Penile Foreskin Research Articles

Pyoderma Vegetans of the Penis

Pyoderma vegetans is a rare benign skin disease characterized by chronic vegetative pustular plaques. We report a case of pyoderma vegetans of the penile foreskin successfully treated with circumcision. To our knowledge this is the first reported case of pyoderma vegetans of the penis. CASE REPORT A 42-year-old HIV positive man with a history of recurrent, acyclovir resistant herpes simplex virus infection of the penis presented with painful weeping pustular lesions of the foreskin that had been increasing in size for several months. The patient denied fever, chills, voiding complaints or penile trauma. Physical examination demonstrated raised, tender, circumferential, exudative plaques producing copious amounts of serous fluid (fig. 1). The remainder of the phallus was normal. Scrotal, testicular and rectal examinations were unremarkable. Circumcision was performed (fig. 2). Pathological evaluation revealed benign skin with epithelial hyperplasia and extensive dermal inflammation with neutrophils, lymphocytes and eosinophils consistent with pyoderma vegetans. Bacterial, viral and fungal cultures were negative. Physical examination 4 months later showed no residual lesions.

Surgical Repair of Anterior Hypospadias with Fish-Mouth Meatus and Intact Prepuce Based on Anatomical Characteristics

Purpose: A variant form of anterior hypospadias, called a megameatus and intact prepuce (MIP), is thought to be less amenable to conventional distal hypospadias repair. The feasibility of using the standard technique with a parameatal-based foreskin flap is described herein. Materials and Methods: Nine children with the MIP variant underwent repair. A foreskin flap for urethroplasty was harvested from either the ventral (Mathiew) or unilateral site. The glans was split along with the cleft glanular groove to create the glans wings. The flap was laid on the urethral plate to form a neourethra, and glanulomeatoplasty was completed by approximation of the glans wings. Sleeve reapproximation of the penile foreskin was performed for uncircumcised skin closure. Results: The functional and cosmetic results of the procedure were excellent in 8 cases including 1 with temporary postoperative edema of redundant foreskin. The last case underwent excision of the ventral excess foreskin for cosmetic reasons. Conclusions: Although the etiology of the MIP variant remains obscure, the urethral plate distal to the meatus is uniformly pliable and healthy in this variant. Furthermore, the ventral portion just proximal to the meatus is well developed and not atretic so that the parameatal ventral foreskin is safely harvested for onlay urethroplasty.

Syndactyly repair performed simultaneously with circumcision: Use of foreskin as a skin-graft donor site

A boy who had simple syndactyly involving the third web space of the left hand presented for elective syndactyly repair. Circumcision had been delayed because of neonatal medical problems. Elective syndactyly repair and circumcision were performed in one operation at age 9 months. Penile foreskin was used as a full-thickness skin graft for the syndactyly repair. The foreskin provided a functional syndactyly repair with good aesthetic characteristics. This obviated the need for two separate operations and for an additional skin graft donor site. To our knowledge, this is the first reported case in which foreskin was used for the repair of syndactyly. In boys with syndactyly, the authors advocate that parents be informed of this reconstructive option. Should the parents consider it to be suitable, then elective circumcision should be delayed until the time of syndactyly repair so that foreskin may be used for the syndactyly repair.

Characterization of T Lymphocytes and Antigen-presenting Cells in the Murine Male Urethra

The male lower urogenital tract is exposed to sexually transmitted pathogens and is therefore a strategic site of immune defense. To further define the immunodynamics of this region, we studied the histology, immune cell distribution, and draining lymph nodes of the murine male lower urogenital tract. The external surface of the foreskin was covered by skin composed of keratinized stratified epithelium containing numerous hair follicles and sebaceous glands. Immunologically the penile foreskin was characterized by the presence of few T lymphocytes and macrophages. Numerous Langerhans cells, however, were detected within the epithelium. The penile urethra was composed of stratified columnar epithelium, with a meatus lined by keratinized squamous epithelium preceding the opening proper. The most abundant immune cells of the penile urethra were macrophages. In young adult, virgin males, these were found primarily underlying the urethral epithelium, but in older, mated mice, they were usually intraepithelial in location, and were more abundant. Langerhans cells could not be specifically identified in the urethral mucosa. T lymphocytes were found underlying and occasionally within the epithelium of the urethral mucosa, with CD4+ cells more abundant than CD8+ cells. The majority of lymphocytes observed around the urethra were positive for the integrin beta 7 alpha M290, which is selectively expressed by mucosal lymphocytes, providing indirect evidence that the urethra is part of the common mucosal system. Lymphocytes expressing the gamma delta T cell receptor and IgA-positive plasma cells were not detected. The primary draining nodes for the vas deferens and urethra were the lumbar nodes. Lymphatic drainage from the rectum also involved the lumbar nodes. Information obtained in this study should help to elucidate optimal genital tract vaccination strategies for defense of the male urogenital tract against sexually transmitted pathogens.

Cicatricial Ectropion in Ichthyosis

Four kinds of ichthyosiform dermatoses have been described. Only lamellar ichthyosis or ichthyosis congenita is associated with the development of ectropion and subsequent eye symptoms. Conservative treatments have been tried but surgical correction of the ectropion was ultimately required for symptomatic relief. Autografts have been used successfully, provided an available donor site can be found. Grafts taken from the arm, eyelids, postauricular skin, and groin have been used with success. An uncircumcised youth with total body involvement from ichthyosis developed bilateral upper and lower ectropion. The penile foreskin was the only possible suitable donor site because it seemed unaffected by the disease. A circumcision was performed and the foreskin divided into four separate full-thickness skin graft triangles to treat the four-lid ectropion. There was successful resolution of the eye symptoms and a watertight closure. To our knowledge, this is a unique case in which penile foreskin has been used to correct cicatricial ectropion.

Detection of HIV DNA in cervical and vaginal secretions: Prevalence and correlates among women in Nairobi, Kenya

Objective. —Factors that influence heterosexual transmission of the human immunodeficiency virus (HIV), including sexually transmitted diseases, contraceptive practices, sexual practices, HIV-related immunosuppression, and presence of cervical ectopy and the penile foreskin, have been identified through cross-sectional and prospective cohort epidemiologic studies. To more directly characterize factors that influence infectivity, we conducted a study of HIV shedding from the genital tract in women. Design. —Ninety-seven HIV-seropositive women attending a sexually transmitted disease clinic in Nairobi, Kenya, completed a questionnaire and underwent a physical examination and an evaluation for sexually transmitted diseases. Cervical and vaginal secretions were obtained for HIV DNA detection using polymerase chain reaction amplification. Results. —Human immunodeficiency virus DNA was detected by polymerase chain reaction in 28 (33%) of 84 cervical samples and 13 (17%) of 77 vaginal samples. The prevalence of HIV was higher in specimens from the endocervix than from the vaginal wall (P=.002), and there was no correlation between presence of virus at the two sites. After adjusting for age, cervical HIV shedding was independently associated with oral contraceptive pill use (odds ratio [OR], 11.6; 95% confidence interval [CI], 1.7 to 77.6), cervical mucopus (OR, 6.2; 95% CI, 0.9 to 41.4;P=.05), cervical ectopy (OR, 5.0; 95% CI, 1.5 to 16.9), and pregnancy (OR, 4.5; 95% CI, 1.2 to 16.3). Conclusions. —Human immunodeficiency virus was detected in one third of cervical samples and one sixth of vaginal samples. The presence of HIV DNA in cervical secretions was significantly associated with oral contraceptive pill use, cervical ectopy, and pregnancy. There was a marginally significant association with cervical mucopus. The identification of factors that increase the infectivity of women suggests potential strategies for reducing heterosexual transmission of HIV. (JAMA. 1993;269:2860-2864)

Detection of HIV DNA in Cervical and Vaginal Secretions

Factors that influence heterosexual transmission of the human immunodeficiency virus (HIV), including sexually transmitted diseases, contraceptive practices, sexual practices, HIV-related immunosuppression, and presence of cervical ectopy and the penile foreskin, have been identified through cross-sectional and prospective cohort epidemiological studies. To more directly characterize factors that influence infectivity, we conducted a study of HIV shedding from the genital tract in women. Ninety-seven HIV-seropositive women attending a sexually transmitted disease clinic in Nairobi, Kenya, completed a questionnaire and underwent a physical examination and an evaluation for sexually transmitted diseases. Cervical and vaginal secretions were obtained for HIV DNA detection using polymerase chain reaction amplification. Human immunodeficiency virus DNA was detected by polymerase chain reaction in 28 (33%) of 84 cervical samples and 13 (17%) of 77 vaginal samples. The prevalence of HIV was higher in specimens from the endocervix than from the vaginal wall (P = .002), and there was no correlation between presence of virus at the two sites. After adjusting for age, cervical HIV shedding was independently associated with oral contraceptive pill use (odds ratio [OR], 11.6; 95% confidence interval [CI], 1.7 to 77.6), cervical mucopus (OR, 6.2; 95% CI, 0.9 to 41.4; P = .05), cervical ectopy (OR, 5.0; 95% CI, 1.5 to 16.9), and pregnancy (OR, 4.5; 95% CI, 1.2 to 16.3). Human immunodeficiency virus was detected in one third of cervical samples and one sixth of vaginal samples. The presence of HIV DNA in cervical secretions was significantly associated with oral contraceptive pill use, cervical ectopy, and pregnancy. There was a marginally significant association with cervical mucopus. The identification of factors that increase the infectivity of women suggests potential strategies for reducing heterosexual transmission of HIV.

Releasing penile foreskin trapped in a zipper.

Zipper injuries to the penis are not uncommon and generally occur when an uncircumcised male zips up his pants too quickly and entraps the foreskin of the penis in the zipper.1-3 The male is usually between 3 and 6 years of age and may not have been wearing underpants. When the patient presents to the office or emergency department, he is usually in a great deal of pain and may be very anxious.

Measurement of blood flow in the parameatal foreskin flap for urethroplasty in hypospadias repair.

During the one-stage repair of hypospadias the blood flow of the parameatal-based foreskin flap was measured in 30 patients by using laser Doppler velocimetry. The mean blood flow in the penile foreskin was estimated to be 15 ml/min/100 g and it increased to 150-200% after the induction of anesthesia, and then decreased to 72% at the tip of the created parameatal foreskin flap. Topical application of papaverine hydrochloride restored the flow to the preincision level in half of the cases. The parameatal foreskin flap, both in the form of a manta-wing and in extended circumferential form, appears to have an enough microcirculation suitable for one-stage repair (OUPF II and OUPF IV, respectively) of hypospadias.

Two Cases of Genital Paget's Disease With Bilateral Axillary Involvement: Mutability of Axillary Lesions

<h3>To the Editor.—</h3> The combination of genital and axillary Paget's disease seems to be extremely rare. We recently experienced two cases of genital Paget's disease with bilateral axillary involvement, and observed that the appearances of their axillary lesions changed daily. <h3>Report of Cases.—Case 1.—</h3> A 77-year-old man had itchy erythema on his penile foreskin and scrotum for about 4 years. Physical examination revealed several erythematous and depigmented macules measuring approximately 1 to 2 cm in diameter on his penis and scrotum. We also noted an ill-defined fingertip-sized irregular erythema on each axilla (Fig 1). After admission, we noticed that the clinical appearances of his axillary lesions changed daily: on our first examination the apparent erythematous lesions of his axillae became fainter and obscure. <h3>Case 2.—</h3> A 72-year-old man had a gradually enlarging erythema on his pubic skin for about 2 years. Physical examination revealed a 23 × 18-mm erythematous plaque on the pubic area and reticular hypopigmented macules around it. There also was an egg-sized illdefined faintly erythematous macule on each axilla (Fig 2, left). After admission, we also found that the clinical appearances of his axillary lesions changed day by day from erythematous plaques to

特異な経過および形態像を呈した陰茎部癌の1例

A 75-year-old male patient showed an extensive erosion mainly restricted to the penile site, which was found when he received appendectomy. The penile lesion had persisted for about ten years, during which period the erosion extended gradually while he missed to consult a physician. The lesion was a florid and wetting erosion, with a definite boundary, which covered the entire circumference of the penile foreskin and also extended to the suprapubic area, scrotum and external urethral orifice. Although the diagnosis could not be made by biopsy, extra mammary Paget's disease was strongly suspected. Bilateral modified inguinal lymphadenectomy and systemic evaluation were first performed to confirm that there was no metastasis or complexed disease in other organs. Then extensive wide resection of the skin lesion and reconstruction using a split-thickness skin graft were performed. Histopathological examination of the surgical specimen revealed poorly differentiated squamous cell carcinoma, although most part showed only inflammatory erosion. Clinical course and the histopathological findings including specific staining patterns led to the diagnosis of poorly differentiated squamous cell carcinoma originated from erythroplasia. During post-operative 18 months until now, no local recurrence or distant metastasis has been observed.

Chitosan: Effects on Wound Healing in Urogenital Tissue: Preliminary Report

We conducted a survey of the effect of chitosan on wounds of the genitourinary system in dogs. Wounds were made in the kidney, ureter and penile foreskin. Chitosan caused no adverse effects on urogenital wound healing. A decrease in fibrosis was seen in the wounds treated with chitosan in all tissues studied. These observations suggest that the morbidity of urogenital surgery may be decreased by treating the wounds with chitosan. (J. Urol, part 2, 140: 1134-1137, 1988)

The best suture for hypospadias?

In a study designed to determine the best suture for use in hypospadias surgery, polydioxanone (PDS), chromic catgut, and polyglycolic acid (Dexon) were studied under similar conditions in the penile foreskin of 16 baboons. Gross and microscopic observations were made at intervals of six to forty-eight days. The wounds sutured with catgut were all healed by twenty-four days with complete suture resorption and no evidence of scar formation. Both polyglycolic acid and polydioxanone sutures showed delayed resorption, wound abscesses, and granulomas. Catgut remains the best available suture to use in the penile foreskin. Polyglycolic acid and polydioxanone sutures, because of their prolonged resorption and excess reaction, should not be used in hypospadias surgery.

Gamma-glutamyl transpeptidase activity in human skin.

ABSTRACTGamma‐glutamyl transpeptidase (γ‐GT) activity was measured in a homogenate of penile foreskin, using γ‐glutamyl‐p‐nitroanilide as a substrate. It was found that γ‐GT activity was present in both the epidermis and the dermis, being more active in the former.The optimum pH for the enzyme was 8.5–9.0 in Tris buffer, which is similar to that for the rat kidney and human serum enzymes. It was also revealed that glycylglycine was the most effective activator of the enzyme. Some activation was also observed in the presence of L‐glutamine. But L‐methionine, L‐homoserine, L‐glutamic acid, L‐arginine, L‐aspartic acid, glycine and L‐valine inhibited the activity, suggesting that these amino acids do not act as acceptors of the γ‐glutamyl moiety. The enzyme was remarkably inhibited by bromsulphalein, oxidized glutathione, and by L‐serine in the presence of borate. These inhibitions were more severe than thoes observed with rat kidney and human serum enzymes.