JMIR Publications

ABSTRACT

Background:

Background:

Circumcision is a common procedure in pediatric and adolescent urology, yet postoperative wound healing varies in routine practice. We compared healing outcomes across four standardized home-care strategies after circumcision, described early postoperative coronal sulcus bacterial culture profiles, and explored whether dominant bacterial isolates were associated with healing outcomes.

Objective:

Objective:

1. Investigate the distribution proportion of microorganisms in the coronal sulcus of the penis after circumcision during adolescence, and the impact of microbial changes on male sexual health in adulthood. 2. Provide scientific guidance on home wound care methods after clinical circumcision to shorten wound healing time for pediatric patients and improve satisfaction. 3. The impact of different nursing methods on the types and quantity changes of dominant bacterial flora in the coronal sulcus, and its subsequent relationship with wound healing. 4. Determine the median wound healing time after circumcision, and conduct a multi-factor analysis to identify the relevant influencing factors for children with faster and slower wound healing.

Methods:

Methods:

This single-center prospective comparative study included children and adolescents undergoing circumcision and standardized postoperative wound care. The original protocol targeted 200 participants. Participants were assigned to one of four care strategies according to the original study allocation schedule: soaking, wiping, spraying, or combined care. Because repeat week-2 culture data were not consistently available in the analyzable dataset, only the first postoperative coronal sulcus culture result after dressing removal was analyzed. The primary outcome was complete wound healing, defined as complete staple detachment with penile swelling recorded as absent at routine follow-up. Delayed healing (>4 weeks) was analyzed post hoc in an exploratory multivariable logistic regression model.

Results:

Results:

A total of 203 participants were included: 50 in the soaking group, 50 in the wiping group, 48 in the spraying group, and 55 in the combined-care group. The median age was 10.0 years (IQR 8.0-11.0). The median time to onset of staple shedding was 2.5 weeks (IQR 2.0-3.0), and the median time to complete healing was 4.0 weeks (IQR 3.5-5.0). No significant between-group differences were observed for time to onset of staple shedding (p = 0.105), complete healing time (p = 0.647), or delayed healing >4 weeks (p = 0.551). The most common early postoperative culture result was Staphylococcus epidermidis (34.0%), followed by no growth/normal flora (25.1%) and Enterococcus spp. (18.7%). Culture distribution did not differ significantly across wound-care groups (p = 0.662). In exploratory multivariable analysis, neither wound-care group, age, nor culture category was independently associated with delayed healing.

Conclusions:

Conclusions:

Early postoperative coronal sulcus cultures after circumcision were dominated by a limited number of recurrent isolate patterns, while healing outcomes were broadly comparable across four standardized home-care strategies. Under routine standardized postoperative management, no single home-care strategy showed a clear healing advantage.