The procedure ensures proper fitting of the Super-ring by first measuring the fully opened diameter of the glans. Depending on the measurement, the ring's size is selected, escalated by one to two levels above the measured diameter, depending on the size range. The penis is then prepared with marker measurements, the ring is inserted symmetrically, and ligature techniques are used to secure it. Positions of anatomical landmarks like the urethral opening and frenulum are verified to ensure a safe fitting .

Post-operative care instructions provided to patients and their families include the topical application of ointments like Bioplacenton or Gentamicin starting the third day after soaking three times a day, and how to consume prescribed analgesic-antipyretics tablets for pain management. They are also given a leaflet containing guidelines for caring for the circumcision area and instructions on medication dosage. Emergency contact information is provided for any complications .

The method adapts to different penis sizes by measuring the diameter of the glans to select the appropriate size of the Super-ring. For penile diameters ranging from 16-36 mm, the selected ring size is two levels higher than the measured size. For smaller penises (10-14 mm diameter), the ring size can be increased by one level. This customization is critical for ensuring a secure fit and effective circumcision .

Maintaining symmetry is emphasized by detailed measurement and alignment steps throughout the procedure. Critical steps include the circumferential marking of the prepuce, measuring the glans, and choosing the correct super-ring size. Careful placement of clamps and ligature techniques ensure symmetrical compression and ring placement, with continuous checks ensuring alignment with anatomical landmarks to prevent asymmetrical healing outcomes .

The SOP policy stipulates that the procedure is reserved for patients with normal penises, specifically excluding cases with complicating factors. This ensures that the Super-ring method can be applied effectively and safely without the additional risks presented by anatomical anomalies .

Local anesthetics are critical in providing pain relief during the circumcision process. They are administered by first applying an anesthetic ointment to the penis 30 minutes before the procedure, followed by local anesthesia injections of 1 to 3 ml, depending on need. This ensures adequate numbness before proceeding with the circumcision to minimize pain and discomfort for the patient .

To ensure aseptic procedures during mass circumcision, the document mandates the use of sterile surgical instruments and disposable sterile gloves. Each patient's instruments can be washed and re-sterilized using alcohol for about 30 seconds after use. Moreover, the standard operating procedure involves handwashing by the operator, cleaning the genital area with Nacl followed by alcohol, and using sterilization methods before the circumcision starts .

Safety checks during Super-ring insertion include verifying the symmetry of the ring placement, ensuring the urethral opening and frenulum are free of risk, and checking for 3-4 folds in the proximal skin to confirm adequate tension. Ligature placement below the ring and secondary checks after tying ensure stable positioning and reduced risk of necrosis or premature ring detachment .

Essentials for the procedure include: sterile circumcision instruments, Super-ring lubricant oil, standard Super-ring Indonesia handle, alcohol spray, tissue, disposable gloves, Nacl spray, and sterile dressing pads. For 10 patients, at least five sets of these instruments need to be provided per two operating tables. These instruments must be re-sterilized using alcohol for 30 seconds after being used on a patient .

The primary objectives of the SOP for mass circumcision using the Super-ring method include providing circumcision services that meet the modern super-ring standards, ensuring post-circumcision comfort, preventing secondary infections, delivering symmetrical and neat circumcision results, preventing anomalous swelling, ensuring the ring detaches by itself between days 5 to 10, administering post-circumcision medication in accordance with the SOP, and ensuring the procedure is carried out aseptically or in a sterile manner .