Current methods of circumcision: choosing the right technique for the right patient.

PURPOSE OF REVIEW: Circumcision remains one of the most commonly performed urological procedures worldwide. This narrative review discusses contemporary methods of circumcision, with emphasis on patient selection, conventional surgery, device-assisted circumcision, ShangRing, stapler devices, laser and energy-assisted techniques, wound closure, and special situations such as severe pathological phimosis and lichen sclerosus.

RECENT FINDINGS: Recent literature has focused on adult phimosis management, modified conventional techniques, disposable circumcision devices, stapler devices, ShangRing, Alisklamp, Unicirc, Plastibell outcomes, laser circumcision, thermocautery, ultrasonic dissection scalpel and tissue adhesive closure. Devices generally offer shorter operative time, consistent excision and favourable cosmetic outcomes in selected patients. However, bleeding, oedema, retained rings or staples, ring-related discomfort, wound gaping and difficulty in severe pathological phimosis remain important considerations.

SUMMARY: Conventional circumcision remains the most versatile reference technique against which newer methods are judged. Laser, ShangRing, stapler devices, tissue adhesive closure and other device-assisted techniques are useful adjuncts when matched appropriately to patient profile, foreskin pathology, surgeon experience and healthcare resources.