Immunochemical Analysis of Nerve Distribution Patterns within Prepucial Tissue

Numerous reports have amassed documenting the extent of pain inflicted while performing neonatal circumcision. Most investigators have theorized that the relative absence of pain during excision of the prepuce is related to the lack of maturation of pain mediating spinal pathways (i.e., spinothalamic tract). In order to document the extent and variations of innervation on an end organ level, we examined prepucial tissue of 35 patients undergoing cosmetic circumcision. Patients ranged from newborn to 32 years of age. Specimens were analyzed histologically using hematoxalin-eosin stains then specifically examined for patterns of nerve distribution using silver stains and neuron specific enolase immunohistochemistry.

Nerve bundle density was noted to be highest in ventral prepucial tissue (mean = 17.9 bundlens/rm) as opposed to dorsal (mean = 6.2 bundles/rm) and lateral (m = 8.6 bundles/rm) tissue. Interestingly, newborns appear to have a higher nerve density in all regions studied perhaps owing to a relative abundance of collagen matrix acquired with age.

Our findings suggest an extensive neuronal network within prepucial tissue which is present in birth with little change to adulthood.

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