Firinci Binali, Aydin Çetin, Yunluel Dilek, Caglar Ozgur, Ahiskalioglu Ali, Aydin Mehmet Dumlu
Department of Pediatric Surgery, Medical Faculty of Ataturk University, Erzurum, Turkey.
Department of Pediatric Surgery, Etlik City Hospital, Ankara, Turkey.
Medicine (Baltimore). 2025 Aug 8;104(32):e43793. doi: 10.1097/MD.0000000000043793.
Despite being a widely practiced and debated procedure for centuries, the impact of different circumcision techniques on spermatogenesis remains insufficiently explored. This study investigates the potential effects of conventional surgical and monopolar electrocautery-assisted circumcision methods on spermatogenesis.
The study was conducted on 18-month-old male New Zealand rabbits, divided into 3 groups: a control group (Group I, n = 5), a surgical circumcision group without electrocautery (Group II, n = 5), and a monopolar electrocautery group (Group III, n = 8), with a total of 18 animals. All procedures were performed under general anesthesia. The animals were monitored for 3 weeks before being sacrificed. Stereological analysis was used to evaluate Onuf nucleus, pudendal ganglia, and sperm counts. Histopathological analyses were performed on the affected tissues to evaluate structural and cellular changes.
Degenerative changes were observed in the dorsal penile fibers of the pudendal nerves, the pudendal ganglia, and Onuf nucleus. The density of degenerative neurons (n/mm³) in Onuf nucleus and pudendal ganglia, along with sperm counts, were as follows: Group I: 4 ± 1, 9 ± 3, and 96,891 ± 11,893, respectively; Group II: 11 ± 4, 154 ± 45, and 93,156 ± 8365; Group III: 121 ± 34, 2121 ± 318, and 76,783 ± 4956. The P-values for comparisons were as follows: Group I versus Group II, P < .005; Group II versus Group III, P < .0005; and Group I versus Group III, P < .00001.
The use of monopolar electrocautery during circumcision may be associated with neurodegenerative changes that originate at the distal pudendal nerve endings and extend retrogradely to the pudendal ganglia and Onuf nucleus. These changes may disrupt testicular innervation and could potentially contribute to reduced sperm production.
尽管包皮环切术作为一种实施了数百年且备受争议的手术，但其不同技术对精子发生的影响仍未得到充分研究。本研究调查了传统手术包皮环切术和单极电灼辅助包皮环切术对精子发生的潜在影响。
对18月龄雄性新西兰兔进行研究，分为3组：对照组（I组，n = 5）、无电灼的手术包皮环切组（II组，n = 5）和单极电灼组（III组，n = 8），共18只动物。所有手术均在全身麻醉下进行。在处死动物前对其监测3周。采用体视学分析评估奥努夫核、阴部神经节和精子计数。对受影响组织进行组织病理学分析以评估结构和细胞变化。
在阴部神经的阴茎背侧纤维、阴部神经节和奥努夫核中观察到退行性变化。奥努夫核和阴部神经节中退行性神经元的密度（个/mm³）以及精子计数如下：I组分别为4±1、9±3和96,891±11,893；II组为11±4、154±45和93,156±8365；III组为121±34、2121±318和76,783±4956。比较的P值如下：I组与II组，P <.005；II组与III组，P <.0005；I组与III组，P <.00001。
包皮环切术中使用单极电灼可能与神经退行性变化有关，这些变化起源于阴部神经远端末梢，并逆行延伸至阴部神经节和奥努夫核。这些变化可能会破坏睾丸神经支配，并可能导致精子生成减少。
