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Erdem E, Caliskan MK, Karagul MI, Akbay E, Coskun Yilmaz B, Aygun YC. Histological and morphological development of the prepuce from birth to prepubertal age. Investig Clin Urol 2024; 65:180-188. [PMID: 38454828 PMCID: PMC10925741 DOI: 10.4111/icu.20230034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/20/2023] [Accepted: 11/19/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE To study the histological changes of the preputial tissue from birth to prepubertal age in order to define unnoticed morphological changes. MATERIALS AND METHODS Prepuce samples were obtained from 79 healthy boys who underwent routine ritual circumcision. Specimens were divided into six groups according to the boys' age: newborn, 0-1 year of age, 2-3 years of age, 4-5 years of age, 6-7 years of age, and 8-9 years of age. Histologic analysis of the specimens was performed by H&E, Masson's trichrome, Verhoeff-Von Gieson, immunohistochemical staining. RESULTS Microscopic examinations showed that average epithelial thickness increased after the neonatal period (p=0.001). When collagen fiber density was evaluated, no significant differences between groups were found (p=0.083). When the elastic fibers in the dermis were evaluated, it was determined that the number and thickness of elastic fibers increased with age. Immunohistochemical examinations showed that the number of peripheral nerves marked with S100 was lower in the neonatal period than at other ages (p=0.048). When the vessels marked with CD105 antibody were counted, there was no significant difference between the groups (p=0.078). CONCLUSIONS This is the first study to examine the age-related structure of connective tissue elements in the foreskin. Our results showed that the prepuce's prepubertal maturation process is continuous, and the first 2 years of life are appropriate not only in relation to the physiological effects of age but also the optimum structural changes for wound healing, such as vessel diameter, epithelium thickness, peripheral nerve count.
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Affiliation(s)
- Erim Erdem
- Department of Urology, Mersin University Faculty of Medicine, Mersin, Türkiye
| | | | - Meryem Ilkay Karagul
- Department of Histology and Embryology, Hatay Mustafa Kemal University Faculty of Medicine, Hatay, Türkiye.
| | - Erdem Akbay
- Department of Urology, Mersin University Faculty of Medicine, Mersin, Türkiye
| | - Banu Coskun Yilmaz
- Department of Histology and Embryology, Mersin University Faculty of Medicine, Mersin, Türkiye
| | - Yuksel Cem Aygun
- Department of Urology, Başkent University Faculty of Medicine, Ankara, Türkiye
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Akyüz O, Tatar Z. Is it safe to use a thermocautery device for circumcision? Examination of the histopathological changes emerging after thermocautery-assisted circumcisions. Andrologia 2021; 53:e13968. [PMID: 33421180 DOI: 10.1111/and.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/08/2020] [Accepted: 12/26/2020] [Indexed: 11/28/2022] Open
Abstract
Multiple number of techniques and devices have been described concerning circumcision method so far. One of them is thermocautery device, and it has been widely used. Although there is controversy that the penis may be damaged due to the heat generated during the use of the device, not enough histopathological studies have been conducted. We aimed to determine the histopathological changes in human foreskin caused by heat after circumcision with thermocautery and to demonstrate the safety of the use of a thermocautery-assisted circumcision. Forty-one patients were divided into two groups according to the thermal energy used during cutting with thermocautery as follows: high temperature (Group 1, n = 22) and low temperature (Group 2, n = 19). The effect of the heat intensity and depth of the coagulation necrosis produced with thermocautery-assisted circumcisions performed at low and high temperatures were evaluated. The difference between the groups was not statistically significant. Tissue damage is extremely limited in thermocautery-assisted circumcisions, even when it is used at high temperatures. The thermocautery device can be used for effective and safe circumcisions.
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Affiliation(s)
- Osman Akyüz
- Medicine Hospital Department of Urology, Atlas University, Istanbul, Turkey
| | - Zeynep Tatar
- Patomer Pathological Cytological Research Center, Istanbul, Turkey
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Wang S, Drummond ML, Guerrero-Juarez CF, Tarapore E, MacLean AL, Stabell AR, Wu SC, Gutierrez G, That BT, Benavente CA, Nie Q, Atwood SX. Single cell transcriptomics of human epidermis identifies basal stem cell transition states. Nat Commun 2020; 11:4239. [PMID: 32843640 PMCID: PMC7447770 DOI: 10.1038/s41467-020-18075-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 07/30/2020] [Indexed: 12/19/2022] Open
Abstract
How stem cells give rise to epidermis is unclear despite the crucial role the epidermis plays in barrier and appendage formation. Here we use single cell-RNA sequencing to interrogate basal stem cell heterogeneity of human interfollicular epidermis and find four spatially distinct stem cell populations at the top and bottom of rete ridges and transitional positions between the basal and suprabasal epidermal layers. Cell-cell communication modeling suggests that basal cell populations serve as crucial signaling hubs to maintain epidermal communication. Combining pseudotime, RNA velocity, and cellular entropy analyses point to a hierarchical differentiation lineage supporting multi-stem cell interfollicular epidermal homeostasis models and suggest that transitional basal stem cells are stable states essential for proper stratification. Finally, alterations in differentially expressed transitional basal stem cell genes result in severe thinning of human skin equivalents, validating their essential role in epidermal homeostasis and reinforcing the critical nature of basal stem cell heterogeneity.
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Affiliation(s)
- Shuxiong Wang
- Department of Developmental and Cell Biology, University of California, Irvine, Irvine, CA, 92697, USA
- Department of Mathematics, University of California, Irvine, Irvine, CA, 92697, USA
- NSF-Simons Center for Multiscale Cell Fate Research, University of California, Irvine, Irvine, CA, 92697, USA
| | - Michael L Drummond
- Department of Developmental and Cell Biology, University of California, Irvine, Irvine, CA, 92697, USA
| | - Christian F Guerrero-Juarez
- Department of Developmental and Cell Biology, University of California, Irvine, Irvine, CA, 92697, USA
- Department of Mathematics, University of California, Irvine, Irvine, CA, 92697, USA
- NSF-Simons Center for Multiscale Cell Fate Research, University of California, Irvine, Irvine, CA, 92697, USA
| | - Eric Tarapore
- Department of Developmental and Cell Biology, University of California, Irvine, Irvine, CA, 92697, USA
| | - Adam L MacLean
- Department of Mathematics, University of California, Irvine, Irvine, CA, 92697, USA
- NSF-Simons Center for Multiscale Cell Fate Research, University of California, Irvine, Irvine, CA, 92697, USA
| | - Adam R Stabell
- Department of Developmental and Cell Biology, University of California, Irvine, Irvine, CA, 92697, USA
| | - Stephanie C Wu
- Department of Developmental and Cell Biology, University of California, Irvine, Irvine, CA, 92697, USA
| | - Guadalupe Gutierrez
- Department of Developmental and Cell Biology, University of California, Irvine, Irvine, CA, 92697, USA
| | - Bao T That
- Department of Developmental and Cell Biology, University of California, Irvine, Irvine, CA, 92697, USA
| | - Claudia A Benavente
- Department of Developmental and Cell Biology, University of California, Irvine, Irvine, CA, 92697, USA
- Department of Pharmaceutical Sciences, University of California, Irvine, Irvine, CA, 92697, USA
- Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, 92697, USA
| | - Qing Nie
- Department of Developmental and Cell Biology, University of California, Irvine, Irvine, CA, 92697, USA.
- Department of Mathematics, University of California, Irvine, Irvine, CA, 92697, USA.
- NSF-Simons Center for Multiscale Cell Fate Research, University of California, Irvine, Irvine, CA, 92697, USA.
- Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, 92697, USA.
- Center for Complex Biological Systems, University of California, Irvine, Irvine, CA, 92697, USA.
| | - Scott X Atwood
- Department of Developmental and Cell Biology, University of California, Irvine, Irvine, CA, 92697, USA.
- NSF-Simons Center for Multiscale Cell Fate Research, University of California, Irvine, Irvine, CA, 92697, USA.
- Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, 92697, USA.
- Center for Complex Biological Systems, University of California, Irvine, Irvine, CA, 92697, USA.
- Department of Dermatology, University of California, Irvine, Irvine, CA, 92697, USA.
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Abstract
Premature ejaculation (PE) is considered the most common male sexual disorder, affecting up to 75% of men at some point in their lives. While medical management is the mainstay of therapy, surgical options such as dorsal nerve neurectomy (DNN), hyaluronic acid (HA) gel glans penis augmentation, and circumcision have been studied as alternative forms of treatment. Preliminary studies have suggested that DNN and HA gel glans penis augmentation are relatively safe and effective, but due to a lack of large, multicenter, randomized-control trials with long-term follow-up, the International Society of Sexual Medicine (ISSM) has been unable to endorse DNN or HA gel glans penis augmentation as options in the treatment of PE. Conflicting data regarding the efficacy and safety of circumcision has similarly led to its exclusion from ISSM recommendations for the treatment of PE. Ethical concerns, particularly the fundamental concept of non-maleficence, are also barriers to the implementation of surgery for PE.
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Affiliation(s)
- James Anaissie
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Faysal A Yafi
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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Naimer SA, Zega K, Silverman WF. Anatomy of the cutaneous surface of the male genitalia, with elaboration upon the inner preputial coronal-shaft junction. J Pediatr Urol 2016; 12:53.e1-5. [PMID: 26441048 DOI: 10.1016/j.jpurol.2015.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 06/12/2015] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Descriptions of the penile prepuce in anatomical and clinical texts either omit details or contain a small, yet potentially serious, error with regard to the manner of its attachment to the penis. OBJECTIVE This study sought to cast light on a ubiquitous but poorly understood and under-appreciated structure, while correcting a long-standing mistake in the medical literature. STUDY DESIGN The foreskins of five male stillborn babies were dissected and carefully examined. Tissue from the apposing surfaces of the various regions of the inner and outer prepuce surfaces and the transition zone itself were collected, embedded in paraffin, sectioned, stained, examined and photographed under microscopy. RESULTS Contradicting the prevailing descriptions in the literature that the inner prepuce is a single, uniform sheath, this study's observations and histological findings demonstrated that it actually splits into separate laminae that connect distally to the shaft at the base of the corona and proximally with the shaft fascia, respectively (Figure). DISCUSSION The penile prepuce is a discrete and deceptively complex part of the male anatomy, yet key details of its interposing surfaces are inaccurately described or entirely omitted in the literature. Understanding the normal anatomy of the prepuce is critically relevant, particularly for urologists and others involved in the performance of circumcision. For example, avoiding potentially catastrophic avulsion of the inner preputial remnant beyond the coronal sulcus during circumcision and accurate assessment of tissue positioning prior to penile reconstruction in cases of hypospadias. CONCLUSION The findings of this study correct a misunderstanding in the anatomy of the prepuce.
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Frisch M, Aigrain Y, Barauskas V, Bjarnason R, Boddy SA, Czauderna P, de Gier RPE, de Jong TPVM, Fasching G, Fetter W, Gahr M, Graugaard C, Greisen G, Gunnarsdottir A, Hartmann W, Havranek P, Hitchcock R, Huddart S, Janson S, Jaszczak P, Kupferschmid C, Lahdes-Vasama T, Lindahl H, MacDonald N, Markestad T, Märtson M, Nordhov SM, Pälve H, Petersons A, Quinn F, Qvist N, Rosmundsson T, Saxen H, Söder O, Stehr M, von Loewenich VCH, Wallander J, Wijnen R. Cultural bias in the AAP's 2012 Technical Report and Policy Statement on male circumcision. Pediatrics 2013; 131:796-800. [PMID: 23509170 DOI: 10.1542/peds.2012-2896] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report's conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non-US-based physicians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.
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Affiliation(s)
- Morten Frisch
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen and Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Abstract
Background and Aim: Premature ejaculation (PE) is the most prevalent sexual dysfunction in every country. There are many types of treatment, but the main limitation of medical treatment for premature ejaculation is recurrence after withdrawal of medicine. The prepuce is a specific erogenous zone that contains a rich and complex network of nerves. Circumcision radically desensitizes the penis, but incomplete circumcision may cause premature ejaculation. We evaluate the effect of removal of foreskin remnants in adults on PE. Materials and Methods: The sensitive area of penile skin and the remaining parts of foreskin in adult men were recognized in 47 selective patients. Under local anesthesia, the remnant parts of foreskin were incised and removed. They were asked to fill the investigating questionnaire about the changes of intravaginal latency ejaculatory time (IVELT), patients and their sexual partners’ satisfaction with sexual life, control over ejaculation, and penile sensitivity, before and after treatment. Results: There were no signs of inflammation and no serious adverse reactions in all cases after operation. IVELT significantly increased from 64.25 before surgery to 731.49 sec after surgery (P<0.001). The percentage of postoperative satisfaction in both the patient and his partner significantly increased (P<0.001). After surgery, 95.7% of men had better control over their ejaculation. This surgery significantly decreased sensitivity of penis (P<0.001), but it did not change glans penis insensitivity. Conclusions: These results indicate that removal of foreskin remnants in adults is an effective modality in selective patients of PE.
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Affiliation(s)
- Mohammad Reza Namavar
- Department of Anatomical Sciences, School of Medicine, Histomorphometric and Stereology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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