Dear Editor,We read with great interest this excellent article by Lv et al.,1 who described their study of the new disposable circumcision suture device (DCSD) for male circumcision. The study assessed the clinical effect and satisfaction of 942 patients in the conventional, Shang ring, and DCSD circumcision groups. The findings indicated that DCSD circumcision was associated with a significant decrease in intraoperative and postoperative pain compared with the other two methods.We agree with their conclusion that both the intraoperative and 1-week postoperative pain scores were lower in the DCSD group than in the conventional and Shang ring circumcision groups (1.9 ± 1.3 vs 6.2 ± 2.2 and 5.8 ± 2.1, and 2.7 ± 0.9 vs 3.3 ± 0.8 and 6.4 ± 2.0, respectively; P < 0.001). However, as the authors reported, the patients in the DCSD group were anesthetized with topical 5% lidocaine cream applied on the surface of the penis, whereas the patients in the other two groups were anesthetized with 2% lidocaine injection for dorsal penile nerve block. Thus, considering the different methods of anesthesia used, the comparison of the pain scores among the three different procedures seems unreasonable and might overestimate the efficacy of DCSD for male circumcision.Cao et al.2 described their experience by comparing the DCSD and conventional circumcision methods, using 5 ml 1% lidocaine injections for dorsal penile nerve block. They concluded that the DCSD circumcision was associated with lower pain score on the first postoperative day than the other two methods. In addition, Wang et al.3 performed a randomized, multicenter pilot clinical trial to compare the DCSD circumcision method with conventional dissection methods, using 10–20 ml of 1% lidocaine injection per patient. However, they found no significant difference in postoperative pain between the groups at 1, 3, 7, and 14 days of follow-up (P > 0.05). Hence, we believe that pain score may well be related to the type and dose of lidocaine administered. Meanwhile, we consider it better to use the same intervention (the same anesthetic type and dose) in the comparison of the three circumcision methods.
COMPETING INTERESTS
The authors declare that they have no competing interests.