The two components, separated
The inner ring seen edge-on,
showing the soft insert
The two components, assembled
The Shang Ring in use
|A Kenyan circumcision carried out with the Shang Ring. From Barone et al, JAIDS 2011 57 e7-e12 (see below)|
Recently, alternative operative techniques using the Shang Ring have been published. The 'no-flip' technique, where the foreskin is not reflexed backward over the ring, is the main variation, but the question of allowing the device to fall off naturally rather than removing it at 7 days was also addressed. There were no adverse consequences of the no-flip method, which simplified operation where phimosis was present. Allowing spontaneus detachment was attended by fewer adverse incidents than removing at 7 days, though many in the 'spontaneous' group actually requested detachment before it happened naturally (which could take up to 14 days). The reference is listed below.
The device is sterilised by gamma radiation (Cobalt-60 exposure) and has a shelf life of 3 years. It is strictly non-reusable.
|Inventor: Jian-Zhong Shang
Manufacturer: Wuhu SNNDA Medical Treatment Appliance Technology Co., Ltd., The Hi-tech. & Pioneering Service Center, North Yinhu Road, Wuhu Economic & Technological Development Zone, Wuhu 241001, China.
Manufacturer's website: http://www.shangring.cn
Peng et al, 2008, Clinical application of a new device for minimally invasive circumcision Asian J Androl 2008; 10 : 447–454.
MA Barone, F Ndede, PS Li, P Masson, Q Awori, J Okech, P Cherutich, N Muraguri, P Perchal, R Lee, HH Kim, M Goldstein, 2011. The Shang Ring Device for Adult Male Circumcision: A Proof of Concept Study in Kenya. JAIDS Journal of Acquired Immune Deficiency Syndromes: 57 e7-e12
MA Barone, PS Li, RK Lee, D Ouma, M Oundo, M Barasa, J Oketch, P Otiende, N Nyangweso, M Maina, N Kiswi, B Chirchir, M Goldstein, QD Awori. 2018. Simplifying the ShangRing technique for circumcision in boys and men: use of the no-flip technique with randomization to removal at 7 days versus spontaneous detachment. Asian J Androl. 2018 Nov 30. doi: 10.4103/aja.aja_91_18. [Epub ahead of print] Abstract here.
Known use of the Shang Ring
This clamp is widely used in China and is also being adopted elsewhere. Extensive trials are being conducted in sub-Saharan Africa, this device being one of a number of contenders for use in campaigns of mass circumcision as part of the WHO/UNAIDS anti-HIV programme.
A London clinic offers Shang Ring circumcision as well as traditional cutting methods:
The Integral Medical Centre, London