Post-Procedure Care Outweighs Device Factors in Determining Clinical Outcomes of Super Ring Circumcision in Indonesia: A Multicenter Retrospective Study — Oak Academic Publishing
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Post-Procedure Care Outweighs Device Factors in Determining Clinical Outcomes of Super Ring Circumcision in Indonesia: A Multicenter Retrospective Study
PT Sunat Modern Indonesia (Modern Circumcision Indonesia), Madiun, Indonesia
,
Sunan Giri Academy of Pharmaceutical and Food Analysis, Ponorogo, Indonesia
,
PT Sunat Modern Indonesia (Modern Circumcision Indonesia), Madiun, Indonesia
,
PT Sunat Modern Indonesia (Modern Circumcision Indonesia), Madiun, Indonesia
,
Faculty of Medicine and Health Sciences, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
,
School of Health Sciences, Stikes Intan Martapura, Banjar, Indonesia
,
Dr. Harjono Regional General Hospital, Ponorogo, Indonesia
,
Faculty of Medicine, Muhammadiyah University of Surakarta, Surakarta, Indonesia
1 PT Sunat Modern Indonesia (Modern Circumcision Indonesia), Madiun, Indonesia
2 Sunan Giri Academy of Pharmaceutical and Food Analysis, Ponorogo, Indonesia
3 PT Sunat Modern Indonesia (Modern Circumcision Indonesia), Madiun, Indonesia
4 PT Sunat Modern Indonesia (Modern Circumcision Indonesia), Madiun, Indonesia
5 Faculty of Medicine and Health Sciences, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
6 School of Health Sciences, Stikes Intan Martapura, Banjar, Indonesia
7 Dr. Harjono Regional General Hospital, Ponorogo, Indonesia
8 Faculty of Medicine, Muhammadiyah University of Surakarta, Surakarta, Indonesia
Introduction: Device-based circumcision techniques, including the super-ring method, have gained increasing acceptance because of their procedural simplicity and potential clinical benefits. However, variability in clinical outcomes persists, and the role of postprocedural care remains underexplored. Methods: This multicenter retrospective study analyzed 321 eligible medical records selected from 436 pediatric patients who underwent super-ring circumcision across 20 circumcision centers in Indonesia. The independent variables included procedural factors and postprocedural care practices. The outcomes were wound healing, time to ring detachment (≤10 vs. >10 days), and edema. Data were analyzed using the chi-squared test and multivariate logistic regression. Results: Most patients achieved complete wound healing (83.2%) and 59.8% experienced ring detachment within 10 days. Ointment use was the strongest predictor of wound healing (odds ratio [OR], 10.65; 95% confidence interval [CI], 4.56 - 24.90; p Conclusion: Post-procedural care factors, particularly ointment application and soaking practices, were more strongly associated with clinical outcomes than device-related factors in super-ring circumcision. These findings support the potential importance of standardized aftercare protocols in optimizing healing and reducing postoperative complications.
Fahmy, M. (2017) Complications of Male Circumcision (MC). In: Fahmy, M., Ed., Congenital Anomalies of the Penis , Springer International Publishing, 227-235. https://doi.org/10.1007/978-3-319-43310-3_35
Morris, B.J., Wamai, R.G., Henebeng, E.B., Tobian, A.A., Klausner, J.D., Banerjee, J., et al . (2016) Estimation of Country-Specific and Global Prevalence of Male Circumcision. Population Health Metrics , 14, Article No. 4. https://doi.org/10.1186/s12963-016-0073-5
Kling, S. (2025) The Ethics of Neonatal Male Circumcision. Current Allergy and Clinical Immunology , 38, 121-217.
Elsayed, B., Elmarasi, M., Madzime, R.J., Mapahla, L., ElBadway, M.M.S. and Chivese, T. (2024) Estimates of the Prevalence of Male Circumcision in Sub-Saharan Africa from 2010-2023—A Systematic Review and Meta-Analysis. PLOS ONE , 19, e0298387. https://doi.org/10.1371/journal.pone.0298387
Porche, D.J. (2007) Adult Male Circumcision. The Journal for Nurse Practitioners , 3, 226-227. https://doi.org/10.1016/j.nurpra.2007.02.014
Fahmy, M.A.B. (2019) Prevalence of Male Circumcision Complications. In: Fahmy, M.A.B., Ed., Complications in Male Circumcision , Elsevier, 49-63. https://doi.org/10.1016/b978-0-323-68127-8.00007-7
Fahmy, M.A.B. (2019) Infectious Complications of Circumcision. In: Fahmy, M.A.B., Ed., Complications in Male Circumcision , Elsevier, 73-98. https://doi.org/10.1016/b978-0-323-68127-8.00009-0
Sağır, S., Azizoğlu, M. and Ergün, M. (2023) Fewer Knots in Circumcision Are Associated with Less Postoperative Pain: A Retrospective Comparative Study. Neonatology , Surgery and Perinatal Medicine , 8, 25-30. https://doi.org/10.24061/2413-4260.xiii.1.47.2023.4
Bailey, R.C., Praptoraharjo, I., Muryani, N., Soeselo, D.A., Ghosh, S. and Levy, J.A. (2025) Introduction of Voluntary Medical Male Circumcision for HIV Prevention in Tanah Papua, Indonesia. AIDS and Behavior , 29, 2420-2430. https://doi.org/10.1007/s10461-025-04704-z
Widjajanto, P.H., Hadi, N., Saputro, I.O., Wibowo, A., Budiono, N., Tusino, A., et al . (2024) Circumcision in Subject with Hemophilia: The Yogyakarta Method. Paediatrica Indonesiana , 64, 244-249. https://doi.org/10.14238/pi64.3.2024.244-9
Fahmy, M.A.B. (2019) Post-Male Circumcision Penile Injuries. In: Fahmy, M.A.B., Ed., Complications in Male Circumcision , Elsevier, 145-169. https://doi.org/10.1016/b978-0-323-68127-8.00012-0
Hosseini, J., Haghdani, S. and Narimani, N. (2019) Glandular Amputation by Strangulating Tied Suture: A Case Report of Late-Onset Complication in the Plastibell Circumcision Technique. BMC Pediatrics , 19, Article No. 175. https://doi.org/10.1186/s12887-019-1554-z
Gamidov, S.I., Druzhinina, N.K., Shatylko, T.V., Gasanov, N.G., Safiullin, R.I. and Guluzade, K.S. (2023) Surgical Correction of Circumcision Complications. Androl ogy and Genital Surgery , 24, 144-154. https://doi.org/10.17650/2070-9781-2023-24-4-144-154
Urakov, A.L., Sagidullina, I.R. and Shabanov, P.D. (2025) Targeted Temperature Management, Warm Alkaline Hydrogen Peroxide Solutions, and Dilute Solutions of Local Anesthetics as Safety Factors for Circumcision. Reviews on Clinical Pharmacology and Drug Therapy , 23, 145-157. https://doi.org/10.17816/rcf677680
PDKI (2021) Super Ring Indonesia. Trademark Registration, Ministry of Law and Human Rights, Republic of Indonesia.
Suwarno, A. and Mazidu, R. (2020) CORPUS Circumcision Overview in Practice & Update Skill of Circumcision. PT Sunat Modern Indonesia.
Divisi Kurikulum PT SMI (2022) Standar Kurikulum Pelatihan Sunat Modern Super Ring. PT Sunat Modern Indonesia.
Suwarno, A., Rahman, L.A., Widodo, N.S.A., Heryyanoor, H., Febriana, A. and Yuliana, I. (2022) Super Ring Modern Circumcision Training with Free Needle Injection Anesthesia in Improving the Skills of Health Workers. Community Empowerment , 7, 994-998. https://doi.org/10.31603/ce.7167
Boakye, S.A. and Obeng, F. (2025) Clinical Outcomes of Circumcisions and Prevalence of Complications of Male Circumcisions: A Five-Year Retrospective Analysis at a Teaching Hospital in Ghana. PLOS Global Public Health , 5, 1-15. https://doi.org/10.1371/journal.pgph.0003788
Peng, L., Han, Y.-F., Chen, D., Lai, B. and Huang, H.-C. (2020) Comparison of the Disposable Circumcision Stapler, Disposable Prepuce Ligator and Traditional Surgical Method in Circumcision. National Journal of Andrology , 26, 1101-1104. https://www.scopus.com/inward/record.uri?eid=2-s2.0-85122549958&partnerID=40&md5=77d59c2bbf41604e28532ef4a6e305c2
Feldblum, P.J., Odoyo-June, E., Bailey, R.C., Jou Lai, J., Weiner, D., Combes, S., et al . (2016) Factors Associated with Delayed Healing in a Study of the Prepex Device for Adult Male Circumcision in Kenya. JAIDS Journal of Acquired Immune Deficiency Syndromes , 72, S24-S29. https://doi.org/10.1097/qai.0000000000000736
Vinci, V., Di Giuli, R., Fontoura Andrade Reis, A.P. and Klinger, M. (2024) Wound Care in Aesthetic Surgery. In: Maruccia, M., Papa, G., Ricci, E. and Giudice, G. Eds., Pearls and Pitfalls in Skin Ulcer Management , Springer International Publishing, 511-521. https://doi.org/10.1007/978-3-031-45453-0_44
Yu, H., Li, Y., Huang, W., et al . (2024) Study on the Use of Auricular Pressure Bean Combined with Compound Tung Leaf Burn Oil in Incision Healing after Circumcision. Journal of Men ’ s Health , 20, 64-71.
Hohlfeld, A.S., Ebrahim, S., Zaki Shaik, M. and Kredo, T. (2022) Circumcision Devices versus Standard Surgical Techniques in Adolescent and Adult Male Circumcisions: A Cochrane Review. BJU International , 130, 26-34. https://doi.org/10.1111/bju.15604
Ahmad, I., Tang, J., Khondker, A., Malik, A., Chua, M., Rickard, M., et al . (2024) Evaluating Safety of Ring versus Clamp Devices in Neonatal Circumcision: A Meta-Analysis. Journal of Pediatric Surgery , 59, Article 161606. https://doi.org/10.1016/j.jpedsurg.2024.06.015
Nuutila, K. and Eriksson, E. (2021) Moist Wound Healing with Commonly Available Dressings. Advances in Wound Care , 10, 685-698. https://doi.org/10.1089/wound.2020.1232
Tan, S.T. and Dosan, R. (2019) Lessons from Epithelialization: The Reason behind Moist Wound Environment. The Open Dermatology Journal , 13, 34-40. https://doi.org/10.2174/1874372201913010034
Leise, B.S. (2018) Topical Wound Medications. Veterinary Clinics of North America : Equine Practice , 34, 485-498. https://doi.org/10.1016/j.cveq.2018.07.006
Bounds, K., Colmer‐Hamood, J.A., Myntti, M., Jeter, R.M. and Hamood, A.N. (2022) The Influence of a Biofilm‐Dispersing Wound Gel on the Wound Healing Process. International Wound Journal , 19, 553-572. https://doi.org/10.1111/iwj.13653
Teskey, S.J.L., Khoma, L., Lorbes, M. and Miller, C.C. (2026) Nitric Oxide-Releasing Gels in the Context of Antimicrobial Stewardship, Biofilm Management, and Wound-Repair Biology. Antibiotics , 15, Article 54. https://doi.org/10.3390/antibiotics15010054
Weller, C. (2009) Interactive Dressings and Their Role in Moist Wound Management. In: Rajendran, S., Ed., Advanced Textiles for Wound Care , Elsevier, 97-113. https://doi.org/10.1533/9781845696306.1.97
Inagawa, K. and Moriguchi, T. (2012) Classification and Selection of Modern Wound Dressing Materials. Japanese Journal of Plastic Surgery , 55, 237-246. https://www.scopus.com/inward/record.uri?eid=2-s2.0-84861493823&partnerID=40&md5=3479c669ec318a77811aa30f06bc0488
Faure-Chazelles, C. (2014) Dressings for Necrosed Skin. In: Téot, L., Meaume, S., Akita, S., Ennis, W.J. and del Marmol, V., Eds., Skin Necrosis , Springer, 251-256. https://doi.org/10.1007/978-3-7091-1241-0_41
Saeed, A., Gregory, D., Amin, R., Khanbhai, M. and Khan, A. (2023) A Novel Disposable Ring (Circumplast) Showed No Ring Migration onto the Shaft of the Penis in First 1000 Male Children’s Circumcisions in a Community Specialist Clinic. Journal of Pediatric Surgery Case Reports , 92, Article 102603. https://doi.org/10.1016/j.epsc.2023.102603
Ikhisemojie, S.O., Ademuyiwa, A.O., Bode, C.O. and Mofikoya, B.O. (2017) Is the Plastibell of Any Haemostatic Value after 24 H? African Journal of Paediatric Surgery , 14, 5-7. https://doi.org/10.4103/ajps.ajps_19_16
Nicassio, L., Ching, C.B., Klamer, B., Sebastião, Y.V., Fuchs, M., McLeod, D.J., et al . (2021) Gomco Vs. Plastibell Office Circumcision: No Difference in Overall Post-Procedural Complications and Healthcare Utilization. Journal of Pediatric Urology , 17, 85.E1-85.E7. https://doi.org/10.1016/j.jpurol.2020.11.019
Ennab, R.M., Aljabali, A.A.A., Charbe, N.B., Barhoum, A., Alqudah, A. and Tambuwala, M.M. (2022) Nanocelluloses in Wound Healing Applications. In: Barhoum, A., Ed., Handbook of Nanocelluloses , Springer International Publishing, 649-676. https://doi.org/10.1007/978-3-030-89621-8_41
Olutoye, O.O., Eriksson, E., Menchaca, A.D., et al. (2024) Management of Acute Wounds—Expert Panel Consensus Statement. Advances in Wound Care , 13, 553-583. https://doi.org/10.1089/wound.2023.0059
Gümüs, N. (2012) Negative Pressure Dressing Combined with a Traditional Approach for the Treatment of Skull Burn. Nigerian Journal of Clinical Practice , 15, 494-497. https://doi.org/10.4103/1119-3077.104539
Kalyenci, B., Benlioglu, C., Ölçücü, M.T., Teke, K., Sever, S., Çift, A., et al . (2025) Retrospective Analysis of Clinical Outcomes and Early Complications of Conventional Circumcision Techniques and Thermocautery-Assisted Circumcision. Scientific Reports , 15, Article No. 7139. https://doi.org/10.1038/s41598-025-91730-5
Palinrungi, M.A., Faruk, M., Marewa, M.R., Chairul, A.M., Arista, A.A., Thalib, N., et al . (2025) Comparison of Novel Dorsal Buttonhole Slit versus Conventional Dorsal Slit Circumcision: Efficacy, Safety, and Parents’ Satisfaction. Archivio Italiano di Urologia e Andrologia , 97, Article No. 13999. https://doi.org/10.4081/aiua.2025.13999
Essa, M. (2023) Safety, Acceptability, and Feasibility of Male Circumcision Using the Alisklamp Device. Journal of Pediatric Urology , 19, 107.E1-107.E10. https://doi.org/10.1016/j.jpurol.2022.09.013
Modekwe, V.I., Ezeifedikwa, C., Nwosu, E.T., Nwankwo, E.U., Ekwunife, O.H., Ugwu, J.O., et al . (2025) A Comparison of Three Techniques in Neonatal Circumcision: Artery Forceps, Bone-Cutter, and Gomco Clamp Methods. Ethiopian Journal of Health Sciences , 35, 28-34. https://doi.org/10.4314/ejhs.v35i1.5
Akyüz, O. and Tatar, Z. (2021) Is It Safe to Use a Thermocautery Device for Circumcision? Examination of the Histopathological Changes Emerging after Thermocautery‐assisted Circumcisions. Andrologia , 53, e13968. https://doi.org/10.1111/and.13968