Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/s41572-021-00246-5","article-title":"Penile cancer","volume":"7","author":"Thomas","year":"2021","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1111\/iju.12154","article-title":"Circumcision related to urinary tract infections, sexually transmitted infections, human immunodeficiency virus infections, and penile and cervical cancer","volume":"20","author":"Hayashi","year":"2013","journal-title":"Int. J. Urol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12963-016-0073-5","article-title":"Estimation of country-specific and global prevalence of male circumcision","volume":"14","author":"Morris","year":"2016","journal-title":"Popul. Health Metr."},{"key":"ref_9","first-page":"222","article-title":"Neonatal circumcision: New recommendations & implications for practice","volume":"111","author":"Simpson","year":"2014","journal-title":"Mo. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1542\/peds.2012-1989","article-title":"Circumcision Policy Statement","volume":"130","author":"Circumcision","year":"2012","journal-title":"Pediatrics"},{"key":"ref_11","unstructured":"World Health Organization (2018). Male Circumcision for HIV Prevention: Manual for Male Circumcision under Local Anaesthesia and HIV Prevention Services for Adolescent Boys and Men, World Health Organization."},{"key":"ref_12","unstructured":"WHO, and Jhpiego, U. (2008). Manual for Male Circumcision under Local Anaesthesia, Version, World Health Organization."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Weiss, H.A., Larke, N., Halperin, D., and Schenker, I. (2010). Complications of circumcision in male neonates, infants and children: A systematic review. BMC Urol., 10.","DOI":"10.1186\/1471-2490-10-2"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.urology.2021.01.041","article-title":"Male Circumcision Complications\u2014A Systematic Review, Meta-Analysis and Meta-Regression","volume":"152","author":"Shabanzadeh","year":"2021","journal-title":"Urology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100288","DOI":"10.1016\/j.esxm.2020.100288","article-title":"A Modified Pressure Dressing to Avoid Severe Bleeding After Circumcision With a Disposable Circumcision Suture Device and a Discussion on the Mechanism of Bleeding with the Disposable Circumcision Suture Device","volume":"9","author":"Jiang","year":"2021","journal-title":"Sex. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1097\/QAI.0b013e3182158967","article-title":"The Shang Ring device for adult male circumcision: A proof of concept study in Kenya","volume":"57","author":"Barone","year":"2011","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"126","DOI":"10.7196\/SAMJ.5419","article-title":"Circumcision-what\u2019s wrong with plastic rings?","volume":"102","author":"Millard","year":"2012","journal-title":"S. Afr. Med. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/j.1464-410X.2007.07274.x","article-title":"Phimosis as a presenting feature of diabetes","volume":"101","author":"Bromage","year":"2008","journal-title":"BJU Int."},{"key":"ref_19","first-page":"120","article-title":"Balanoposthitis with a volcano-like appearance may be the first clinical presentation of undiagnosed diabetes mellitus","volume":"5","author":"Ke","year":"2011","journal-title":"Incont. Pelvic. Floor. Dysfunct."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"513","DOI":"10.2337\/dc17-2131","article-title":"Risk of Infection in Type 1 and Type 2 Diabetes Compared With the General Population: A Matched Cohort Study","volume":"41","author":"Carey","year":"2018","journal-title":"Diabetes Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"4152","DOI":"10.21037\/tau-21-673","article-title":"Can circumcision be avoided in adult male with phimosis? Results of the PhimoStop(TM) prospective trial","volume":"10","author":"Carilli","year":"2021","journal-title":"Transl. Androl. Urol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"642899","DOI":"10.3389\/fneur.2021.642899","article-title":"Glycated Hemoglobin as a Marker for Predicting Outcomes of Patients With Stroke (Ischemic and Hemorrhagic): A Systematic Review and Meta-Analysis","volume":"12","author":"Bao","year":"2021","journal-title":"Front. Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"331","DOI":"10.3109\/09546634.2013.789473","article-title":"Adverse events associated with botulinum toxin injection: A multidepartment, retrospective study of 5310 treatments administered to 1819 patients","volume":"25","author":"Kim","year":"2014","journal-title":"J. Dermatol. Treat"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Liu, G.-M., and Xu, Z.-Q. (2021). The Morphological Classification of the Penile Frenulum in Chinese\u2019s People and its Clinical Application Value in the Frenulum Malposition of Circumcision with the Disposable Circumcision Suture Device (DCSD), Research Square.","DOI":"10.21203\/rs.3.rs-900176\/v1"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1016\/j.juro.2013.11.111","article-title":"Clinical investigation of a novel surgical device for circumcision","volume":"191","author":"Yuan","year":"2014","journal-title":"J. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ijsu.2017.04.060","article-title":"Comparative efficacy and safety of different circumcisions for patients with redundant prepuce or phimosis: A network meta-analysis","volume":"43","author":"Huang","year":"2017","journal-title":"Int. J. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.urology.2020.06.018","article-title":"Modified Circumcision Using the Disposable Circumcision Suture Device in Children: A Randomized Controlled Trial","volume":"143","author":"Rao","year":"2020","journal-title":"Urology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1097\/00006565-199602000-00018","article-title":"Treating complications of circumcision","volume":"12","author":"Baskin","year":"1996","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_29","first-page":"187","article-title":"Impaired immune responses in diabetes mellitus: Analysis of the factors and mechanisms involved. Relevance to the increased susceptibility of diabetic patients to specific infections","volume":"18","author":"Moutschen","year":"1992","journal-title":"Diabete Metab."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Okonkwo, U.A., and DiPietro, L.A. (2017). Diabetes and Wound Angiogenesis. Int. J. Mol. Sci., 18.","DOI":"10.3390\/ijms18071419"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1017\/ice.2015.249","article-title":"Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis","volume":"37","author":"Martin","year":"2016","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"453","DOI":"10.4103\/1008-682X.127816","article-title":"Disposable circumcision suture device: Clinical effect and patient satisfaction","volume":"16","author":"Lv","year":"2014","journal-title":"Asian J. Androl."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1007\/s11255-016-1213-3","article-title":"Application of a novel disposable suture device in circumcision: A prospective non-randomized controlled study","volume":"48","author":"Zhang","year":"2016","journal-title":"Int. Urol. Nephrol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1590\/1414-431x20154530","article-title":"Adult male circumcision with a circular stapler versus conventional circumcision: A prospective randomized clinical trial","volume":"48","author":"Jin","year":"2015","journal-title":"Braz. J. Med. Biol. Res."},{"key":"ref_35","first-page":"5013","article-title":"A Comparative Study on the Clinical Efficacy of Two Different Disposable Circumcision Suture Devices in Adult Males","volume":"14","author":"Shen","year":"2017","journal-title":"Urol. J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1590\/s1677-5538.ibju.2016.0204","article-title":"Novel penile circumcision suturing devices versus the shang ring for adult male circumcision: A prospective study","volume":"43","author":"Han","year":"2017","journal-title":"Int. Braz. J. Urol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"454","DOI":"10.12659\/MSM.889722","article-title":"Safety and efficacy of a novel disposable circumcision device: A pilot randomized controlled clinical trial at 2 centers","volume":"20","author":"Wang","year":"2014","journal-title":"Med. Sci. Monit."},{"key":"ref_38","first-page":"1007","article-title":"A novel disposable circumcision device versus conventional surgery in the treatment of redundant prepuce and phimosis","volume":"23","author":"Zhao","year":"2017","journal-title":"Natl. J. Androl."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.mib.2015.11.003","article-title":"Infection in an aging population","volume":"29","author":"Kline","year":"2016","journal-title":"Curr. Opin. Microbiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1016\/j.humimm.2014.10.004","article-title":"Anti-pneumococcal deficits of monocyte-derived macrophages from the advanced-age, frail elderly and related impairments in PI3K-AKT signaling","volume":"75","author":"Verschoor","year":"2014","journal-title":"Hum. Immunol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1830","DOI":"10.1017\/S0007114510000152","article-title":"Body mass index and the risk of infections in institutionalised geriatric patients","volume":"103","author":"Dorner","year":"2010","journal-title":"Br. J. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/S1473-3099(10)70304-2","article-title":"Obesity-related immunodeficiency in patients with pandemic influenza H1N1","volume":"11","author":"Nave","year":"2011","journal-title":"Lancet Infect. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/S0302-2838(02)00396-2","article-title":"What importance do women attribute to the size of the penis?","volume":"42","author":"Francken","year":"2002","journal-title":"Eur. Urol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1007\/s10508-008-9439-5","article-title":"The association between penis size and sexual health among men who have sex with men","volume":"39","author":"Grov","year":"2010","journal-title":"Arch. Sex. Behav."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1046\/j.1464-410X.1996.85023.x","article-title":"The prepuce: Specialized mucosa of the penis and its loss to circumcision","volume":"77","author":"Taylor","year":"1996","journal-title":"Br. J. Urol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"100315","DOI":"10.1016\/j.esxm.2020.100315","article-title":"Male Circumcision Due to Phimosis as the Procedure That Is Not Only Relieving Clinical Symptoms of Phimosis But Also Improves the Quality of Sexual Life","volume":"9","author":"Czajkowski","year":"2021","journal-title":"Sex. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/20\/6206\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:58:42Z","timestamp":1760144322000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/20\/6206"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,21]]},"references-count":46,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["jcm11206206"],"URL":"https:\/\/doi.org\/10.3390\/jcm11206206","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,21]]}}}