Pediatric Surgery, Al Azher University, Cairo, Egypt
Absent prepuce in a child is not a surgical problem, which needs no intervention, just exclusion of any other associated anomalies and family reassurance may be enough in certain communities where circumcision is a routine or ritual practice, but preputial reconstruction may be considered in societies considering socially unacceptable and ugly to have a glans penis without a preputial covering. Cases of aposthia could raise a couple of questions which deserve further researches.
KeywordsForeskinNatural circumcisionCongenital circumcisionPreputial reconstruction
Natural circumcision, congenital absence of preputial foreskin.
Aposthia is a rare congenital condition in humans, in which the foreskin of the penis is completely missing in a normally developed penis and urethra (Figs. 4.1 and 4.2).
Aposthia in neonate with completely normal glans and urethra (dorsal view)
Neonate with aposthia and minimal scrotal transposition
4.1 Historical Background
Religious literature from various sources reflects the history of aposthia; as this condition was first referenced in Jewish law of 1567 CE, in relation to a child born circumcised. Toward the end of the nineteenth century, E.S. Talbot claimed in Medicine that aposthia among Jews was evidence for the now-discredited Lamarckian theory of evolution. It is likely that the cases he described were actually hypospadias. The Midrash of Ki Tetzei notes that Moses was born aposthic. Other sources tell us that Jacob and David were also born aposthic. Jewish law requires males born without a foreskin or who lost their foreskin through means other than a formal circumcision ceremony to have a drop of blood let from the penis at the point where the foreskin would have been attached. Later on, the Prophet Muhammad was said to have been born with “natural circumcision” (in Ibn Sad Tabaqatul-Kubara). However, certain studies have reported that the trait aposthia with normal development of the urethra and glans is very rare because it is generally accepted that normal preputial development is required for the successful canalization of the glans urethra.