Figure - available from: Journal of Tissue Engineering
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The human foreskin shape after surgical removal: (a) schematic representation of human foreskin after surgical removal via circumcision and (b) representation of the sequential steps performed to identify the shape of the human foreskin after surgical removal via circumcision.
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The circumcision of males is emphatically linked to numerous sexual dysfunctions. Many of the purported benefits do not hold up to the scrutiny of extensive literature surveys. Involuntary circumcision, particularly when not medically warranted, is also associated with many psychological and emotional traumas. Current methods to reconstruct the abl...
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Introduction
Active debate concerns whether male circumcision (MC) affects sexual function, penile sensation, or sexual pleasure.
Aim
To perform a systematic review examining the effect of MC on these parameters.
Methods
PRISMA-compliant searches of PubMed, EMBASE, the Cochrane Library, and Google Scholar were performed, with “circumcision” used...
Circumcision is the excision of the foreskin of the penis which may be performed in the neonatal period or in later life. Circumcision benefits are minimizing urinary tract infection, enhances of penile hygiene, prevents of penile carcinoma. However, circumcision may cause complications such as bleeding, and infection. Some of these complications c...
Citations
... The amount of purple or blue formazan production is then detected by spectrophotometry at 570 nm and is directly proportional to the number of viable cells. MTT is a sensitive and quantitative assay for cell proliferation and determining the absence of viable cells [55]. The strength of using the MTT assay to confirm decellularized ECM is that even small changes in metabolic activity can provoke an alteration in MTT. ...
... Both of them led to the successful decellularization of the foreskin. Several decellularization protocols have been used previously, with maintaining the ECM components and the 3D structure of the foreskin ECM [27][28][29]. The majority of them applied SDS to remove cells with high efficacy, but SDS can solubilize nuclear and cytoplasmic membranes [23]. ...
The rapid development of tissue engineering (TE) and regenerative medicine brings an acute need for biocompatible and bioactive biological scaffolds to regenerate or restore damaged tissue. Great attention is focused on the decellularization of tissues or even whole organs, and the subsequent colonization of such decellularized extracellular matrices by recipient cells. The foreskin is an integral, normal part of the external genitalia that forms the anatomical covering of the glans penis and the urinary meatus of all human and non-human primates. It is mucocutaneous tissue that marks the boundary between mucosa and skin. In this work, we compared two innovative decellularization techniques for human foreskins obtained from donors. We compared the efficacy and feasibility of these protocols and the biosafety of prepared acellular dermal matrixes that can serve as a suitable scaffold for TE. The present study confirms the feasibility of foreskin decellularization based on enzymatic or detergent methods. Both techniques conserved the ultrastructure and composition of natural ECM while being DNA-free and non-toxic, making it an excellent scaffold for follow-up research and TE applications.
... MPa, respectively. 54 This study did not consider the effect of anisotropy or strain rate which may have a profound effect on human skin. 55,56 It is evident that there is generally a lack of knowledge on the mechanics of the penile tissues. ...
Introduction:
Erectile dysfunction (ED) affects to some degree approximately 52% of the male population aged 40-70 years. Many men do not respond to, or are precluded from using, pharmaceutical treatments for ED and are therefore advised to consider penile prostheses. Different types of penile prosthesis are available, such as inflatable penile prostheses (IPPs). IPPs consist of a pair of inflatable cylinders inserted into the corpora cavernosa (CC). During inflation/deflation of these cylinders, the CC and other surrounding tissues such as the tunica albuginea (TA) are highly impacted. Therefore, it is critical to understand the mechanics of penile tissues for successful implantation of IPPs and to reduce tissue damage induced by IPPs.
Objectives:
We explored the importance of the biomechanics of penile tissues for successful IPP function and reviewed and summarized the most significant studies on penile biomechanics that have been reported to date.
Methods:
We performed an extensive literature review of publications on penile biomechanics and IPP implantation.
Results:
Indenters have been used to characterize the mechanical behavior of whole penile tissue; however, this technique applied only local deformation, which limited insights into individual tissue components. Although one reported study addressed the mechanical behavior of TA, this investigation did not consider anisotropy, and there is a notable absence of biomechanical studies on CC and CS. This lack of understanding of penile tissue biomechanics has resulted in computational models that use linear-elastic materials, despite soft tissues generally exhibiting hyperelastic behavior. Furthermore, available benchtop/synthetic models do not have tissue properties matched to those of the human penis, limiting the scope of these models for use as preclinical testbeds for IPP testing.
Conclusion:
Improved understanding of penile tissue biomechanics would assist the development of realistic benchtop/synthetic and computational models enabling the long-term performance of IPPs to be better assessed.
... 19 In preclinical studies, decellularized animal urethras from dogs, porcine, and rabbits were performed to evaluate their potential for application in urethral regeneration. [23][24][25] Several scientific groups have been trying to decellularize various parts of the urogenital tract, including the foreskin, 26 urethra, 27,28 ureter, 29 and bladder 30,31 up to the complete human phallus, 32 to solve complex urogenital and penile defects. However, no decellularized human urethras we used in a clinical setting so far. ...
Recently, several scaffolds have been introduced for urethral tissue engineering. However, acellular human urethral scaffold harvested from deceased donors may provide significant advantages compared to synthetic, composite, or other biological scaffolds. This study aims to develop the protocol for decellularization of the human urethra that preserves substantial extracellular matrix (ECM) components, which are essential for subsequent recellularization mimicking the natural environment of the native ECM. A total of 12 human urethras were harvested from deceased donors. An equal part of every harvested urethra was used as a control sample for analyses. The protocol design was based on the enzyme-detergent-enzyme method. Trypsin and Triton X-100 were used to remove cells, followed by DNase treatment to remove DNA residues. Subsequently, the specimens were continually rinsed in deionized water for seven days. The efficiency of decellularization was determined by histochemistry, immunohistochemical staining, scanning electron microscopy (SEM), and DNA quantification. Histological analysis confirmed cell removal and preservation of urethral structure after decellularization. The preservation of collagen IV and fibronectin was confirmed by histologic examination and immunohistochemical staining. SEM confirmed the maintenance of the ultrastructural architecture of ECM and fibers. DNA content in decellularized urethra was significantly lower compared to the native sample (P < 0.001), and so the criteria for decellularized tissue were met. Cytotoxicity analysis data showed that the matrix-conditioned medium did not contain soluble toxins and had no significant inhibitory effect on cell proliferation, providing evidence that the decellularized samples are not toxic. This study demonstrates the feasibility of the enzyme-detergent-enzyme-based decellularization protocol for removing cellular components and maintaining urethral ECM and its ultrastructure. Moreover, obtained results provide solid ground for recellularization and urethral tissue engineering, which will follow.
... Respondents were asked about interest in regenerative medicine for foreskin restoration (Q37). Significant progress in this realm has been made by Foregen [89]. Sixty seven percent (67%) of respondents were either somewhat interested (n=457, 25.53%) or very interested (n=737, 41.17%), especially if it were financially feasible (ca. ...
Foreskin Restorers: Insights into Motivations, Successes, Challenges and
Experiences with Medical and Mental Health Professionals - Unabridged Supplement
... The multifaceted nature of human foreskin, which is a highly vascularized and densely innervated bilayer tissue, is comparable to that of few other parts of the human anatomy. Foreskin circumcision has ancient roots, but its modern version dates back to the early 19 th century (12). Foreskin circumcision is performed on most male children in Iran, providing an abundant supply of waste tissue that can be used as a skin graft without damaging the donor. ...
... In some countries, including Iran, circumcision is a common practice, and the foreskin is considered a wasted tissue (22). The importance of repurposing this wasted tissue as a biological scaffold is compounded by the fact that it possesses components that are anatomically and structurally similar to skin (12). Furthermore, thicker skin grafts contain undesired hair follicles, eventually leading to hair growth in the graft (23). ...
... Here we compared two decellularization techniques: the so-called SDS-M and an OFD-M developed in this work to obtain a better scaffold. Other methods of skin decellularization have been reported in the literature (12,24), and each protocol aims to remove the cells while maintaining the ECM components and the threedimensional structure of the ECM (25). SDS is a popular detergent for tissue decellularization, which can solubilize both nuclear and cytoplasmic membranes efficiently. ...
Objective:
Acellular matrices of different allogeneic or xenogeneic origins are widely used as structural scaffolds in regenerative medicine. The main goal of this research was to optimize a method for decellularization of foreskin for skin regeneration in small wounds.
Materials and methods:
In this experimental study, the dermal layers of foreskin were divided into two sections and subjected to two different decellularization methods: the sodium dodecyl sulfate method (SDS-M), and our optimized foreskin decellularization method (OFD-M). A combination of non-ionic detergents and SDS were used to decellularize the foreskin in OFD-M. The histological, morphological, and biomechanical properties of both methods were compared. In addition, human umbilical cord mesenchymal stem cells (hucMSCs) were isolated, and the biocompatibility and recellularization of both scaffolds by hucMSC were subsequently determined.
Results:
We observed that OFD-M is an appropriate approach for successful removal of cellular components from the foreskin tissue, without physical disturbance to the acellular matrix. In comparison to SDS-M, this new bioscaffold possesses a fine network containing a high amount of collagen fibers and glycosaminoglycans (GAG) (P≤0.03), is biocompatible and harmless for hucMSC (viability 91.7%), and exhibits a relatively high tensile strength.
Conclusion:
We found that the extracellular matrix (ECM) structural integrity, the main ECM components, and the mechanical properties of the foreskin are well maintained after applying the OFD-M decellularization technique, indicating that the resulting scaffold would be a suitable platform for culturing MSC for skin grafting in small wounds.
... The prepuce is an integrated feature of the external genitalia, having evolved to function in concert with other genital structures; for example, it forms the anatomical covering of the glans penis or clitoris, thereby internalizing each and "decreasing external irritation and contamination" (Cold & Taylor, 1999, p. 34). In the case of the penile prepuce, an additional function-alongside its biomechanical role in sexual intercourse (Purpura et al., 2018)-is to protect the urinary opening from abrasion, as this runs through the penile, but not the clitoral glans (Fahmy, 2020). The penile prepuce has a mean reported surface area of between 30 and 50 square centimeters in adults (Kigozi et al., 2009;Werker et al., 1998) and is the most sensitive part of the penis, both to light touch stimulation and sensations of warmth (Bossio et al., 2016;Sorrells et al., 2007). ...
In recent years, there has been a resurgence in debates on the ethics of child genital cutting practices, both female and male, including within a Muslim context. Opponents of female genital cutting sometimes assert that the practice is not mentioned explicitly in the Qur’an as a way of implying that it does not have any religious standing within Islam. However, neither is male genital cutting mentioned explicitly in the Qur’an, and yet most people accept that it is a Muslim religious practice. Both practices, however, are mentioned in secondary sources of Islamic jurisprudence, with disagreement among religious authorities about the status or authenticity of some of these sources. This paper considers the religious status of both female and male genital cutting practices within Islam and employs a philosophical argument based on “peer disagreement” to ask whether either practice is necessary (i.e., religiously required) for a devout Muslim to endorse.
... The prepuce is an integrated feature of the external genitalia, having evolved to function in concert with other genital structures; for example, it forms the anatomical covering of the glans penis or clitoris, thereby internalizing each and 'decreasing external irritation and contamination' (Cold & Taylor, 1999, p. 34). In the case of the penile prepuce, an additional function -alongside its biomechanical role in sexual intercourse (Purpura et al., 2018) -is to protect the urinary opening from abrasion, as this runs through the penile, but not the clitoral glans (Fahmy, 2020). The penile prepuce has a mean reported surface area of between 30 and 50 square centimeters in adults Werker et al., 1998) and is the most sensitive part of the penis, both to light touch stimulation and sensations of warmth (Bossio et al., 2016;Sorrells et al., 2007). ...
... This striking comparison -between female and male so-called 'circumcision' within this Muslim community -forms a backbone of Shweder's analysis (see Table 1 for further comparison). (Baskin et al., 2018;Bossio et al., 2016;Cold & Taylor, 1999;Fahmy, 2015Fahmy, , 2020Hodson et al., 2019;Kigozi et al., 2009;Myers & Earp, 2020;O'Connell et al., 2008;Pippi Salle et al., 2007;Purpura et al., 2018;Sorrells et al., 2007;Werker et al., 1998) (Adler, 2012;Askola, 2011;Boyle et al., 2000;Brigman, 1984;Davis, 2001;Earp, 2020a;Geisheker, 2013;Mason, 2001;Merkel & Putzke, 2013;Price, 1997;Somerville, 2004;Svoboda et al., 2016Svoboda et al., , 2019 If non-consensual, medically unnecessary FC is legally considered to be physical assault and battery (which parents are not entitled to authorize for their children) (see, e.g., United States of America vs. Jumana Nagarwala et al., 2018). ...
Defenders of male circumcision increasingly argue that female ‘circumcision’ (cutting of the clitoral hood or labia) should be legally allowed in Western liberal democracies even when non-consensual. In his target article, Richard Shweder (2022) gives perhaps the most persuasive articulation of this argument to have so far appeared in the literature. In my own work, I argue that no person should be subjected to medically unnecessary genital cutting of any kind without their own informed consent, regardless of the sex characteristics with which they were born or the religious or cultural background of their parents. Professor Shweder and I agree that Western law and policy on child genital cutting is currently beset with cultural, religious and sex-based double standards. We disagree about what should be done about this. In this commentary, I argue that ‘legalising’ childhood FGC so as to bring it into line with current treatment of childhood MGC is not an acceptable solution to these problems. Instead, all medically unnecessary genital cutting of non-consenting persons should be opposed on moral and legal grounds and discouraged by all appropriate means.
... One can engage in foreskin reconstruction, such as nonsurgical restoration, although after completion, one merely becomes πισπασμóς ἐ (stretchedone), as the ancient Greeks referred to it, which is effectively just a secondary status (Schultheiss et al. 1998). Moreover, both surgical and non-surgical restoration, while restoring a great deal of physical function and cosmesis, can never truly replace specific tissues and specialized structures of the natural foreskin; however, advances in tissue engineering and regenerative medicine are likely to overcome this barrier (Purpura et al. 2018). ...
This paper seeks to address the ethical and moral implications of the utilization of neonatal foreskin tissue in biotechnology. Under the framing of Heidegger’s 𝘛𝘩𝘦 𝘘𝘶𝘦𝘴𝘵𝘪𝘰𝘯 𝘊𝘰𝘯𝘤𝘦𝘳𝘯𝘪𝘯𝘨 𝘛𝘦𝘤𝘩𝘯𝘰𝘭𝘰𝘨𝘺, I extend the Heideggerian concept of Enframing and standing-reserve into the utilization of neonatal tissue as a resource for biotechnology and as a commodity in general. I proceed with a meticulous moral analysis of this practice employing a synthesis of Kantian and Schopenhauerian moral philosophies. I argue that the practice of using neonatal tissue in this routine, commodified manner constitutes partial murder of the child, theft, and wrongful use, which violates Kantian ethical principles. As such, the use of neonatal foreskin tissue in the current paradigm must be abandoned.
... The amount of purple/blue formazan production then is detected by spectrophotometry at 570 nm and is directly proportional to a number of viable cells. MTT is a sensitive and quantitive assay for cell proliferation and determining the absence of viable cells (Purpura et al. 2018) the strength of using MTT assay to confirm decellularized ECM is even small changes in metabolic activity can provoke alteration in MTT. ...
The extracellular matrix (ECM) of mammalian organs and tissues has been applied as a substitute scaffold to simplify the restoration and reconstruction of several tissues. Such scaffolds are prepared in various arrangements including sheets, powders, and hydrogels. One of the more applicable processes is using natural scaffolds, for this purpose discarded tissues or organs are naturally derived by processes that comprised decellularization of following tissues or organs. Protection of the complex structure and 3D (three dimensional) ultrastructure of the ECM is extremely necessary but it is predictable that all protocols of decellularization end in disruption of the architecture and potential loss of surface organization and configuration. Tissue decellularization with conservation of ECM bioactivity and integrity can be improved by providing well-designed protocols regarding the agents and decellularization techniques operated during processing. An overview of the characterization of decellularized scaffolds and the role of reagnets can validate the applied methods' efficacy.
