Rapid, minimally invasive adult voluntary male circumlcision with the Unicirc, a novel disposable device.

324 May 2014, Vol. 104, No. 5 Rapid, minimally invasive adult voluntary male circumcision with the Unicirc, a novel disposable device To the Editor: I congratulate Millard et al.[1] on their publication. My co-workers and I have studied the PrePex male circumcision device in three clinical trials,[2-4] and I would like to share our opinions. The Unicirc is intended to be used exclusively with glue. We therefore consider that any suturing that is necessary with the device should be defined as an adverse event and should have been documented as such, as in the authors’ previous reported study.[5] We have some concerns about the safety of using cyanoacrylate glue in adult circumcisions. According to recommendations, adhesives such as DermaBond (2-octyl cyanoacrylate)[6] are contraindicated for skin that may be regularly exposed to body fluids, as the foreskin is, and should also not be used in high skin tension areas (knuckles, elbows and knees) unless they are immobilised; erections cannot be immobilised, so the use of this type of glue on the penis poses risks. Millard et al.’s report of healing time lacks a definition of complete healing. Moreover, in their previous report[5] they stated that ‘there was no independent, objective measure of wound healing outcomes’. Their conclusion that ‘The cost of expendable materials was similar using the two techniques’ is puzzling, as in the same article[5] they report the following costs of expendables for the two arms: surgical = $15; Unicirc + glue = $4 + $5 + $20 = $29. Regarding the reported procedure time, we could not work out whether the waiting time for the local anaesthetic to numb the foreskin was included. Millard et al. report that removal of the PrePex is unpleasant. What scientific research was performed to back up this statement? We have data on acceptability from questionnaires and have reported satisfaction rates as high as 92 100% with regard to men’s experience during the removal procedure.[4] In respect of the report of odour, we have recently determined that any odour is directly related to the patient’s personal foreskin hygiene and not to the device or the necrotic foreskin (article under review).