Aposthia




(1)
Pediatric Surgery, Al Azher University, Cairo, Egypt

 



Abstract

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.


Keywords
ForeskinNatural circumcisionCongenital circumcisionPreputial reconstruction



Nomenclature

Natural circumcision, congenital absence of preputial foreskin.


Definition

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).

A417561_1_En_4_Fig1_HTML.gif


Fig. 4.1
Aposthia in neonate with completely normal glans and urethra (dorsal view)


A417561_1_En_4_Fig2_HTML.jpg


Fig. 4.2
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.

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Jun 30, 2017 | Posted by in UROLOGY | Comments Off on Aposthia

Full access? Get Clinical Tree

Get Clinical Tree app for offline access