hypospadias was the most common type followed by anterior hypospadias (table 2).
Based on the location, glanular, coronal, subcoronal and midshaft hypospadias were classified as distal, and penoscrotal
and perineal ones were classified as proximal hypospadias.
Clinical Assessment: In isolated cryptorchidism, a chromosomal anomaly may be present in approximately 3% cases, in hypospadias 7% and in a combination of cryptorchidism and hypospadias, in 13% cases.13 In infants with proximal hypospadias (penoscrotal
, scrotal, perineal), detailed studies performed revealed a likely cause in 31% of cases.14 Infants with suspected DSD who require further clinical evaluation should include those with isolated perineal hypospadias, isolated micropenis, isolated clitoromegaly, any form of familial hypospadias and those who have a combination of genital anomalies with an external masculinisation score (EMS) of<11.15
Reconstructive strategy and classification of penoscrotal
Although classifying hypospadias is not necessarily useful in determining surgical approach, the meatal position can be anterior (distal) that includes glanular, coronal or subcoronal, mid penile and posterior (proximal) that includes posterior penile, penoscrotal
, scrotal or perineal.
(13) as a second-line imaging examination in 48 out of 230 patients, referred with a variety of penoscrotal
diseases, including a small number of benign intratesticular pathologies, namely four cases of acute epididymoorchitis, two cases of intratesticular cysts, one adrenal rest tissue, three cases of torsion, four cases of trauma, four cases of hydrocele and two inguinal hernias.
Reconstructive surgery is often considered to be the only treatment for serious penoscrotal
elephantiasis. The goal of the therapy is to re-establish function and reduce physical disability.
Penile venous Doppler ultrasonography showed no pathology but the patient continued to have penoscrotal
swelling in the following weeks.
Proper preoperative assessment to recognize possible complicating anatomical factors (penoscrotal
webbing, ventral skin deficiency, suprapubic fat pad) and adequate postoperative instructions to ensure retraction of the residual shaft skin can prevent most complications.
* The penis must be of normal size and without anatomical defect--no micropenis, hypospadias, or penoscrotal
Approximately 20% of this cohort had penoscrotal
hypospadias, and this subset was responsible for nearly 50% of the reported complications in the group.
On physical exam, the patient had mild tenderness to palpation at the penoscrotal
junction with induration, no crepitus was palpated, and there were no skin changes.