兔包皮上皮细胞的分离培养和鉴定

目的:收集兔的小块包皮组织,分离培养上皮细胞,并传代增殖,为组织工程化尿道构建提供细胞来源.方法:取雄性家兔包皮小块组织,酶消化成单细胞悬液,接种后静置培养、传代.并定期观察细胞形态变化及生长增殖情况,免疫组化染色,细胞计数及MTT测定以判断细胞增殖能力.结果:分离消化后的上皮细胞生长良好,经免疫组化测定为正常上皮细胞,并传代3代,细胞数量达到植入生物支架并生长的需要.结论:家兔的包皮上皮细胞可在体外培养增殖并传代,并达到相应细胞数量.     

Hypertrophic scar and keloid formation after male circumcision—a case report

Male circumcision is a standard surgical procedure to remove part of the foreskin for cultural, religious, or medical reasons such as phimosis. Hypertrophic scars and keloids after male circumcision are very rare postoperative complications. To our knowledge, only a handful of cases have been published previously. In this case report, we present our experience using a running-w-plasty after extralesional excision. Postoperative silicone-gel-sheets have been applied for a duration of 3 months. Using these techniques, we achieved a very satisfactory functional and cosmetic result and our patient still showed no signs of recrudescence 1 year after surgery.     

Effect of topical steroid on non-retractile prepubertal foreskin by a prospective, randomized, double-blind study

OBJECTIVE: The present study, conducted in Hong Kong, aimed to evaluate the effect of topical steroid in non-retractile prepubertal foreskin by a prospective, randomized, double-blind design. MATERIAL AND METHODS: 137 boys with non-retractile foreskin were randomized to betamethasone (n = 66) or placebo (n = 71 ) for 4 weeks with application of the cream twice daily. Non-responders to treatment were offered steroid treatment for a further 4 weeks. RESULTS: The mean pretreatment grade of the foreskin in the steroid and control groups was 5.08 +/- 0.66 and 4.97 +/- 0.70, respectively. At the 4-week follow-up, 49 of the former (74%) had a retractile foreskin (grade less than or equal to 3, mean 2.38 +/- 1.41). In contrast, only 31 of the control group (44%) had a retractile foreskin (less than or equal to 3, mean 3.55 +/- 1.55) (p < 0.001). Only 14 boys were circumcised because 43 of the remaining 57 boys had a retractile foreskin after 4 weeks of treatment. CONCLUSION: when treatment is necessary, application of topical steroid as a first line of treatment may avoid surgery in almost 90% of cases.     

Foreskin preputioplasty and intralesional triamcinolone: a valid alternative to circumcision for balanitis xerotica obliterans

BackgroundWe previously reported our short-term experience of foreskin preputioplasty as an alternative to circumcision for the treatment of foreskin balanitis xerotica obliterans (BXO). In this study, we aimed to compare this technique with circumcision over a longer period.MethodsBetween 2002 and 2007, boys requiring surgery for BXO were offered either foreskin preputioplasty or primary circumcision. The preputioplasty technique involved triradiate preputial incisions and injection of triamcinolone intralesionally. Retrospective case-note analysis was performed to identify patient demographics, symptoms, and outcomes.ResultsOne hundred thirty-six boys underwent primary surgery for histologically confirmed BXO. One hundred four boys opted for foreskin preputioplasty, and 32, for circumcision. At a median follow-up of 14 months (interquartile range, 2.5-17.8), 84 (81%) of 104 in the preputioplasty group had a fully retractile and no macroscopic evidence of BXO. Of 104, 14 (13%) developed recurrent symptoms/BXO requiring circumcision or repeat foreskin preputioplasty. In the circumcision group, 23 (72%) of 32 had no macroscopic evidence of BXO. The incidence of meatal stenosis was significantly less in the foreskin preputioplasty group, 6 (6%) of 104 vs 6 (19%) of 32 (P = .034).ConclusionOur results show a good outcome for most boys undergoing foreskin preputioplasty and intralesional triamcinolone for BXO. There is a small risk of recurrent BXO, but rates of meatal stenosis may be reduced.     

Reconstruction of the hypospadiac hooded prepuce

PURPOSE: The role of foreskin reconstruction as part of distal hypospadias repair remains uncertain. Thus, we wished to define better the indications with a view to improving the success of this cosmetic alternative. We reviewed the outcome in a group of patients who underwent foreskin reconstruction to highlight the criteria for likely success. MATERIALS AND METHODS: The records of 51 boys who underwent foreskin reconstruction from 1996 to 2001 were reviewed from a total hypospadias repair group of 223. Boys who underwent foreskin reconstruction were 4 months to 9 years old (median age 9.3 months). Surgery included a meatal advancement and glanuloplasty procedure in 22 patients, Mathieu urethroplasty in 2, King-Duplay repair in 2 and a meatotomy in 1, while in 24 with a normal glans meatus foreskin plasty was the only surgery. Cases in which the foreskin was required for chordee release and those in which the gap between the ventral aspects of the foreskin was wide were excluded from foreskin reconstruction. Also, patients were selected by intraoperative assessment of the ability to approximate the foreskin in the midline at the level of the coronal groove. If this maneuver can be performed without placing the foreskin under tension, the foreskin is considered suitable for reconstruction. All patients received regional and general anesthesia plus intraoperative antibiotics. After suitable urethroplasty the technique of foreskin reconstruction was generally similar for all types of the condition. RESULTS: The result was excellent in 36 patients (70.6%) with a normal-appearing foreskin that retracted easily. There was a good result in 8 patients (15.7%) with a satisfactory meatus at the tip of the glans and a retractable foreskin but minor foreskin deformity. Only 3 patients had a minor complication, including a fistula through the prepuce in 2 and wound infection in 1. No boy had a complication due to urethroplasty and there were no urethral fistulas. CONCLUSIONS: Our study shows that foreskin reconstruction is successful, particularly if the proximal, coronal groove portion of the prepuce can be easily approximated manually and the procedure can be combined with a range of distal repairs. We would recommend reconstruction of the prepuce if parents would prefer their son to be uncircumcised, providing that the foreskin is suitable for preservation.     

舌黏膜与颊黏膜或包皮拼接重建尿道治疗长段尿道狭窄

目的 探讨舌黏膜与颊黏膜或包皮拼接尿道成形治疗多节段或长段尿道狭窄的安全性和治疗效果.方法 尿道狭窄患者11例,年龄24～56岁,平均32岁.其中前尿道长段狭窄7例,狭窄长度10～15 cm,平均12 cm;尿道2～3处狭窄4例.病程6个月～8年.取舌黏膜条与颊黏膜条拼接尿道成形治疗7例,舌黏膜条与包皮瓣拼接尿道成形治疗4例.结果 11例手术顺利.1例舌黏膜与包皮拼接尿道成形患者术后3个月并发尿道外口狭窄,经手术矫正后排尿通畅,术后8个月最大尿流率27.5 ml/s.余10例排尿通畅、尿线粗,术后随访5～12个月,平均10个月,最大尿流率21～36 ml/s,平均26.8 ml/s.结论 舌黏膜与颊黏膜或包皮拼接尿道成形具有取材方便、患者创伤小的特占点,是治疗长段尿道律窄的较好术式.尤其适用于尿道多处狭窄者.     

Adherence of bacteria to human foreskins

The mucosal surface of the human foreskin from newborns shows a propensity to be colonized by pathogenic bacteria. Bacteria with P fimbriae and type 1 fimbriae adhere. However, hydrophobic interaction as well as electrostatic charge appear to be as important in this adherence as are fimbriae. Since bacterial adherence has been shown to precede urinary tract infection in female patients it is assumed that this adherence to the foreskin in male patients also may be necessary before initiation of the disease. The high incidence of urinary tract infection in uncircumcised male patients combined with these findings of adherence of pathogenic bacteria to the mucosal surface of the foreskin, thus, would seem to be related. Prevention of urinary tract infection and acute pyelonephritis in male neonates then may require either circumcision or the prevention of bacterial adherence to the human foreskin.     

Foreskin preservation in penile surgery

PURPOSE: Most hypospadias repairs performed in the United States involve the removal of any foreskin that is not used in the repair, resulting in a circumcised penis. Occasionally, the wishes of the parents or the child are for the final appearance to be that of a normal uncircumcised penis. We report our collective experience from 4 institutions in the reconstruction of the foreskin during penile surgery. MATERIALS AND METHODS: A total of 58 patients underwent penile surgery with reconstruction of the foreskin during a 6-year period. Of the patients 49 underwent hypospadias repair, 8 underwent phalloplasty for chordee correction without hypospadias and 1 underwent reconstruction of the foreskin for a dorsal hood without hypospadias or chordee. Of the 49 hypospadias repairs 46 were distal, 2 mid shaft and 1 proximal shaft. The technique for foreskin reconstruction consisted of a multilayered reapproximation of the lateral margins of the dorsal hood after completion of the urethroplasty and glanuloplasty. RESULTS: Among 49 hypospadias repairs 2 patients had dehiscence of the reconstructed foreskin, with development of a urethral fistula in 1. Of the 58 total patients undergoing penile surgery 56 had retractable foreskin, of whom 4 required postoperative steroid application. Three patients/parents requested a secondary circumcision, 2 for an unacceptable cosmetic result and 1 based on personal preference. CONCLUSIONS: Foreskin reconstruction in association with penile surgery can be performed safely and with a low complication rate in appropriately selected patients. Cases with a higher risk of complications include those involving more proximal hypospadias and those requiring complete degloving of the penile shaft. Of the reconstructions resulting in phimosis most can be salvaged with the application of steroids.     

Preputial variability and preferential association of long phimotic foreskins with penile cancer: an anatomic comparative study of types of foreskin in a general population and cancer patients

Difficulty in foreskin retraction and phimosis are risk factors for penile carcinoma that may be related to the anatomically variable length of the foreskin. This observation has stimulated us to postulate the hypothesis that foreskin length is related to penile cancer. To compare the foreskin in the general population and patients with penile cancer, an anatomic classification of foreskin was designed. We examined the foreskin of 215 uncircumcised males without cancer (age range 15-93 years) and the foreskin of 23 patients with cancer (age range 31-90 years). Foreskin types were classified as long (with the preputial orifice located beyond glans meatus and entirely covering the glans), medium (with the preputial orifice located between meatus and glans corona), and short (with the preputial orifice located between corona and coronal sulcus). Phimosis was defined as a nonretractable prepuce of the long type. We found that 77% of noncancer population cases had long foreskin and that only 7% of these cases were phimotic. Cancer patients showed long foreskin in 78% of the cases, and phimosis was significantly frequent in this group (52%) as compared with the other (p <0.001). Coexistence of a long foreskin and phimosis may explain the high incidence of penile cancer in some geographic regions. To better document these findings, a comparison of foreskin types in countries with high and low incidence of penile cancer will be interesting. However, because phimosis appears to be a major factor, the presence of long foreskin may be a necessary but not a sufficient condition for cancer development. For these reasons we support preventive circumcision in patients with long and phimotic foreskins living in high-risk areas. Cancers not related to long foreskins and phimosis may be causally different.     

Hypospadiac or intact foreskin graft for syndactyly repair

BACKGROUND/PURPOSE: Syndactyly is one of the most common malformations of the hands and feet. Repair may necessitate the use of a full-thickness skin graft. The prepuce is an excellent choice for grafting because of its lack of hair, elasticity, and degree of thickness. The authors report 4 cases of syndactyly repair using foreskin for grafting. METHODS: The authors reviewed 4 cases of syndactyly repaired at Children's Hospital, where foreskin was used for grafting. There was one congenital band syndrome and 3 cases of simple syndactyly. Three patients had a normal prepuce and underwent simultaneous circumcision. One patient presented with coronal hypospadias and underwent simultaneous meatal advancement and glanuloplasty. RESULTS: All patients experienced a satisfactory outcome with no graft loss and no complications. No grafts showed hair, and 3 grafts showed slight relative hyperpigmentation. Excess foreskin was available in all cases of simple syndactyly. Concominant hypospadias repair did not increase the morbidity of the surgery. CONCLUSION: The intact or hypospadiac foreskin is an excellent choice for a free graft in syndactyly repair when available.     

Modified foreskin reconstruction for distal hypospadias and chordee without hypospadias

Abstract:   Although foreskin reconstruction was established for hypospadias surgery in Europe two decades ago, it appears to introduce an extra risk of postoperative complications. We modified foreskin reconstruction in order to reduce the complications caused by its use. After correction of penile curvature and urethroplasty, the inner mucosal layer of the foreskin was separated from the outer skin layer. The approximation of each layer in the midline was limited and transverse adaptation was added to the remaining portion. We carried out the modified foreskin reconstruction for 11 patients and no patients developed postoperative complications. After the foreskin reconstruction, the glans, which was concealed by the reconstructed foreskin, was easily exposed by retracting the foreskin.     

Free graft patch 1-stage procedure to repair penile hypospadias unsuitable for the flip-flap procedure: indications and experience

From January 1983 to December 1985, 14 procedures were performed in which a free graft of skin from either the foreskin or elsewhere was substituted for the flipped flap in the repair of hypospadias. This obviates the problem of thin skin below the urethral meatus, since a flipped flap in such a case will result in devascularization of the flap. Moderate chordee was not necessarily a contraindication to the use of this procedure, provided the chordee could be corrected without moving the meatus proximally. Cosmetic and functional results have been good, and there was only 1 urethral fistula. Nevertheless, because of the need for a scrotal flap of fat to prevent fistula formation and to ensure vascularization of the graft, and because of the availability of a vascularized flap from the foreskin in most cases, the free graft patch procedure is best reserved for cases in which the foreskin is either absent or deficient.     

Current concepts in hypospadias surgery

Abstract:   Anatomical anomalies in hypospadias are an abnormal ventral opening of the urethral meatus, abnormal ventral curvature of the penis and abnormal distribution of the foreskin around the glans with a ventrally deficient hooded foreskin. The techniques of hypospadias surgery continue to evolve. The current standard of care for hypospadias repair includes not only a functional penis adequate for sexual intercourse and urethral reconstruction offering the ability to stand to urinate, but also a satisfactory cosmetic result. Tubularized incised plate repair has been the mainstay for distal hypospadias. In cases of proximal hypospadias, one-stage repairs such as the Duckett repair or the Koyanagi repair have been well established, while two-stage repairs remain important alternatives. Whether dorsal plication or ventral lengthening should be used to correct penile curvature is still controversial, and long-term results are required. Efforts have been made in this decade to improve cosmetic appearance, constructing a slit-like meatus or performing foreskin reconstruction, and to prevent onerous complications.     

Clinical application of a new device for minimally invasive circumcision

Aim： To study the clinical effects of a disposable circumcision device in treatment of male patients of different ages with either phimosis or excess foreskin. Methods： One thousand two hundred patients between the age of 5 and 95 years underwent circumcision using this procedure in the 2-year period between October 2005 and September 2007. Of these cases, 904 had excess foreskin and 296 were cases of phimosis. Results： In 96.33% of the cases the incision healed, leaving a minimal amount of the inner foreskin with no scarring and producing good cosmetic results. There were no incidents of device dislocation or damage to the frenulum. The average operative time was 2.5 min for excess foreskin, and 3.5 min for phimosis. During the 7 days of wearing the device, mild to moderate edema occurred in 10.08 % of cases with excess foreskin and in 2.58 % of those with phimosis. Edema in the frenulum was seen in 1.67% of patients, and only 0.67% had an infection of the incision. A total of 86.25% of patients reported pain due to penile erection. After removal of the device, 0.58% of the cases had minimal bleeding around the incision, and 2.42% had wound dehiscence. Conclusion： The new device can be applied to an overwhelming majority of patients with phimosis and excess foreskin. This technique is relatively simple to perform, and patients who underwent this surgery had very few complications. Antibiotics were not required and patients reported less pain than those who were circumcised using conventional methods. Circumcision with this device requires minimal tissue manipulation, and is quicker and safer than circumcision using conventional techniques.     

冗余包皮增大慢性前列腺炎／慢性骨盆区疼痛综合征的发病可能

有证据表明包皮内板上存在着大量可以与病原体相互作用的抗原递呈细胞,这可能为病原体入侵机体提供了新的途径,而以往的研究中,病原体对慢性前列腺炎／慢性骨盆区疼痛综合征（CP／CPPS）如何发挥作用没有明确的结论,也没有相关的研究阐明包皮和CP／CPPS之间的关系。因此我们收集了322名CP／CPPS患者为病例组,并按年龄配对了341名对照组。统计了参与者的人口统计学资料、生活状态资料,以及入选者的包皮长度。应用多因素逻辑斯特回归分析来计算包皮长度对CP／CPPS的危险性。我们得出结论,与对照组相比,当包皮的长度超过阴茎头1／2后,包皮越长,CP／CPPS的风险越高。包皮覆盖小部分阴茎头时,不增31CP／CPPS的风险,包皮覆盖大部分阴茎头时,CP／CPPS的风险增高,OR为1．66（95％CI,1．04-2．66）,而包皮完全覆盖阴茎头时,OR上升到了1．86（95％CI,1．2-2．88）。导致这种结果的机制可能是病原体与包皮内板上的抗原递呈细胞相互作用,继而激活了T细胞介导的过敏性炎症反应,造成前列腺组织发生自身免疫作用。     

Circumcision is not mandatory in penile surgery

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To assess the outcome of not circumcising patients having surgery to correct a congenital or acquired curvature, through a subcoronal approach.

PATIENTS AND METHODS

In a series of 251 consecutive patients (mean age 46 years, range 17–74) that had their penis straightened by either a Lue (86), or a Nesbit procedure (162) or a combination of both (three) between 2000 and 2008, a subcoronal circumferential incision was used for the degloving in 241. Among the 183 patients who had not been previously circumcised, 22 presented with a tight foreskin and were offered a circumcision; six of them refused to be circumcised. Of the remaining 161 patients, 115, including two who had previous penile surgery, opted not to be circumcised.

RESULTS

After a median (range) follow‐up of 5.5 (1–50) months, secondary circumcision was performed in three of the six patients with a tight foreskin, in one of the 113 (0.8%) with a normal retractable foreskin and in one of the two who had had previous penile surgery and had a normal foreskin.

CONCLUSIONS

Circumcision should not be considered as a routine part of penile surgery unless a significant phimosis is present or revisional surgery is contemplated.     

Prepuce-Sparing hypospadias repair with tubularized incised plate urethroplasty

Objectives:   Modifications in surgical methods of hypospadias repair have been influenced by social considerations. Most Japanese parents wish their children to retain their foreskin during hypospadias repair. We report on short-term results of foreskin reconstruction associated with hypospadias repair.
Methods:   Of 44 tubularized incised plate urethroplasty-patients, 42 (95%) underwent foreskin reconstruction at the time of urethroplasty during the last 2 years. After the urethroplasty was completed, the foreskin was re-approximated in three layers.
Results:   Complications related to urethroplasty consisted of fistula in two patients with penoscrotal hypospadia, and mild stenosis of the glandular urethra in one patient. Complications related to foreskin reconstruction included dehiscence of the ventral foreskin in two patients. In all cases parents were well satisfied with the reconstructed prepuce.
Conclusions:   Pre-operative information about preputial reconstruction should be given to parents if they would prefer their son to be uncircumcised.     

经包皮内板切口阴茎延长增粗术的研究

目的探讨经包皮内板切口阴茎延长增粗术的方法。方法通过阴茎包皮内板切口进行阴茎浅悬韧带和部分深悬韧带的切断,以及真皮脂肪游离移植的阴茎延长增粗术。结果本组12例患者行包皮内板切口阴茎延长术,其中3例同时行阴茎增粗术,阴茎静态长度增加2.0~3.5cm,静态周径增加1.5~2.5cm,术区无血供障碍,感觉良好,效果满意。结论经包皮内板切口的阴茎延长增粗术用于包皮过长的患者可以获得更佳的手术效果,且切口隐蔽,避免了耻骨区的瘢痕形成。     

Dorsal longitudinal foreskin cut is associated with reduced risk of HIV,syphilis and genital herpes in men: a cross‐sectional study in Papua New Guinea

Introduction : Various forms of penile foreskin cutting are practised in Papua New Guinea. In the context of an ecological association observed between HIV infection and the dorsal longitudinal foreskin cut, we undertook an investigation of this relationship at the individual level. Methods : We conducted a cross‐sectional study among men attending voluntary confidential HIV counselling and testing clinics. Following informed consent, participants had a face‐to‐face interview and an examination to categorize foreskin status. HIV testing was conducted on site and relevant specimens collected for laboratory‐based Herpes simplex type‐2 (HSV‐2), syphilis, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) testing. Results : Overall, 1073 men were enrolled: 646 (60.2%) were uncut; 339 (31.6%) had a full dorsal longitudinal cut; 72 (6.7%) a partial dorsal longitudinal cut; and 14 (1.3%) were circumcised. Overall, the prevalence of HIV was 12.3%; HSV‐2, 33.6%; active syphilis, 12.1%; CT, 13.4%; NG, 14.1%; and TV 7.6%. Compared with uncut men, men with a full dorsal longitudinal cut were significantly less likely to have HIV (adjusted odds ratio [adjOR] 0.25, 95%CI: 0.12, 0.51); HSV‐2 (adjOR 0.60, 95%CI: 0.41, 0.87); or active syphilis (adjOR 0.55, 95%CI: 0.31, 0.96). This apparent protective effect was restricted to men cut prior to sexual debut. There was no difference between cut and uncut men for CT, NG or TV. Conclusions : In this large cross‐sectional study, men with a dorsal longitudinal foreskin cut were significantly less likely to have HIV, HSV‐2 and syphilis compared with uncut men, despite still having a complete (albeit morphologically altered) foreskin. The protective effect of the dorsal cut suggests that the mechanism by which male circumcision works is not simply due to the removal of the inner foreskin and its more easily accessible HIV target cells. Exposure of the penile glans and inner foreskin appear to be key mechanisms by which male circumcision confers protection. Further research in this unique setting will help improve our understanding of the fundamental immunohistologic mechanisms by which male circumcision provides protection, and may lead to new biomedical prevention strategies at the mucosal level.     

帽状包皮腹侧转移纵形带蒂皮管一期尿道下裂成形术

目的：探讨利用包皮行尿道下裂一期尿道成形的手术方式。方法：先天性尿道下裂患者28例，采用包皮腹侧转移纵型带蒂皮管一期尿道下裂成形术治疗。结果：术后10－12d拔除支架管，排尿正常，仅1例术后1个月并发尿道外口狭窄，其余患者未发生任何并发症。结论：帽状包皮腹侧转移纵型带蒂皮管一期尿道下裂成形术是治疗先天性尿道下裂简单，有效，可靠的手术方式。