Stapler vs. sleeve circumcision for multiple penile condylomata acuminata: a comparative study.

BACKGROUND: Multiple penile condylomata acuminata (CA) often involve the inner foreskin and frenulum. This retrospective study compared conventional sleeve and disposable circular stapler circumcision, each combined with ablation of visible lesions, in selected patients with multiple penile CA. METHODS: Consecutive patients aged 18-55 years with at least 5 visible lesions involving the foreskin and/or frenulum who underwent treatment between January 2020 and December 2024 were screened. Propensity-score matching (1:1 nearest neighbor, caliper 0.05) using prespecified covariates yielded 41 patients per group. Outcomes included operative time, blood loss, complications, baseline and 12-month IIEF-15, cosmetic appearance, patient satisfaction, and 12-month recurrence. RESULTS: After matching, baseline characteristics were well balanced (all standardized mean differences <0.1). Compared with sleeve circumcision, stapler circumcision was associated with shorter operative time (mean difference -14.2 min, 95% CI -16.7 to -11.7), less blood loss (mean difference -7.5 mL, 95% CI -9.2 to -5.8), higher patient- and surgeon-rated cosmetic scores (mean differences 0.7 and 0.8, respectively), and higher patient satisfaction (mean difference 0.7). IIEF-15 scores were similar. Recurrence occurred in 6/41 (14.6%) stapler patients and 8/41 (19.5%) sleeve patients (risk difference -4.9%, 95% CI -21.1% to 11.4%; odds ratio 0.71, 95% CI 0.22 to 2.26). No major complications occurred. CONCLUSION: In this single-center retrospective matched cohort of carefully selected patients without anatomical contraindications to stapler placement, stapler circumcision was associated with perioperative and patient-reported advantages. The recurrence estimate was imprecise and does not establish equivalence or non-inferiority. These findings are hypothesis-generating and require confirmation in larger prospective studies with longer follow-up.