Sub-preputial wetness - Its nature

Summary

Sub-preputial space collects material unless kept clean. This does not happen in phimotics without sub-preputial adhesions. In the absence of any glands or secretions in this region, a study was made to explain the wetness in the sub-preputial space. A bio-chemical examination of the collected material as well as the washings indicated that the wetness was due to the prostatic, vesicular and urethral secretions. Urine played no part in this wetness.

Introduction

Sub-preputial space tends to be wet in most individuals. Spotting of underclothing is a common feature. If not cleaned, this space collects a material, commonly labeled as smegma. Contrary to popular conception, this collection does not occur if there is a preputial stenosis, i. e. phimosis, without adhesions (Parkash and Rao 1980; Parkash et al. 1973; Lakshmanan and Satya Parkash 1980). There are no glands in this space to explain this lesion, the Tyson's glands being a non-entity (Keith and Shellitoe 1904; Ashley Montague 1943; Parkash et al. 1973). A lot of importance has been given to collections in this region because of their likely association to squamous cell carcinoma. In the absence of a secretion, this wetness can be due to: --

1. Possible hygroscopic nature of the collection. This chiefly consists of epithelial debris (Parkash et al. 1973).
2. Urine spreading out in this space and also whirling around in phimotics, thus flusing (sic) it out.
3. non-urinary secretions or discharge from the urethra, spreading out by capillary action, continuously or intermittently, with a possible cleansing action of the epithelial debris, in the phimotics. Besides testicular, other secretions passed through the urethra are prostatic, vesicular and that of the urethral glands.

Urine is rich in urea, the content being about 2 gms%. The prostatic secrations (sic) contain about 3950 KA units/ml. of acid phosphatase (Mann 1954). Seminal vesicle discharge has 140-295 units/ml. of fructose, while urethral gland secretion is rich in much (Young 1961). As such a study was made todetermine the level of these in the sub-preputial region.

Materials and Methods

Eleven specimens of pooled and un-pooled sub-preputial collections were examined for moisture content, hygroscopic properties, mucoproteins and the urea content (Varley 1975).

Washings with 2 c.c. of distilled water from five non-phimotic individuals were examined for acid phosphatase (Varley 1975) and fructose content (Roe 1934).

A fine polythene catheter was inserted in five phimotic individuals (without adhesions) and washings obtained by repeated irrigation with 2 c.c. of distilled water; examined as above.

The findings were summarised in Tables I and II. No hygroscopic property could be demonstrated. The urea content was negligible. The average fructose content was about 22 mgm% in non-phimotics and 26.8 mgm% in phimotics. The acid phosphatase content was about 12.4 K.A. units in non-phimotics and 15.6 K.A. units in phimotics. The difference is statistically significant.

Table I. Moisture  Content, Mucoprotein and Urea in Sub-Preputial collections

         (Non-Phimotics)

Moisture       Mucoprotein          Urea mg%
content        % of dry
               weight

54              17                  6.4
55              18                  4.2
56              21                  6.4
57              16.6                6.5
58              18                  6.4
57.5            19.2                6.8
57.2            17.2                4.2
56.7            17.5                6.4
54.8            16.9                4.2

Average           56.5            17.9                5.4
plus/minus S. D.   1.41           1.25                1.14
plus/minus S. E.   0.42           0.37                0.34

Table II. Analysis of Washings in Non-Phimotics and Phimotics

in wash                      Units in wash
-------------------------    -------------------------
Non-Phimotics   Phimotics    Non-Phimotics   Phimotics
I (A)          II (A)         I (B)        II (B)

22             28             12            12
20             28             14            14
22             24             14            18
23             26             12            18
23             28             10            16

Average      22             26.8           12.4          15.6

S. D. +/-     1.22           1.789          1.67          2.608

The difference between I(A) and II(A) is highly significant at 1% level, i.e. P 0.01.
The difference between I(B) and II(B) is also highly significant at 5% level, i.e. P 0.05.

Discussion and Conclusion

The space is usually wet, even in the absence of a collection, excluding hygroscopic properties of the material in this space as a factor. The collection was also not found to be hygroscopic. Ballooning of the space occurs only in patients who have a pinhole opening, while there is an absence of collection in all non-adherent phimotics. As such a whirl pool effect of the urine can be excluded. The urea content of the collected material was also very low and indeterminable in the absence of a collection, that is, inthe washings.

The prostatic and seminal vesicle secretions are known to be rich in lytic material.  [ Note: See CIRP note below]  Presence of appreciable amounts of fructose and acid phosphtase and a higher content of these in phimotics is a significant observation.

Hyalase content could not be determined due to lack of facilities but can be presumed to raised along with the other constituents of the prostatic secretion as suggested by the acid phosphtase content in the washings.

As such it appears safe to conclude that the space is kept moist and also clean in those with preputial stenosis, by the secretions of the prostate, supplemented by the seminal secretion of the mucin content of the secretion of the urethral glands.

Acknowledgements

The authors are grateful to the  British Council for obtaining the photostat of the first two references cited in this study.

*Professor and Head of the Department of Surgery
**Senior Resident in Surgery
***Research Fellow, ICMR, Department of Biochemistry
****Professor of Biochemistry

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