The penis must be of normal size and without anatomical defect--no micropenis, hypospadias, or penoscrotal
In one instance, a group of 16 males ages 20-45 presented with penoscrotal
aphthous ulcers after 13 to 35 days from fever onset (6).
Our spectrum included children presenting first time with hypospadias ranging from mid-penile, proximal penile, penoscrotal
to scrotal hypospadias.
Specifically, two patients in Group A and two patients in Group B had testicular ascension, all of whom also had initial condition of penoscrotal
hypospadias and resultant postoperative penile complications.
1 The earliest medical text describing hypospadias dates back to the second century AD and was the work of Galen, the first to use the term descriptive locations include anterior (glanular, subcoronal and distal penile), middle ( mid shaft) and posterior (proximal penile, penoscrotal
, scrotal and perineal) hypospadias.
RUG yield 1 false positive result due to bending of urethra at the penoscrotal
junction which looks like stricture.
Today, the two-stage hypospadias repair is a commonly used technique repair of proximal penile, penoscrotal
and scrotal hypospadias with chordee.
Finally, the distribution of the diagnosis for the remaining 19 cases was as follows: five cases of penis malformation including partial penoscrotal
inversion (n = 2), penis agenesis (n = 1), abnormal penis rotation (n = 1), and penoscrotal
adherence (n = 1); clitoral malformation included clitoris agenesis (n = 4), severe clitoris hypoplasia (n = 1), and lipoma on the clitoris (n = 1); diagnosis in cases with multiple complex malformations included exstrophy of the cloaca and cardiomyopathy (n = 2), Prune-Belly syndrome (n = 1), and perineal lipoma (n = 1) (Table 1).
Genitourinary examination revealed a nontender swelling, 30 mm in diameter, at the right penoscrotal
junction with a discharging sinus tract.
Two patients with penoscrotal
lymphedema were successfully treated with wide radical excision of the lymphedematous tissue and reconstruction with good cosmetic and functional results 8 and 15 years afterwards and no recurrence.
The most important advantage of admission to a hospital for circumcision is that the physical examination of the penoscrotal
area by a surgical practitioner creates an opportunity to detect any hidden abnormality and if needed the child can be referred to an expert dealing with the surgical reconstruction of the genital anomalies.
plication as a uniform approach to reconstruction of penile curvature.