ZSR Circumcision: A Modern Surgical procedure for Phimosis
What Is Phimosis?
Phimosis is a health condition in which the prepuce (foreskin) covering the glans (head of the penis) is too tight to be retracted or pulled back. It is common in babies. Older children may also develop it because of scarring from a skin condition.
Young boys usually do not need any treatment for this condition unless they develop symptoms. However, as they grow up, the need for proper treatment is likely to increase.
There are two forms of phimosis—physiologic and pathologic. Physiologic phimosis refers to the condition in which a child is born with a tight foreskin. Easy retraction occurs as they grow old naturally. Pathologic phimosis means scarring-induced phimosis or infection in the penis or the foreskin.
What Are the Symptoms of Phimosis?
In most cases, phimosis does not cause symptoms besides the inability to retract the prepuce. However, when symptoms develop, they might include the following:
• foreskin
• Soreness
• Redness
• Swelling
• Difficulty in urination
In some cases, mainly due to poor hygiene, phimosis can also cause inflammation of the penis. It is known as balanitis.
The signs and symptoms of balanitis include:
• Itchiness, soreness
• Pain while passing urine
• Fluid buildup
What Are the Causes of Phimosis?
It is natural in boys with an uncircumcised penis. However, usually, the foreskin detaches over time (between 2 to 6 years).
In older boys, it is likely to develop because of the following reasons:
• Recurring UTIs (Urinary Tract Infections)
• Foreskin trauma
• Infection in the foreskin
• Infection in penis
In adults, the causes may include the following:
• Sexually transmitted infections (STIs)
• Eczema (a skin condition that makes the skin dry, red, and itchy)
• Lichen sclerosis (a skin condition causing foreskin scarring)
• Lichen planus (a skin condition)
• Psoriasis (another skin condition that makes skin flaky and red)
What are the risks of untreated phimosis?
Boys or adult males with phimosis are at an increased risk of developing penile cancer. Moreover, if this condition is left untreated, it is likely to worsen the symptoms. In extreme cases, it may also lead to gangrene formation and, eventually, penis loss.
What are the treatment options for phimosis?
The treatment options for phimosis are likely to vary, depending on the severity of the condition. Some standard treatment options include the following:
• Daily gentle retraction of the foreskin (manual)
• Topical corticosteroid ointment
• Conventional circumcision
• ZSR circumcision
What is ZSR circumcision?
ZSR circumcision (removal of the foreskin covering the head of the penis) is a revolutionary circumcision procedure that uses a surgical stapler to cut and staple (close up) the sides of the foreskin instead of using standard sutures.
A Chinese firm, ZSR Biomedicals, developed this avant-garde circumcision technology. It is a quick and minimally-invasive procedure where the surgeon cuts, covers the skin edges with silicon ring and staples it to hold the skin together using the same device, unlike conventional circumcision.
In the case of traditional circumcision, the doctor, at first, cuts the foreskin and then seals it using sutures. It takes time and is likely to be painful. However, the ZSR procedure causes negligible or no pain and bleeding. Moreover, the procedure does not use surgical stitches but metal clips (disposable circumcision staples) on silicon rings.
A disposable circumcision stapler is a hand-held, sterile surgical equipment that makes an incision in the foreskin of the penis while applying clips in circular rows near the incision line.
The stapler part comprises a dome and a circular cutting stapler with a manual lever. The surgeon implants the dome under the foreskin covering the glans while using the circular cutting device to connect over the outer portion of the penis.
A comparative analysis between ZSR and Conventional Circumcision
| Parameters | Conventional Method | ZSR circumcision |
| Duration | > 30 Minutes | 5 - 10 Minutes |
| Safety | Some risks involved | Safe |
| Bleeding during Surgery | A lot of bleeding | Minimal bleeding |
| Postoperative Pain | 3 to 5 days | Minimal or no pain |
| Stitches | Required | No stitches |
| Restrictions | Avoid heavy work, running, cycling for 2 weeks and sex for 2 months | Avoid heavy work, running, cycling for 1 week and sex for 1 month |
| Cosmetic | May leave uneven skin and ugly scars and stitch marks | Clean and scarless as the mechanized stapler makes a circular cut and no stitching of skin is done |