PURPOSE: We evaluated the effect of a topical steroid(0.05% clobetasol propionate[Dermovate(R)]) on phimosis. MATERIALS AND METHODS: Between May 2005 and May 2007, 30 boys with phimosis were assigned to receive topical application of Dermovate(R). Of the 30 boys, 19 boys had concealed penises. The parents of the boys were instructed to retract the foreskin gently without causing pain, and to apply the topical steroid over the stenotic opening of the prepuce twice daily for 4 weeks then for another 4 weeks if no improvement was achieved. Retractibility of the prepuce was graded from 1-6. Response to treatment was arbitrarily defined as improvement in the retractibility score(complete response, score 5 and 6; partial response, score 3 and 4; no response, score 1 and 2). The effect of treatment was studied with respect to the duration of treatment, age, and an associated concealed penis. RESULTS: The pretreatment grade in all patients was a retractibility score of 1. The mean age of the patients was 48.5+/-27.6 months(range, 7-108 months). The complete response rates in boys treated for 4 and 8 weeks were 50% and 73.3%, respectively. In boys younger than 3 years of age (n=12) and older than 3 years of age(n=18), the complete response rates were 75% and 72.2%, respectively(p=0.866). In boys with or without an associated concealed penis(n=19 and n=11, respectively), the complete response rates were 63.1% and 90.9%, respectively(p=0.199). No adverse effect was encountered in all patients. CONCLUSIONS: Our data suggest that the application of topical steroids for 8 weeks as a first line treatment of phimosis may be effective, although further studies are needed to establish the definite efficacy and safety of this procedure.
Child ; Clobetasol ; Female ; Foreskin ; Humans ; Male ; Parents ; Penis ; Phimosis ; Steroids

In the repair of hypospadia, the use of bladder mucosal grafts in cases in which previous adequate foreskin for urethral reconstruction is lacking or in which previous repairs have failed, is feasible. The bladder mucosal graft offers several theoretical advantages. It is of the same histologic character as the normal urethra, is not hair bearing, tends to re-epithelialize exposed surfaces and has great dispensability. We have experienced two cases of the perineal and penoscrotal hypospadias repaired successfully by the bladder mucosal graft technique.
Female ; Foreskin ; Hair ; Hypospadias* ; Male ; Transplants* ; Urethra ; Urinary Bladder*

Vitiligo is an acquired systemic disease of the skin characterized by circumscribed patches of complete pigment loss due to destruction of melanocytes. A 28-year old male patient presented with generalized depigmented patchs. We performed microscopic studies of cultured melanocytes from this patient and compared them with those of normal neonatal foreskin. Phase contrast microscopic findings revealed no difference between the two groups of melanocytes, but transmission electron microscopic findings showed dilated circular rough endoplasmic reticulum in cultured melanocytes from our vitiligo patient. We could observe the innate cellular structural aberration of melanocytes from the vitiligo subject.
Adult ; Endoplasmic Reticulum, Rough ; Foreskin ; Humans* ; Male ; Melanocytes* ; Skin ; Vitiligo*

PURPOSE: Penoscrotal transposition is found in cases with severe form of hypospadias. In those cases, severe chordee generally coexists and a long length of urethra may be necessary for its correction. We evaluated the clinical outcome of surgical repairs for 12 patients of proximal hypospadias with penoscrotal transposition. MATERIALS AND METHODS: Out of 12 cases, there were 2 with penoscrotal type, 7 with scrotal type and 3 with perineal type hypospadias. All cases had moderate to severe chordee. Five cases were treated with one-stage repair and seven cases with multi-stage repair. We analysed operative methods, postoperative complications and those managements between the cases of one-stage and multi-stage repairs. RESULTS: For one-stage repair, we used transverse preputial island flap method in 3 cases and urethroplasty using scrotal skin flap in 2 cases. For multi-stage repair, we performed Thiersh-Duplay urethroplasty in 2 cases, bladder mucosal graft in 2 cases and Belt-Fugua urethroplasty in 3 cases. Correction of penoscrotal transposition was performed successfully in all cases. In all cases, a paucity of skin was the most difficult problem. The overall complication rate was 50.0%. In cases treated with one-stage repair, there were two cases with urethrocutaneous fistulas. However, in cases treated with multi-stage repair, there were four cases with complications such as urethral strictures, urethrocutaneous fistulas with or without large skin defect. Overall the complications in cases with multi-stage repair were more severe than those in cases with one-stage repair. CONCLUSIONS: Our experience suggests that multi-stage operation may be not superior to one-stage operation in cases with proximal hypospadias associated with penoscrotal transposition. Thus we recommand one-stage repair in those cases despite a paucity of foreskin.
Female ; Fistula ; Foreskin ; Humans ; Hypospadias* ; Male ; Postoperative Complications ; Skin ; Transplants ; Urethra ; Urethral Stricture ; Urinary Bladder

BACKGROUND: Melanocytes synthesize melanin pigment by the action of specific enzyme tyrosinase. In normal skin, melanocytes maintain their constant population and steady melanogenic activity. But several stimuli to the skin such as UV irradiation and chemical irritation may accelerate the proliferation and differentiation of melanocytes and subsequently lead to hyperpigmentation of the skin. Endothelin-1(ET-1), produced by human keratinocyte acts as a strong mitogen on human melanocyte and has an effect on paracrine linkage between keratinocytes and melanocytes, and plays an important role in UVB induced hyperpigmentation as an intrinsic factor. OBJECTIVE: In this study, the role of ET-1 on melanocyte proliferation and melanogenesis was investigated, and the effects of ETRA(endothelin receptor antagonist) in cultured melanocyte was also evaluated. METHODS: Primary melanocytes from neonatal foreskins were cultured in complete MCDB 154 medium. To examine the effects of ET-1 on melanocytes, cultuled melanocytes were treated with ET-1 at various concentration(5nM, 10nM, 15nM, 20nM). Three days later, melanocyte proliferation and melanin content were measured. Also, we examined the effects of ETRA on ET-1 treated melanocytes. Five kinds of ETRA were added into 10nM of ET-1 treated melanocyte. After three days cultuviation, inhibitory effect of ETRA on ET-1 activity was measured. RESULTS: 1. The number of melanocytes increased in the groups of incubation with melanocyte medium of concentration in 10nM ET-1 than others. 2. The melanin contents increased most in the groups of incubation with melanocyte medium of concentration in 10nM ET-1 than others. 3. The number of melanocytes decreased in the groups of inhibited with ETRA I. 4. The melanin contents decreased in the groups of inhibited with ETRA II. CONCLUSION: This study provided an important confirmation of the proposal that ET-1 is intrinsic factor for proliferation and differentiation of human melanocytes, and ETRA has inhibitory effect on ET-1 induced melanogenesis and melanocyte proliferation. These findings suggest that ET-1 is an important mediator in epidermal pigmentation, and we will be able to use ETRA as a new whitening agent.
Endothelin-1 ; Foreskin ; Humans* ; Hyperpigmentation ; Intrinsic Factor ; Keratinocytes ; Melanins ; Melanocytes* ; Monophenol Monooxygenase ; Pigmentation ; Skin

Adenosine deaminase (adenosine aminohydrolase, AL)A), which catalyzes the deamination of adenosine to yield inosine and amrnonia, was assayed in human penile foreskin. The skin tissue was separated into two layers; epidermis and dermis. They were sliced with scissors into gel state, 4 volumes of 0.05M phosphate buffer solution were added and the tissue homogenized. After centrifugation at 4,000xg for 5 minutes, the supernatant was used as an enzyme solution. ADA activity was measured according to the method f Giuseppe" ADA was found to be present in both layers (epidermis; 0.24 OD/mg protein, dermis; 0.19 OD/mg protein) with slightly higher activity in the epidermis. As in earlier reports, it was found that ADA in the skin showed nearly even activity in the pH range of 5.0-8.0. Considering the significance of ADA in immunological function, the presence of ADA in the skin suggests that the tissue may participate in the immune function.
Adenosine Deaminase* ; Adenosine* ; Centrifugation ; Deamination ; Dermis ; Epidermis ; Foreskin ; Humans* ; Hydrogen-Ion Concentration ; Inosine ; Skin*

The distribution of pemphigus subclass autoantibodies in a patient with pemphigus vulgaris (PV) has been investigated by semiquantitative indirect immunofluorescence (IIF), using the HP series monoclonal antibodies specific for four human IgG subclasses on human foreskins. IgG1 and IgG4 intercellular substance-specific autoantibodies were detected in the serum of the patient, whereas IgG2 and IgG3 autoantibodies were absent. In addition to foreskins, human tonsillar epithelia were used as substrates of IIF for detecting the PV autoantibodies and it was one of satisfactory substitutes for monkey esophagus.
Antibodies, Monoclonal ; Autoantibodies* ; Esophagus ; Fluorescent Antibody Technique, Indirect ; Foreskin ; Haplorhini ; Humans ; Immunoglobulin G* ; Pemphigus*

BACKGROUND: The regulatory rnechanisrns of melanocytes underlying ultraviolet(UV) melanogenesis have been an interest tu many investigators. They have shown that several materials produced and secreted frorn norm il human keratinocytes play roles as mitogens of human melanocytes, and demonstrated that UVB exposure stirnulated highly the paracrine linkage of endothelin(ET) be tween keratinocytes and melanocytes. It suggest that ET is one of keratinocytes-derived intrinsic mitogens in UVB induced hyperpigmentation. OBJECTIVE: To evaluate whether ET secreted from keratinocytes under the UV irradiation works as paracrine effects such as melanocyte pro)iferation and function, the present, study was under taken. METHODS: Primary kevatinocytes and rnelanocytes cultures from neonatal foreskins were grown in complete MCDB 154 medium. Cultured human keratinocytes were irradiated with UVB 50mJ/ cm2. Twenty fours hour later, conditioned medium of keratinocytes was added into the growth medium of melanocytes of concentration in 10%, 20%, and 30%, respectively. Four days later, in order to detect of melanocytes proliferat.ion and function, number of melanocytes, melanin granules and tyrosinase activity v ere measured. RESULTS: J. The number of me anocytes were higher increase in groups of incubation with conditioned medium of irradiated keratinocytes than that of incubation with conditioned mediurn of irradiated keratinocytes and treatment of anti-ET-1(5ug/ml)(p>0.05). 2. The melanin contents were significantly higher increase in groups of incubation with conditioned medium(20%, 30%) of irradiated keratinocytes than that of incubation with conditioned medium of irradiated keiatinocytes and treatment of anti-ET-1(5ug/ml)(p<0.05). 3. The tyrosinase activity of melanocyte incubated with 30% COllcentration of conditioned medium from cultured keratinocyte irradiated with UVB was significantly higher increase than that of melanocyte incubated with 30% concentration of conditioned mediurn from cultured keratinocytes irradiated with UVB and treated with anti-ET-1(p<0.05). CONCLUSION: This stud provided an important confirmation of the proposal that ET-1 is intrin sic factor for proliferation and differentiation of human melanocytes. These findings suggest that keratinocyte derived ET-1 make a considerable effect on human melanocyte proliferation and function in UV melanog nesis.
Culture Media, Conditioned ; Endothelin-1* ; Foreskin ; Humans* ; Hyperpigmentation ; Keratinocytes* ; Melanins ; Melanocytes* ; Mitogens ; Monophenol Monooxygenase ; Research Personnel

PURPOSE: Phimosis is the inability to retract the foreskin of the penis over the glans of the penis. Even though phimosis is not pathogenic, the presence of phimosis is known to increase the risk of urinary tract infection in infancy. The use of topical steroids has been advocated as a safe and economical alternative to surgical intervention. The purpose of the study was to assess the effectiveness of topical steroids for the treatment of phimosis in young boys. METHODS: A total of 53 boys with phimosis were divided into two groups to distinguish between the efficacy of low-potency topical steroid (group 1, 27 cases) and of high-potency topical steroid (group 2, 26 cases). RESULTS: The success rate increased in the process of time. After 6 weeks, the success rate was 21 cases in group 1 and 22 cases in group 2. There was no significant differences in treatment outcomes between the two groups. The age of the boys, the appearance of prepuce prior to treatment, and the presence of previous symptoms, including symptoms of UTI, and ballooning of the prepuce at micturation had no significant difference on treatment outcomes. CONCLUSION: Topical steroid was effective in treatment of phimosis in boys younger than 4 years old. Although treatment outcomes between low- and high-potency topical steroids were not significantly different, those treated with a high-potency steroid cream showed more fast improvement. Further studies are necessary to assess systemic side effects of steroid treatment, duration of treatment and prevention of genitourinary tract infection in male infants.
Child, Preschool ; Female ; Foreskin ; Humans ; Infant ; Male ; Penis ; Phimosis* ; Steroids ; Urinary Tract Infections

The cutaneous synthesis of vitamin D in response to ultraviolet radiation exposure is the most important factor in maintaining vitamin D balance in Man. The skin is not only the site of vitamin D synthesis, but also a target organ for calcitriol(1, 25-dihydroxy-vitamin D) which is naturally occuriag, hormonally active form of vitamin E. It is now known that calcitriol inhibits the proliferation of epidermal cells and induces her differentiation. In this study, epidermal keratinocytes and melanocytes were isilated from the neonatal foreskin, and were culturod using a MCDB 153 and modified TIC media, respectively. And then various concentratioris of calcipotriol(MC 903), a synthetic aralogue of calcitriol, were added to each culture. The effects of calcipotriol on the growth of human keratinocytes and melanocytes were investigated. The results were as follows : 1. The addition of calopotriol to human keratinocyte and melalocyte cultures inhibited their proliferation in a dosdependent manner. 2. Calcipotriol had no effects on the melanization process of the melanocyte. 3. Calcipotriol was found to inhibit the proliferation, however it induced the terminal differentiation of cultured keratinocytes, as judged by morphologicai changes. The decreased density of kerationcytes, The formation of cornified cells, and the cellular destruction in a concentration of 10 M of calcipotriol were observed. 4. By using the light atid the electron microscope, we observed that the epidermal thickness was decreased and terminal differentiation was facilitateir. Living Skin Equivalent (LSE) according to the increasing concentration of calcipotriol. A]i)parent cytotoxic effects were observed in 10 M, 10 M of calcipotriol. In summary, the above results indicate that the addition of calcipotriol to the in vitro culture system of human keratinocyte and melanocyte induces the biologic process of terminal differentiation of keratinocytes and inhibits proliferation of keratinoytes and melanocytes in a dose-dependent manner.
Calcitriol ; Cholecalciferol* ; Foreskin ; Humans* ; Keratinocytes* ; Melanocytes* ; Skin ; Tics ; Vitamin D ; Vitamin E ; Vitamins*