Rubber and Plastic Device Enables Surgery-Free Circumcision

Will a rubber-band technology help solve the AIDS crisis in Africa?

Three studies have now demonstrated that circumcising adult males reduces the chance of infection by 60% or more. So public health experts are looking at devices that can make the process faster, cheaper, and safer in order to circumcise 20 million African men by 2015, reports Donald G. McNeil Jr. in The New York Times.

A few weeks ago, the Food and Drug Administration approved PrePex. The rubber and plastic device was created in 2009 by four Israelis, including a urologist, who heard a request for doctors to circumcise men in Africa. The World Health Organization may also approve the device soon, according to The New York Times.

McNeil explains that “circumcision is believed to protect heterosexual men because the foreskin has many Langerhans cells, which pick up viruses and ‘present’ them to the immune system — which H.I.V. attacks.”

A skilled surgeon can do a circumcision in about 15 minutes. But in most African countries, surgeons and operating rooms are scarce and needed for more complicated procedures, such as obstructed labor. Two trained nurses can administer a new device for circumcision called PrePex in about three minutes.

McNeil writes that the safety studies of the device conducted in Rwanda show it to be “faster, less painful and more bloodless than any of its current rivals.” Here’s how the device works:

The band compresses the foreskin against a plastic ring slipped inside it; the foreskin dies within hours for lack of blood and, after a week, falls off or can be clipped off ‘like a fingernail,’ said Tzameret Fuerst, the company’s chief executive officer, who compared the process to the stump of an umbilical cord’s shriveling up and dropping off a few days after it is clamped.

It is done with topical anesthetic cream, and there is usually no bleeding. And PrePex can be put in place and removed by nurses with about three days’ training.

Fuerst noted to McNeil that “you won’t believe how high-tech the rubber band is,” and that PrePex’s ultimate cost may end up in the $15-to-$20 range, which is similar to a surgical circumcision kit.

Robert C. Bailey, an epidemiologist at the University of Illinois in Chicago who helped design Kenya’s circumcision efforts, told The New York Times that he opposes devices that reduce circumcision from, for example, 20 minutes to five minutes because the truly time-consuming parts of the process are counseling and HIV testing. “But he conceded, ‘If PrePex really doesn’t require anesthesia, that’s truly an advance.’”

Source: “AIDS Prevention Inspires Ways to Make Circumcisions Easier,” The New York Times, 1/30/12
Source: “BBC News – New device makes circumcision safer and cheaper,” YouTube

Rachel Petkewich is a freelance science writer and editor. She has worked as a research scientist in the chemical industry and spent eight years as a staff writer and editor at various science journals and magazines, including Chemical & Engineering News.