Trial reportBJU international2009
The number of procedures required to achieve optimal competency with male circumcision: findings from a randomized trial in Rakai, Uganda.
Trial report in BJU international, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Wound healing rates and wound problems of conventional circumcision compared with ring circumcision: A meta-analysis.International wound journal · 2023Pooled it
- Efficacy and safety of two disposable circumcision suture devices for circumcision in adults: a prospective comparative multicenter study.International journal of impotence research · 2025Trial
- Trial
- Trial
- Simple circumcision device: proof of concept for a single-visit, adjustable device to facilitate safe adult male circumcision.Fertility and sterility · 2014Trial
- Shang Ring versus forceps-guided adult male circumcision: a randomized, controlled effectiveness study in southwestern Uganda.Journal of acquired immune deficiency syndromes (1999) · 2013Trial
- Evaluation of the safety and efficiency of the dorsal slit and sleeve methods of male circumcision provided by physicians and clinical officers in Rakai, Uganda.BJU international · 2012Trial
- Urethrocutaneous fistula following VMMC: a case series from March 2013 to October 2019 in ZAZIC's voluntary medical male circumcision program in Zimbabwe.BMC urology · 2022Article
- Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version).Canadian Urological Association journal = Journal de l'Association des urologues du Canada · 2018Article
- Trends in the Marginal Cost of Male Circumcision in Rural Rakai Uganda.Journal of acquired immune deficiency syndromes (1999) · 2016Article
- Surgical Outcomes of Newly Trained ShangRing Circumcision Providers.Journal of acquired immune deficiency syndromes (1999) · 2016Observational
- The characteristics of circular disposable devices and in situ devices for optimizing male circumcision: a network meta-analysis.Scientific reports · 2016Article
- Rates of adverse events associated with male circumcision in U.S. medical settings, 2001 to 2010.JAMA pediatrics · 2014Article
- Safety of adult medical male circumcision performed by non-physician clinicians in Kenya: a prospective cohort study.Global health, science and practice · 2014Article
- Safety, effectiveness and acceptability of the PrePex device for adult male circumcision in Kenya.PloS one · 2014Article
- Factors associated with the safety of voluntary medical male circumcision in Nyanza province, Kenya.Bulletin of the World Health Organization · 2012Article
- Building a global health education network for clinical care and research. The benefits and challenges of distance learning tools. Lessons learned from the Hopkins Center for Clinical Global Health Education.Infectious disease clinics of North America · 2011Article
- Implementation science for the prevention and treatment of HIV/AIDS.Journal of acquired immune deficiency syndromes (1999) · 2010Article
- Male circumcision: towards a World Health Organisation normative practice in resource limited settings.Asian journal of andrology · 2010Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
Abstract
objectiveTo assess the number of procedures required to achieve optimal competency (time required for surgery with minimal adverse events) in Rakai, Uganda, and thus facilitate the development of guidelines for training providers, as male circumcision reduces the acquisition of human immunodeficiency virus (HIV) in men and is recommended for HIV prevention. PATIENTS AND
methodsIn a randomized trial, 3011 men were circumcised, using the sleeve method, by six physicians who had completed training, which included 15-20 supervised procedures. The duration of surgery from local anaesthesia to wound closure, moderate or severe surgery-related adverse events (AEs), and wound healing were assessed in relation to the number of procedures done by each physician.
resultsThe median age of the patients was 24 years. The number of procedures per surgeon was 20-981. The mean time required to complete surgery was approximately 40 min for the first 100 procedures and declined to 25 min for the subsequent 100 circumcisions. After controlling for the number of procedures there was no significant difference in duration of the surgery by patient HIV status or age. The rate of moderate and severe AEs was 8.8% (10/114) for the first 19 unsupervised procedures after training, 4.0% for the next 20-99 (13/328) and 2.0% for the last 100 (P for trend, 0.003). All AEs resolved with management.
conclusionThe completion of more than 100 circumcisions was required before newly trained physicians achieved the optimum duration of surgery. AEs were higher immediately after training and additional supervision is needed for at least the first 20 procedures after completing training.
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