Table 1.
Summary of studies that examined the keratin thickness of the foreskin.
| STUDY | SUBJECTS | INDICATION FOR CIRCUMCISION | STI STATUS | SPECIMEN PROCESSING & MICROSCOPY | RESULTS & CONCLUSIONS |
|---|---|---|---|---|---|
| Patterson, 2002 [7] | 14 subjects10 months - 69years from Chicago, USA |
Phimosis, Balanitis,
Adhesions (3 subjects) Religious, Cultural or cosmetic (11subjects) |
Not specified | Processed within: 3 hours Fixed with: Streck Tissue Fixative Embedded in: Paraffin or OCT Section size: 5µm Stained with: immunohistochemistry Examined with: MetaMorph software V4.5 | IFS (data not shown) OFS (data not shown) Extent of keratinisation was much greater in the OFS surface than the IFS. Concluded that keratin layer of OFS is thicker than IFS. (OFS>IFS) |
| McCoombe, 2006 [6] |
9
cadavers† (mean age 77.4 years) 21 subjects† (mean age 28.9 years) 8 penile necropsy specimens† (mean age 30.9years) from Melbourne, Australia |
Not specified | HIV negative | Processed within: necropsy specimens obtained within 18 hours of death Fixed with: Formalin Embedded in: Paraffin Section size: 8µm Stained with: H & E stains and Ayoub-Shklar stains Examined with: Light microscopy 200-400 magnification | IFS - 1.8 units OFS - 3.3 units (Units; 0-no keratin 5- max keratin> 20 µm assessed subjectively) Concluded that IFS and frenulum are protected by a much thinner layer of keratin than those in the glans penis or OFS (OFS>IFS). |
| Qi Qin, 2009 [11] |
80
subjects, 60
were 2-7 years 20 were 20-29 years from Hangzhou, China |
Phimosis or redundant foreskin with UTI (30 boys) Cultural or cosmetic (30 boys) Not specified for adults who were otherwise healthy | Not specified | Processed within: Not specified Fixed with: 4% Para formaldehyde Embedded in: Paraffin Section size: 4µm Stained with: H & E Examined with: Light microscopy 100-400 magnification | IFS - 12.1 ± 4.1 µm OFS - 9.3 ± 2.0 µm Concluded that OFS is less keratinized than the IFS in healthy adults and in boys with infectious history (IFS > OFS). |
| Dinh, 2010 [9] | 16 subjects† from Chicago, USA | Phimosis | Not specified | Processed within: Not specified Fixed with: 3.7% Formaldehyde, 0.1mol/l PIPES buffer Embedded in: Paraffin, OCT Section size: 10µm ( cryosections) Stained with: immunofluorescence and H & E Examined with: DeltaVision RT systems using Softworx software |
IFS
(data not shown) OFS (data not shown)
Keratin thickness of 7 subjects- IFS > OFS Keratin thickness of 3 subjects- IFS < OFS Keratin thickness of 6 subjects- No difference Concluded no difference between the IFS and OFS keratin layers (IFS=OFS). |
| Dinh, 2012 [10] | 19 subjects 21-41 years from Rakai, Uganda | As prophylactic measure for HIV acquisition | HIV negative No evidence of current STIs | Processed within: Not specified Fixed with: 3.7% Formaldehyde, 0.1mol/l PIPES buffer Embedded in: OCT Section size: 10 µm Stained with: immunofluorescence and H & E Examined with: DeltaVision RT systems using Softworx software | IFS - 14.676 ± 7.48 µm OFS -13.306 ± 8.49 µm frenar band -16.916 ± 12.42 µm Concluded no difference between the IFS and OFS keratin layers (IFS=OFS). |
†
Age range not specified.
(IFS, inner foreskin; OFS, outer foreskin; LC, Langerhans cells STI, sexually transmitted infection PBS, phosphate buffered solution OCT, Optimum Cutting Temperature).