Search Results (18)

Phimosis is rarely reported in cats and involves the inability to exteriorize the penis through an absent or abnormally narrowed preputial orifice. This case report describes the clinical presentation, surgical management, and outcome of two male domestic shorthair kittens with suspected congenital type II phimosis. Both cats presented with recurrent stranguria and dysuria, preputial swelling, urine pooling or dribbling, a markedly stenotic preputial orifice, and penile–preputial adhesions. In Case 1, cystic struvite urolithiasis was also identified; treatment included cystotomy and ventrally performed modified preputial urethrostomy because of extensive adhesions, penile hypoplasia, and limited penile mobility. In Case 2, adhesions were limited to the distal penis and were released, allowing circumferential preputioplasty. No postoperative complications occurred. Clinical signs resolved, and normal urination was recorded during available follow-up, which was 12 months in Case 1 and 2 months in Case 2. The congenital origin was suspected based on early onset of clinical signs but could not be definitively confirmed. These cases suggest that selected feline type II phimosis cases can be managed successfully by tailoring surgery to anatomical abnormalities, using ventral-modified preputial urethrostomy when adhesions and penile hypoplasia restrict mobilization, or circumferential preputioplasty when adhesions are limited distally. Full article

Reproductive emergencies in male dromedary camels (Camelus dromedarius) threaten fertility, health, and welfare but remain poorly documented. This review consolidates knowledge on the diagnosis, management, and prognosis of acute reproductive pathologies, including traumatic injuries (testicular trauma, penile hematoma, and preputial laceration), obstructive conditions (urethral obstruction, phimosis, and paraphimosis), vascular emergencies (spermatic cord torsion, priapism), inflammatory diseases (orchitis, epididymitis, pizzle rot), congenital anomalies (persistent frenulum), iatrogenic complications, and pharmacologic-induced dysfunction. Systematic breeding soundness examination and ultrasonography are indispensable for assessing testicular perfusion and guiding intervention. Given the scarcity of camel-specific literature, this narrative clinical review integrates evidence from published camelid studies, relevant reports from other domestic species, and representative clinical observations documented by the authors to provide a practical framework for diagnosis and management. Field constraints, the stoic nature of camels, and harmful ethnoveterinary practices often delay diagnosis and compromise outcomes. Prognosis varies considerably depending on the condition and timeliness of intervention; early aggressive management can preserve reproductive function, while delayed treatment frequently results in permanent infertility or death. Given the economic and cultural importance of camels in arid regions, improving outcomes for reproductive emergencies is essential for sustaining breeding programs and enhancing animal welfare. This narrative clinical review integrates published literature with representative clinical observations and retrospective field cases to summarize the diagnosis, management, and prognosis of reproductive emergencies in male dromedary camels. It also provides a structured clinical framework to support veterinarians in managing these acute conditions and highlights critical gaps requiring further research. Full article

Background: Adult circumcision is an effective surgical treatment for symptomatic phimosis, but its effects on sexual function and psychosocial outcomes remain incompletely characterized. This study aimed to assess patient-reported motivations for circumcision due to phimosis and to evaluate changes in sexual function, genital self-image, and depressive symptoms after surgery. Methods: We performed a prospective, single-center observational pre–post cohort study of adult men who underwent circumcision for symptomatic phimosis at a tertiary academic center in Poland between January 2023 and April 2025. Participants completed an author-designed questionnaire and validated patient-reported outcome measures before surgery and at six months after circumcision. The primary endpoint was the change in sexual function measured by the International Index of Erectile Function (IIEF-15). Secondary endpoints included changes in genital self-image assessed using the Male Genital Self-Image Scale (MGSIS-7), depressive symptoms measured with the Beck Depression Inventory (BDI-II), and patient-reported motivations for surgery. Paired comparisons were performed using the Wilcoxon signed-rank test. Results: A total of 148 men were included in the study. The most common reasons for surgery were pain/discomfort (58/148, 39.2%) and impaired sexual activity (51/148, 34.5%). The total IIEF-15 score increased from 46.4 ± 20.4 to 57.5 ± 21.0 (p < 0.001), with significant improvements across all domains (all p < 0.001). The total MGSIS-7 score improved from 19.9 ± 4.5 to 23.1 ± 4.0 (p < 0.001). Paired BDI-II data were available for 77 men; the total BDI-II score decreased from 1.2 ± 3.8 to 0.3 ± 1.6 (p = 0.004). Most men reported improved sexual life (127/148, 85.8%) and cosmetic satisfaction (124/148, 83.8%), and 119/148 (80.4%) reported no complications. Conclusions: Circumcision for symptomatic phimosis was associated with improved sexual function and genital self-image, alongside a statistically significant but clinically negligible decrease in subclinical depressive symptoms. Full article

Background/Objectives: Stevens–Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, potentially fatal immunological conditions that affect cutaneous and mucosal surfaces and have the potential to involve the genitourinary tract. While genital involvement is common, urological manifestations are under-recognised clinically and there is a paucity of clear, evidence-based management pathways specific to urological manifestations of SJS/TEN. To map the spectrum of urological manifestations of SJS/TEN, to describe the short- and long-term outcomes of these manifestations, and to synthesise management and prevention strategies to inform clinical practice. Methods: This was a scoping review conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guideline. Data sources: Medline and PubMed articles published in English with publication date up to December 2025. Study selection: Eligible studies included case reports, case series, observational studies, clinical guidelines, and review articles describing urological manifestations, outcomes, management, or prevention strategies for patients with SJS/TEN. Articles limited to renal or isolated gynaecological involvement were excluded. Data extraction and synthesis: Articles were screened independently by two reviewers using a pre-defined data extraction template covering four domains: urological manifestations, outcomes and sequelae, management strategies, and prevention strategies. This criterion was refined after a pilot of 20 studies. Discrepancies were resolved by consensus with a third reviewer. Formal risk-of-bias assessment was not performed, consistent with scoping review methodology. Results: One hundred and four studies published between 1987 and 2025 were included in this review. Selected articles included case reports (n = 63), retrospective cohort studies (n = 23), prospective studies (n = 2), guidelines (n = 5), and summary articles (n = 11). Reported urological involvement ranged from genital cutaneous and mucosal disease including erosions, adhesions, and balanitis to urethral manifestations such as urethritis, stenosis, and strictures, as well as scarce upper urinary tract involvement including ureteric stricture and ureteric mucosal sloughing. While some manifestations resolved with supportive care, others progressed to chronic sequelae including persistent urethral strictures, voiding dysfunction, sexual dysfunction, recurrent infection, and in rare cases, obstructive uropathy. A multidisciplinary approach was recommended for all patients with SJS/TEN. Urological management centred around early and repeated urogenital examination, manual lysis of adhesions, urinary catheterisation, and timely intervention for urethral or ureteric obstruction. Long-term urological follow-up of 12 months was recommended for patients with significant urogenital involvement. Conclusions: Urological manifestations of SJS/TEN are diverse, clinically significant, and frequently under-recognised. Early urological involvement, systematic genital and urinary tract assessment, and proactive preventative measures may reduce long-term morbidity. This review provides a comprehensive synthesis of knowledge and recommendations to support urologists’ role in multidisciplinary care of patients with this pathology. This review also highlights the need for prospective research to guide further evidence-based management of urological complications of SJS/TEN. Full article

Background: Hypospadias is often associated with abnormal prepuce development. Investigating the differences between the inner prepuce of hypospadias patients and normal controls at the transcriptomic level and histological characteristics helps to reveal the causes of its developmental abnormalities or implement targeted treatments. Materials and Methods: Dorsal and ventral inner preputial tissues were collected from 31 hypospadias patients and 21 phimosis children (controls). Differences in gene expression between the two groups were studied via transcriptomic sequencing and enrichment analysis. Corresponding histological features were further validated by histological staining. Results: Transcriptomic sequencing results showed that, compared to the control group, the dorsal inner prepuce of the hypospadias group had 97 upregulated and 10 downregulated genes; the ventral prepuce had 140 upregulated and 99 downregulated genes. Among all upregulated genes, 44 were closely related to fibrosis. Other significantly enriched terms included cornified envelope formation, efferocytosis, C-type lectin receptor signaling pathway, and complement and coagulation cascades. Histological validation revealed that the dorsal inner prepuce of hypospadias children contained more collagen fibers, a higher ratio of type I/III collagen, and lower microvessel density, showing some correlation with the severity of hypospadias. Conclusions: This study demonstrated a hyper-fibrotic state in the inner prepuce of hypospadias, which may significantly impact post-operative wound healing and complications. Full article

Background: The primary objectives of platelet-rich plasma (PRP) therapy are to enhance the wound-healing process, reduce pain, and minimize the loss of productivity due to recovery time. Localized application of PRP, which is enriched with growth factors such as PDGF, TGF-β1, IGF-1, VEGF, and FGF-2, as well as interleukins (IL-1, IL-4, IL-6, IL-10, and IL-13), has been documented to accelerate the healing process by approximately 30–40%. This study aimed to assess the safety and efficacy of platelet-rich plasma (PRP) in enhancing outcomes following circumcision in male children. Methods: The patients were divided into two groups: one undergoing standard circumcision and the other receiving PRP application during circumcision. Pain scores, edema level, bleeding, local infection, and safety of PRP were evaluated. Results: This study evaluated 80 male children undergoing circumcision, divided into two groups: Group CS (n = 44) underwent classical circumcision, and Group PRP (n = 36) received PRP application. Median ages were comparable (p = 0.101). Penile edema occurred less frequently in the PRP group (5.6%) compared to the CS group (18.2%) (p = 0.089), with no severe edema observed in the PRP group. Postoperative bleeding was present in 6.8% of the CS group but absent in the PRP group (p = 0.110). Other complications, such as nausea (CS: 6.8%, PRP: 5.6%, p = 0.816), vomiting (CS: 4.5%, PRP: 2.8%, p = 0.679), local infection (CS: 2.3%, PRP: 0%, p = 0.363), wound dehiscence (CS: 2.3%, PRP: 0%, p = 0.363), and skin tunnel formation (CS: 6.8%, PRP: 2.8%, p = 0.409), showed no significant differences. No cases of necrosis, chordee, rotational anomaly, or secondary phimosis were observed. Safety analysis of PRP revealed minor complications during blood draw: hypotension in one patient (2.8%) and local ecchymosis in two patients (5.6%), resolving without intervention. During PRP application, one allergic reaction (2.8%) occurred, presenting as a transient rash that resolved spontaneously. Group PRP consistently reported lower pain scores than Group CS at all time points. Conclusions: PRP application during circumcision is safe. The findings provide preliminary but important evidence regarding the potential benefits of PRP in pediatric circumcision. Full article

Male fertility is important to ensure herd health and productivity. The camelid male breeding soundness examination (BSE) is strongly recommended because natural mating remains the primary breeding method due to the challenges in semen cryopreservation and artificial insemination. Guidelines for the BSE have been proposed but not adopted in practice. The investigation of male reproductive failure includes history, general health examination, examination of the genitalia, semen evaluation, and testing for contagious diseases. Difficulties in ejaculate collection and semen viscosity are challenges in camelid male fertility investigation. This review summarizes the outcomes of BSE in our practice on South American camelids (SACs) and camels. The results and discussion are presented under four main categories: congenital defects, impotentia coeundi, impotentia generandi, and male reproductive emergencies. There is a difference between camels and SACs in the incidence of various disorders. Congenital defects are common in SACs in particular cryptorchidism, testicular hypoplasia and rete testis cysts. Orchitis is more common in camels, particularly in areas where brucellosis is prevalent. Testicular degeneration occurs in all camelids and has been associated with heat stress, aging, systemic diseases and overuse of anabolic steroids. Precise diagnosis of fertility impairment may require disease testing, testicular biopsy, cytogenetics and endocrine evaluation. A significant proportion of males are referred because of reproductive emergencies, due to poor management, which results in loss of genetic potential. Implementation of regular BSE is possible in SACs but can be difficult in dromedaries because of the large variation in breed characteristics and management systems. Full article

The lodging resistance of rice is a prerequisite for ensuring yield and rice quality. An in-depth analysis of key traits affecting rice lodging resistance is crucial for guiding the cultivation of excellent rice varieties and field production. Given consumer demand for high-quality rice and frequent extreme weather conditions, this study focused on six high-quality conventional rice varieties and compared the main stem internode physical traits, stem and sheath plumpness traits, main stem mechanical properties, yield-related traits, and panicle characteristics of the plants based on field phenotype measurements. Among them, three varieties showed lodging resistance in the field, while the other three varieties all experienced varying degrees of lodging susceptibility. The results showed that lodging-resistant varieties exhibited a more reasonable internode structure, lower plant height, gravity center height, and relative gravity center height, as well as shorter and thicker second internodes (N2). Additionally, they had higher sheath phimosis degree, greater bending stress, internode-breaking moment, and plant-breaking moment, along with a lower lodging index compared to lodging-susceptible varieties. Specifically, lodging-resistant varieties had 0.83–9.61% lower plant height, 4.11–16.10% lower gravity center height, and 0.09–12.68% lower relative gravity center height than those of lodging-susceptible varieties. Their N2 internode length was 8.96–44.69% shorter, while stem and sheath weight ratios were 16.37–268.58% and 8.27–165.01% higher than those of lodging-susceptible varieties, respectively. At the same time, lodging-resistant varieties exhibit the ability to stabilize yield while reducing their own risk of lodging by increasing effective panicles and reducing single panicle weight. In addition, NX42, LD3, and SY17 were ultimately evaluated as low-risk lodging varieties in this study. This study aims to address the lodging problem of high-quality conventional rice and analyze the key mechanisms underlying its lodging resistance. The research provides important theoretical support for genetic improvement of high-quality conventional rice. Full article

Background: Penile cancer is an uncommon malignancy in European and North America countries, accounting for less than 1% of malignant neoplasms. The etiology of penile cancer involves a complex interplay of clinical and behavioral factors, including phimosis, smoking, excess body weight, and HPV infection. The significance of these factors varies according to geographical and socioeconomic contexts. A comprehensive understanding of these interactions is essential for developing targeted prevention strategies and improving outcomes across diverse populations. However, the majority of existing studies originate from South America or Africa; there is a lack of data regarding these associations and prognoses in European populations, particularly in Central Europe, including Poland. Objectives: This study aimed to investigate the prevalence of well-established clinical and behavioral characteristics associated with penile cancer and their influence on penile cancer prognosis in a cohort of 153 patients who underwent surgical intervention at a single tertiary medical center in Central Europe. Materials and Methods: This retrospective study was conducted from October 2011 to October 2024 at a single tertiary medical center and included 153 patients who underwent surgical treatment for penile cancer during this period. Demographic and histopathological data were collected. A comprehensive, self-administered patient survey was conducted to identify the presence of potentially relevant clinical and lifestyle characteristics. Moreover, the prevalence of human papillomavirus (HPV) in penile cancer specimens was determined using p16 immunohistochemistry. Results: The median age of the participants in the study was 64 years (range: 30–87). The predominant identified features were phimosis (47.06%), residence in small agglomerations (43.14%), obesity (43.14%), overweight (40.52%), and smoking (38.56%). HPV infection was detected in only 14.38% of the patients. Phimosis was associated with a more locally advanced penile cancer stage (T-stage). The stage of the primary tumor, lymph node involvement, and histopathological grading significantly affected patient survival, with a poorer prognosis observed in more advanced stages and associated with poorly differentiated histopathological features. Among all the examined clinical and lifestyle characteristics, only smoking demonstrated a significant two-fold higher risk of mortality and was associated with a significantly lower overall survival compared to the absence of smoking (p = 0.047). Conversely, human papillomavirus (HPV) infection was associated with a six-fold reduction in the risk of death (p = 0.063). Conclusions: Phimosis was the most frequently observed clinical characteristic in our cohort study and was correlated with a more advanced penile cancer tumor stage. Smoking was associated with lower rates of patient survival, while HPV-positive patients demonstrated a trend toward lower mortality compared to HPV-negative patients. Full article

Many ozone-based products that promote the healing process of wounds have been released in recent years. In this study, we evaluate a new spray dressing preparation based on stable ozonides with Vitamin E Acetate in children operated for distal hypospadias. Methods: We included all patients with distal hypospadias, who underwent Tubularized Incised Plate Urethroplasty (TIPU) over a 12-month period. The patients were randomized in two groups according to the type of medication: ozonide spray with Vitamin E Acetate (G1); hyaluronic acid cream (G2). After discharge, parents changed the dressing twice a day for 2–3 weeks postoperatively. The patients were evaluated at 7, 14, 21, 30, 60, and 180 postoperative days and thereafter annually. At the end of the treatment, we submitted a satisfaction questionnaire to parents. Results: Eighty-six patients (median age 18 months) were included. The wound healing was significantly faster in G1 compared with G2 (p = 0.001). No adverse skin reactions occurred in either group. Foreskin dehiscence and re-operation rates were lower in G1. Postoperative foreskin retractability was better in G1, with a significantly higher incidence of secondary phimosis in G2. The median treatment costs were significantly lower in G1 compared with G2 (p = 0.001). Group 1 found the spray dressing easy to use, improving patient management and adherence. Conclusions: The new preparation of ozonide-based product adopted promoted faster wound healing compared to conventional dressing. Furthermore, this spray preparation is easy to apply, economical, and simpler to preserve. This is better for parents who do not have to touch the wound to apply the product. Full article

Background: There are numerous methods of circumcision performed worldwide, typically classified into two main groups: conventional surgical techniques and various device-assisted techniques. Each method has its own advantages, limitations, and potential complications. The aim of this study was to compare outcomes of the Alisklamp technique versus the dorsal slit technique in male circumcision procedures. Method: This multicenter RCT compared the dorsal slit and Alisklamp techniques for circumcision, assessing patient demographics and intraoperative and postoperative outcomes. All patients, under local anesthesia via dorsal penile nerve block, were discharged on the same day and followed up at 24–48 h, 1 week, and 1 month. Results: A total of 180 patients enrolled, and 166 patients were included. The study compared postoperative outcomes between the Alisklamp (AK) and dorsal slit (DS) circumcision techniques in 166 patients. Key findings included significantly higher penile edema in the DS group (19%) compared to the AK group (2.4%) (p < 0.001), with severe edema occurring only in the DS group. Wound gaping was more common in the AK group (8.3%) compared to the DS group (1.2%) (p = 0.030). Skin tunnels were observed only in the DS group (9.5%) (p = 0.004). There were no significant differences in nausea, vomiting, bleeding, necrosis, infection, wound dehiscence, chordee, rotational anomalies, or secondary phimosis between the groups. Mean operation time was lower in the AK group than the DS group (7.8 min vs. 15.5 min; p < 0.001). Conclusions: The Alisklamp technique is recommended as the preferred method for circumcision because it minimizes complications, shortens the procedure time, and is easy to apply. Full article

Background: Phimosis is the inability to completely retract the foreskin and expose the glans. The treatment of phimosis varies depending on the age of the patient and the severity of the disease; a great number of conservative or surgical treatments are currently available. Aim: To provide the first review summarizing the available options for the treatment of adult phimosis. Methods: A PubMed, Cochrane and Embase search for peer-reviewed studies, published between January 2001 and December 2022 was performed using the search terms “phimosis AND treatment”. Results: A total of 288 publications were initially identified through database searching. Thirty manuscripts were ultimately eligible for inclusion in this review. Conservative treatment is an option. and it includes topical steroid application and the new medical silicon tubes (Phimostop™) application for gentle prepuce dilation. Concerning the surgical approach, the gold-standard treatment is represented by circumcision in which tissue synthesis after prepuce removal can be also obtained with barbed sutures, fibrin glues or staples. Laser circumcision seems to be providing superior outcomes in terms of operative time and postoperative complication rate when compared to the traditional one. Several techniques of preputioplasty and use of in situ devices (which crush the foreskin and simultaneously create haemostasis) have been also described. These in situ devices seem feasible, safe and effective in treating phimosis while they also reduce the operative time when compared to traditional circumcision. Patient satisfaction rates, complications and impact on sexual function of the main surgical treatments are presented. Conclusion: Many conservative and surgical treatments are available for the treatment of adult phimosis. The choice of the right treatment depends on the grade of phimosis, results, complications, and cost-effectiveness. Full article

Background: A major worry of juvenile penile LS is potential malignant degeneration to spinocellular carcinoma (SCC) in adulthood. LS is characterized by increased CD8+ and CD57+ cells, dermal sclerosis, epidermal atrophy, and hyperkeratosis. p53 and Ki67 are reliable premalignant markers. Our aim was to define the LS immunohistochemical profile of foreskin in children, focusing on tissue immune response and cell proliferation. Methods: Thirty specimens of foreskins removed from pediatric patients during circumcision were included: six from ritual operation (A), twelve from phimosis (B), and twelve from phimosis with LS (C). Formalin-fixed paraffin-embedded sections were stained for histomorphology and immunohistochemistry. A quantitative evaluation for CD8, CD57, p53, and Ki-67 and a statistical analysis were performed. Results: As compared to groups A and B, the samples from group C patients showed an acanthotic epidermis, a dermal band of lymphoid infiltrate with a significant enhancement of CD8+ CD57+ lymphocytes, and a keratinocytic hyperplasia with an overexpression of Ki67+ and p53+ cells. Conclusions: Immunohistological findings confirmed an immune reaction and proliferative behavior in juvenile LS of foreskin. We believe that radical circumcision should be the first treatment of choice in pediatric patients with clinical suspicious of LS for the potential risk of transformation to SCC in adulthood. Full article

Objective: to evaluate the anesthetic effect among adult male patients with the single use of compound lidocaine cream in device-assisted circumcision, hoping to provide an anesthetic method for the simplification of the surgical process. Methods: Male adult patients undergoing device-assisted circumcision through prepuce local anesthesia using lidocaine cream in Xiangya Hospital of Central South University from December 2020 to August 2021 were selected. According to different age groups and different surgical procedures, the anesthetic effect of compound lidocaine cream was analyzed considering the aspects of anesthetic cost, anesthetic time, anesthetic duration, anesthetic effect, anesthetic side effects and anesthetic satisfaction. Results: In the study, 99.1% of 649 patients needed only 1 application of compound lidocaine cream to complete the operation. The time taken for anesthesia was short; the whole anesthesia process only required approximately 2–5 min. However, for patients with severe phimosis, the time to complete the anesthesia procedure was correspondingly longer. The pain degree caused by anesthesia was low, and the patients with a pain score of ≤3 points accounted for 96.7%. The anesthetic effect lasted for a sufficiently long period, and the time of algesia recovery from local anesthesia was almost 1 h after surgery. The anesthesia effect was sufficient, and patients with an intraoperative pain score of ≤3 accounted for 98.7%, which could meet the surgical requirements. There were few side effects of the anesthesia. The overwhelming majority of patients were pleased with the anesthesia, and 98.9% of patients had an anesthesia satisfaction score of ≥7. Conclusion: The compound lidocaine cream, as a local anesthetic, is safe and effective for most adult male device-assisted circumcisions. More useful information needs to be corroborated by more advanced evidence, especially for severe phimosis. Full article

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 ± 7.05 years, 25.47 ± 4.73, 10.12 ± 1.61, and 7 ± 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 ± 9.96 min, 2.54%, and 9.39%, respectively. The mean VAS postoperative pain scores at D0 and D1 were 4.4 ± 2.4 and 1.9 ± 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 ≤ 0.001). Multivariate analyses revealed only DM as a statistically significant factor (p < 0.001). Our box–whisker plot revealed no significant difference between the HbA1c level of infection (Hb1Ac = 7.77 ± 1.39) and non-infection groups (Hb1Ac = 6.92 ± 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 > 9%), users should be highly cautious due to the increased risk of infection, dehiscence, and hematoma. Full article