Rapid, minimally invasive adult voluntary male circumcision: A randomised trial of Unicirc, a novel disposable device

Background. Voluntary medical male circumcision (VMMC) is a priority HIV preventive intervention. To facilitate VMMC scale-up, the World Health Organization is seeking circumcision techniques that are faster, easier, and safer than open surgical methods.Objective. To compare open surgical circumcision with suturing v. the Unicirc disposable instrument plus tissue adhesive.Methods. We conducted a non-blinded randomised controlled trial at an outpatient primary healthcare clinic in Cape Town, South Africa, with 2:1 allocation ratio of 150 male volunteers who were at least 18 years of age. Our primary outcome was intraoperative time and secondary outcomes were ease of performance, post-operative pain, adverse events, time to healing, patient satisfaction and cosmetic result. Results. The intraoperative time was less with the Unicirc/adhesive technique (median 13 v. 22.6 min, respectively; p<0.001). The intraoperative suturing rate was 17% using the Unicirc device. Other adverse events and wound healing outcomes were similar in both groups, but the cosmetic result was superior in the Unicirc group. Doctors found the Unicirc procedure easier to perform and preferred it to the open surgical technique. Conclusions. This study has important implications for the scale-up of VMMC services. Excising the foreskin with the Unicirc instrument and sealing the wound with cyanoacrylate tissue adhesive in adults is quicker, easier to learn, and is potentially safer than open surgical VMMC. Further studies should be conducted with the optimised device. This new instrument has the potential to facilitate more rapid scale-up and save costs.

Adult circumcision in the prevention of HIV/AIDS

CITATION: Goldstuck, N. D. 2014. Adult circumcision in the prevention of HIV/AIDS. South African Medical Journal, 104(1):17, doi:10.7196/SAMJ.7216.The original publication is available at http://www.samj.org.zaNo abstract.http://www.samj.org.za/index.php/samj/article/view/7216Publisher's versio

The efficacy of intrauterine devices for emergency contraception and beyond : a systematic review update

CITATION: Goldstuck, N. D. & Cheung, T. S. 2019. The efficacy of intrauterine devices for emergency contraception and beyond : a systematic review update. International Journal of Women's Health, 11:471-479, doi:10.2147/IJWH.S213815.The original publication is available at https://www.dovepress.comBackground: The copper intrauterine device (IUD) is a very effective form of emergency contraception. The failure rate is about 0.1%. IUDs are also very cost-effective when used as long acting-reversible contraception (LARC). The purpose of this review is to attempt to confirm these findings. Methods: The references for this study were generated by entering the terms “intrauterine device” “and “emergency contraception” in Medline, PubMed, Popline, Global Health and ClinicalTrials.gov. Chinese references were obtained from the Wanfang database. For the emergency contraception study, articles with a defined population who were followed up until outcome were eligible. Women who were adequately followed for at least 6 months were included in the long term arm of the study. Results: There were 18 (of 228) studies which met our selection criteria and were conducted in five countries, between August 2011 and January 2018. There were 1720 insertions of seven types of copper IUD with a failure rate of 0.12%. The maximum time from intercourse to IUD insertion was 14 days. The discontinuation rate at 12 months was over 20% in the long term studies. Conclusion: There are now a combined total of 8550 reported insertions from two reviews with 8 pregnancies and a failure rate of 0.093%. Copper IUDs remain an effective form of emergency contraception, for which they are under-promoted. The major limitation of the studies is the lack of data relating unprotected intercourse to the day of the cycle.https://www.dovepress.com/the-efficacy-of-intrauterine-devices-for-emergency-contraception-and-b-peer-reviewed-fulltext-article-IJWHPublisher's versio

Insertion of intrauterine devices after cesarean section : a systematic review update

CITATION: Goldstuck, N. D. & Steyn, P. S. 2017. Insertion of intrauterine devices after cesarean section : a systematic review update. International Journal of Women’s Health, 9:205-212, doi:10.2147/IJWH.S132391.The original publication is available at https://www.dovepress.comBackground: Women who undergo a cesarean section (CS) are in a unique position to receive the intrauterine contraceptive device (IUD). They may also want to use the IUD as a long-acting reversible contraceptive method provided the IUD is safe and effective in the presence of a CS scar. Search strategy: We researched and reviewed the MEDLINE, POPLINE, Google Scholar, and ClinicalTrials.gov databases from January 1968 to June 2015. Selection criteria: Eligible studies reported event rates or practical problems relating to IUD usage in post-placental or interval insertion (>90 days) after CS. Studies with ≥20 subjects were included. Data collection and analysis: Analysis of eligible data collected from the search followed the PRISMA guidelines. Main results: Twelve eligible studies of post-placental IUD insertion after CS included four randomized controlled trials of post-placental versus delayed insertion. Women randomized to delayed insertion were less likely to receive a device. Six studies examined the problem of missing IUD threads at follow-up with only 30%–60% presence of strings observed. Conclusion: The IUD is a long-acting reversible contraceptive method that is suitable for use in all women undergoing CS. The problems of device expulsion, missing threads at follow-up, and the tendency of increased puerperal bleeding need to be solved. Solutions are proposed.https://www.dovepress.com/insertion-of-intrauterine-devices-after-cesarean-section-a-systematic--peer-reviewed-article-IJWHPublisher's versio

No-Needle, Single-Visit Adult Male Circumcision with Unicirc: A Multi-Centre Field Trial

<div><p>Background</p><p>Voluntary medical male circumcision (VMMC) is a priority HIV preventive intervention. Current adult circumcision methods need improvement.</p><p>Methods</p><p>Field trial in 3 primary care centres. Minimally invasive VMMC using the Unicirc instrument following topical lidocaine/prilocaine anesthetic. Men were followed up at 1 and 4 weeks.</p><p>Results</p><p>We circumcised 110 healthy volunteers. Two men complained of transient burning pain during circumcision, but none required injectable anaesthesia. Median blood loss was 1ml and median procedure time was 9.0 min. There were 7 (6.3%) moderate complications (5 (4.5%) post-operative bleeds requiring suture and 2 (1.8%) post-operative infections) affecting 7 men. No men experienced significant wound dehiscence. 90.4% of men were fully healed at 4 weeks of follow-up and all were highly satisfied.</p><p>Conclusions</p><p>Use of topical anaesthesia obviates the need for injectable anesthetic and makes the Unicirc procedure nearly painless. Unicirc is rapid, easy to learn, heals by primary intention with excellent cosmetic results, obviates the need for a return visit for device removal, and is potentially cheaper and safer than other methods. Use of this method will greatly facilitate scale-up of mass circumcision programs.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT02091726?term=unicirc&rank=1" target="_blank">NCT02091726</a></p></div

Four-week follow-up.

<p>Four-week follow-up.</p

Unicirc placement.

<p>Unicirc placement.</p

Applying cyanoacrylate adhesive.

<p>Applying cyanoacrylate adhesive.</p