Histological Analysis of Preputial Circumcision Specimen: The Argument for and Against Neonatal Circumcision
Victor I MODEKWE, Felix E MENKITI, Chidimma C OSUIGWE, Chukwudi O OKANI, Frank C Akpuaka
The prepuce, however, is a specialised tissue with protective, sensory, and reconstructive functions, and its routine removal raises anatomical and ethical concerns.Objective: To evaluate the histological features of the neonatal prepuce excised during circumcision and also to assess its functional and surgical significance.
The discussion has always centred on the indications, benefits, complications and contra-indications. There has been little or no discussion on what is lost in neonatal circumcision –the real victim of the procedure, the prepuce.
The eyelid resembles the prepuce in structure and in function –which is protection.14The arrangement of the preputial structure and its thickness emphasize the role it is to play beyond adding to the girth of the penis. According to Fahmy MAB,4the mucosa of the inner prepuce is lined by stratified squamous epithelium, similar to the frictional mucosa of the vagina, the inner eyelid, the mouth, and the oesophagus.
Histology revealed five distinct layers: epidermis, dermis, Dartos fascia, lamina propria, and mucosa, with a mean thickness of 3.96 ± 0.95 mm. The lamina propria was highly vascularised (5–9 vessels/mm²), and nerve bundles were present in 86% of Dartos samples. Both epidermis and mucosa showed keratinised squamous epithelium with intact basement membranes. Inflammatory infiltrates were seen in 44% of specimens, but no dysplasia or malignancy was observed.Conclusion: The neonatal prepuce is a complex tissue with structural and functional importance. Routine circumcision lacks sufficient histological justification, warranting multidisciplinary review and public debate on its continued practice.
In conclusion, the prepuce is a uniquely created tissue in the body. It has a rich neurovascular supply. There is nothing clinically, grossly, histologically and microbiological wise that suggests that the prepuce is a redundant tissue or poses a threat to the male child.