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Aksel S, Derpinghaus A, Cao M, Li Y, Cunha G, Baskin L. Neurovascular anatomy of the developing human fetal penis and clitoris. J Anat 2024; 245:35-49. [PMID: 38419143 PMCID: PMC11161816 DOI: 10.1111/joa.14029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/15/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
The human penile and clitoral development begins from a morphologically indifferent genital tubercle. Under the influence of androgen, the genital tubercle forms the penis by forming a tubular urethra within the penile shaft. Without the effect of the androgen, the genital tubercle differentiates into the clitoris, and a lack of formation of the urethra within the clitoris is observed. Even though there are similarities during the development of the glans penis and glans clitoris, the complex canalization occurring along the penile shaft eventually leads to a morphological difference between the penis and clitoris. Based on the morphological differences, the main goal of this study was to define the vascular and neuronal anatomy of the developing penis and clitoris between 8 and 12 weeks of gestation using laser scanning confocal microscopy. Our results demonstrated there is a co-expression of CD31, which is an endothelial cell marker, and PGP9.5, which is a neuronal marker in the penis where the fusion is actively occurring at the ventral shaft. We also identified a unique anatomical structure for the first time, the clitoral ridge, which is a fetal structure running along the clitoral shaft in the vestibular groove. Contrary to previous anatomical findings which indicate that the neurovascular distribution in the developing penis and clitoris is similar, in this study, laser scanning confocal microscopy enabled us to demonstrate finer differences in the neurovascular anatomy between the penis and clitoris.
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Affiliation(s)
- Sena Aksel
- Department of UrologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Amber Derpinghaus
- Department of UrologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Mei Cao
- Department of UrologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Yi Li
- Department of UrologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Gerald Cunha
- Department of UrologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Laurence Baskin
- Department of UrologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Al-Beltagi M, Saeed NK, Bediwy AS, Shaikh MA, Elbeltagi R. Microphallus early management in infancy saves adulthood sensual life: A comprehensive review. World J Clin Pediatr 2024; 13:89224. [PMID: 38947989 PMCID: PMC11212752 DOI: 10.5409/wjcp.v13.i2.89224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/30/2024] [Accepted: 03/20/2024] [Indexed: 06/07/2024] Open
Abstract
Microphallus/Micropenis is a rare condition with significant physical and psychological implications for affected individuals. This article comprehensively reviews micropenis, its etiology, epidemiology, and various treatment options. We conducted a thorough literature review to collect relevant information on micropenis and microphallus, as well as related disorders. Our primary databases were PubMed, Medline, and Google Scholar. We searched for articles published in English between 2000 and 2023. Our analysis included 67 review articles, 56 research studies, 11 case reports, one guideline, and one editorial. Our search terms included "microphallus", "micropenis", "congenital hypogonadotropic hypogonadism", "androgen insensitivity syndrome", "pediatric management of micropenis", "testosterone therapy", and "psychosocial implications of micropenis". We focused on diagnosing micropenis and related conditions, including hormonal assessments, medical and surgical treatment options, psychosocial and psychological well-being, sexual development of adolescents, and sociocultural influences on men's perceptions of penile size. Additionally, we explored parenting and family dynamics in cases of micropenis and disorders of sex development, implications of hormonal treatment in neonates, and studies related to penile augmentation procedures and their effectiveness. The article highlights the importance of early diagnosis and intervention in addressing the physical and psychological well-being of individuals with micropenis. Surgical procedures, such as penile lengthening and girth enhancement, and non-surgical approaches like hormonal therapy are explored. The significance of psychological support, education, and lifestyle modifications is emphasized. Early management and comprehensive care are crucial for individuals with micropenis, from infancy to adolescence and beyond. A multidisciplinary approach involving urologists, endocrinologists, and mental health professionals is recommended. Regular assessment of treatment effectiveness and the need for updated guidelines are essential to provide the best possible care. Healthcare professionals should prioritize early diagnosis, and neonatologists should measure stretched penile length in neonates. A collaborative effort is needed among professionals, parents, and affected individuals to create a supportive environment that recognizes worth beyond physical differences. Continuous research and evidence-based updates are crucial for improving care standards.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatric, Faculty of Medicine, Tanta University, Tanta 31511, Egypt
- Department of Pediatric, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
- Department of Pediatric, University Medical Center, Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Department of Medical Microbiology Section and Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Bahrain
- Department of Medical Microbiology Section and Pathology, Irish Royal College of Surgeon, Busaiteen 15503, Bahrain
| | - Adel Salah Bediwy
- Department of Pulmonology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
- Department of Pulmonology, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
- Department of Pulmonology, University Medical Center, Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Majed A Shaikh
- Department of Pediatrics, Ibn Al Nafees Hospital, Manama 54533, Bahrain
| | - Reem Elbeltagi
- Department of Medicine, The Royal College of Surgeons in Ireland-Bahrain, Busiateen 15503, Bahrain
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Stancampiano MR, Meroni SLC, Bucolo C, Russo G. 46,XX Differences of Sex Development outside congenital adrenal hyperplasia: pathogenesis, clinical aspects, puberty, sex hormone replacement therapy and fertility outcomes. Front Endocrinol (Lausanne) 2024; 15:1402579. [PMID: 38841305 PMCID: PMC11150773 DOI: 10.3389/fendo.2024.1402579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
The term 'differences of sex development' (DSD) refers to a group of congenital conditions that are associated with atypical development of chromosomal, gonadal, and/or anatomical sex. DSD in individuals with a 46,XX karyotype can occur due to fetal or postnatal exposure to elevated amount of androgens or maldevelopment of internal genitalia. Clinical phenotype could be quite variable and for this reason these conditions could be diagnosed at birth, in newborns with atypical genitalia, but also even later in life, due to progressive virilization during adolescence, or pubertal delay. Understand the physiological development and the molecular bases of gonadal and adrenal structures is crucial to determine the diagnosis and best management and treatment for these patients. The most common cause of DSD in 46,XX newborns is congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, determining primary adrenal insufficiency and androgen excess. In this review we will focus on the other rare causes of 46,XX DSD, outside CAH, summarizing the most relevant data on genetic, clinical aspects, puberty and fertility outcomes of these rare diseases.
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Salvi NB, Ghassabian A, Brubaker SG, Liu H, Kahn LG, Trasande L, Mehta-Lee SS. Prenatal phthalate exposure and fetal penile length and width. Pediatr Res 2024; 95:1587-1595. [PMID: 38057576 PMCID: PMC11127776 DOI: 10.1038/s41390-023-02939-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 05/08/2023] [Accepted: 06/26/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Phthalates are endocrine-disrupting chemicals with anti-androgenic qualities and studies reported associations between prenatal phthalate exposure and infant genitalia. This study investigated whether increased prenatal phthalate exposure is associated with decreased fetal penile measures. METHODS Data was from the New York University Children's Health and Environment Study (2016-2019). Maternal urinary concentrations of 16 phthalate metabolites were quantified at <18 weeks gestation as a proxy for fetal exposure (n = 334 male pregnancies). We retrospectively measured penile length and width using ultrasounds conducted 18-24 weeks gestation (n = 173 fetuses). Associations of maternal urinary levels of phthalates with fetal penile length and width were determined using linear regression models. RESULTS 57.2% of women were Hispanic, 31.8% Non-Hispanic White, 6.4% Asian, 2.3% Non-Hispanic Black, and 2.3% multiple races. Mean maternal age was 32 years (standard deviation [SD] = 5.7). Mean penile length was 7.13 mm (SD = 1.47) and width was 6.16 mm (SD = 0.87). An inverse relationship was observed between maternal levels of mono-ethyl phthalate and fetal penile length, and mono-(7-carboxy-n-heptyl) phthalate and penile width, though estimates were small and not significant when considering correction for multiple comparisons. CONCLUSIONS In our cohort we found no clinically meaningful associations between early pregnancy phthalate exposure and fetal penile length or width. IMPACT First-trimester phthalate metabolites were assessed in pregnant women in New York City. Penile length and width were retrospectively measured on clinically assessed ultrasounds conducted ≥18 weeks and <24 weeks of gestation. In this cohort, no clinically meaningful associations were observed between first-trimester prenatal phthalate exposure and fetal penile length. This study contributes to the limited but growing research on the impact of prenatal phthalate exposure on male fetal genital development. The results emphasize that there may not be a clear association between prenatal phthalate exposure and fetal penile length and width, and further research on this topic may be required.
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Affiliation(s)
- Nicole B. Salvi
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY
| | - Akhgar Ghassabian
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY
| | - Sara G. Brubaker
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY
| | - Hongxiu Liu
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
- Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei, P.R. China
| | - Linda G. Kahn
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Leonardo Trasande
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY
| | - Shilpi S. Mehta-Lee
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY
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Wood D, Wilcox D. Hypospadias: lessons learned. An overview of incidence, epidemiology, surgery, research, complications, and outcomes. Int J Impot Res 2023; 35:61-66. [PMID: 35352016 DOI: 10.1038/s41443-022-00563-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022]
Abstract
Hypospadias is a common condition and familiar, though sometimes challenging territory for the pediatric urologist. This review is a summary of hypospadias incidence, epidemiology, surgery, research, and complications intended for the non-specialist. It outlines the history, the principles of surgery for hypospadias, and the long-term outcomes.
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Affiliation(s)
- Dan Wood
- University of Colorado, Aurora, CO, USA. .,Center for Childrens' Surgery Children's Hospital Colorado, Aurora, CO, USA.
| | - Duncan Wilcox
- Center for Childrens' Surgery Children's Hospital Colorado, Aurora, CO, USA
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Stancampiano MR, Suzuki K, O'Toole S, Russo G, Yamada G, Faisal Ahmed S. Congenital Micropenis: Etiology And Management. J Endocr Soc 2022; 6:bvab172. [PMID: 35036822 PMCID: PMC8754418 DOI: 10.1210/jendso/bvab172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Indexed: 01/23/2023] Open
Abstract
In the newborn, penile length is determined by a number of androgen dependent and independent factors. The current literature suggests that there are interracial differences in stretched penile length in the newborn and although congenital micropenis should be defined as a stretched penile length of less than 2.5 SDS of the mean for the corresponding population and gestation, a pragmatic approach would be to evaluate all boys with a stretched penile length below 2 cm, as congenital micropenis can be a marker for a wide range of endocrine conditions. However, it remains unclear as to whether the state of micropenis, itself, is associated with any long-term consequences. There is a lack of systematic studies comparing the impact of different therapeutic options on long-term outcomes, in terms of genital appearance, quality of life, and sexual satisfaction. To date, research has been hampered by a small sample size and inclusion of a wide range of heterogeneous diagnoses; for these reasons, condition-specific outcomes have been difficult to compare between studies. Lastly, there is a need for a greater collaborative effort in collecting standardized data so that all real-world or experimental interventions performed at an early age can be studied systematically into adulthood.
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Affiliation(s)
| | - Kentaro Suzuki
- Department of Developmental Genetics, Institute of Advanced Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Stuart O'Toole
- Department of Paediatric Surgery and Urology, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Gianni Russo
- Department of Pediatrics, Endocrine Unit, Scientific Institute San Raffaele, Milan 20132, Italy
| | - Gen Yamada
- Department of Developmental Genetics, Institute of Advanced Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Syed Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow G51 4TF, UK
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Baskin LS. EDITORIAL COMMENT. Urology 2020; 144:192-193. [DOI: 10.1016/j.urology.2020.04.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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