1
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Benson M, Hanna MK. A novel technique to construct a neo-scrotum out of preputial skin for agenesis and underdeveloped scrotum. J Pediatr Urol 2018; 14:449.e1-449.e4. [PMID: 29887296 DOI: 10.1016/j.jpurol.2018.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Congenital scrotal agenesis (CSA) is an extremely rare condition with fewer than 10 cases reported in the literature. These patients are often further complicated by undescended testicles as well as systemic developmental disorders. Herein, we report our experience and an innovative surgical technique for creation of a neo-scrotum in three children. MATERIALS AND METHODS We evaluated the records of three children in our database who were labeled as having an absent (1 patient) or severely underdeveloped scrotum (2 patients). Patients were aged 6, 14, and 16 months. All patients were uncircumcised, and the decision was made to create a neo-scrotum using the foreskin. The prepuce was harvested on a pedicle of dartos and transposed over the perineal cleft to create a neo-scrotal pouch. The flap was allowed to heal for 12-14 weeks, at which time the orchidopexy was performed. RESULTS The follow-up to the surgery was 5 years, 3 years, and 6 months, respectively. There were no instances of flap necrosis, dehiscence, or wound infection. The three children had a capacious, aesthetically pleasing scrotal sac, which in all cases accommodated both testicles. CONCLUSION In our experience, a well-vascularized preputial skin flap rotated to the perineum based on its ventral dartos pedicle provides an excellent source of tissue for creation of a neo-scrotum. We believe that the esthetic outcome of our technique rivals that of other reported techniques.
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Affiliation(s)
- Michael Benson
- Division of Urology, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Moneer K Hanna
- Department of Urology, New York-Presbyterian Weill Cornell Medical Center (MKH), New York, NY, USA
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2
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Spagnoli A, Borsellino A, Crucianelli S, Bizzarri C, Mucciolo M, Trucchi A, Ferro F. Complete Scrotal Agenesis: New Surgical Approach Using Self-inflating Tissue Expander. Urology 2017; 112:169-171. [PMID: 29080783 DOI: 10.1016/j.urology.2017.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/03/2017] [Accepted: 10/10/2017] [Indexed: 02/07/2023]
Abstract
Complete agenesis of the scrotum is an extremely rare entity: to date, only 8 cases have been reported. The authors describe 1 case carrying a heterozygous genomic variant in exon 17 of the MAP3K1 gene, whose surgical treatment included osmotic prosthesis implant to achieve reconstruction of a new scrotum. By constant and gradual expansion, self-inflating prothesis avoids patient discomfort and facilitates orchiopexy.
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Affiliation(s)
- Antonio Spagnoli
- Andrological Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Alessandro Borsellino
- Andrological Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy.
| | - Serena Crucianelli
- Andrological Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Carla Bizzarri
- Unit of Endocrinology, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Mafalda Mucciolo
- Medical Genetics-Department of Biotechnology, University of Siena-Policlinico S. Maria delle Scotte, Siena, Italy
| | - Alessandro Trucchi
- Andrological Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Fabio Ferro
- Andrological Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
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3
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Psarris A, Dimopoulou A, Iakomidis E, Zavras N, Vaos G. Hemiscrotal Agenesis: A Rare Congenital Anomaly. J Clin Diagn Res 2017; 11:PD19-PD20. [PMID: 28969205 DOI: 10.7860/jcdr/2017/28605.10507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/23/2017] [Indexed: 12/28/2022]
Abstract
Hemiscrotal Agenesis (HSA) is the rarest developmental malformation of the scrotum. It is characterized by the absence of either half of the scrotal rugae with an intact midline raphe. We report the case of a 16-month-old boy with HSA, with an island of scrotal tissue in the pubic tubercle region and ipsilateral cryptorchidism. To our knowledge, this is the first case of HSA with heterotopic development of scrotal tissue.
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Affiliation(s)
- Alexandros Psarris
- Resident, Department of Gynaecology, Agios Savvas Cancer Hospital, Athens, Greece
| | - Anastasia Dimopoulou
- Consultant, Department of Paediatric Surgery, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Iakomidis
- Senior Resident, Department of Paediatric Surgery, Agia Sofia Children's Hospital, Athens, Greece
| | - Nikolaos Zavras
- Assistant Professor, Department of Paediatric Surgery, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Vaos
- Professor, Department of Paediatric Surgery, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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4
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Bruel AL, Masurel-Paulet A, Rivière JB, Duffourd Y, Lehalle D, Bensignor C, Huet F, Borgnon J, Roucher F, Kuentz P, Deleuze JF, Thauvin-Robinet C, Faivre L, Thevenon J. Autosomal recessive truncating MAB21L1 mutation associated with a syndromic scrotal agenesis. Clin Genet 2016; 91:333-338. [PMID: 27103078 DOI: 10.1111/cge.12794] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 12/28/2022]
Abstract
We report on a boy with a rare malformative association of scrotum agenesis, ophthalmological anomalies, cerebellar malformation, facial dysmorphism and global development delay. The reported patient was carrying a homozygous frameshift in MAB21L1 detected by whole-exome sequencing, considered as the most likely disease-causing variant. Mab21l1 knockout mice present a strikingly similar malformative association of ophthalmological malformations of the anterior chamber and preputial glands hypoplasia. We hypothesize that MAB21L1 haploinsufficiency cause a previously undescribed syndrome with scrotal agenesis, ophthalmological anomalies, facial dysmorphism and gross psychomotor delay as remarkable hallmarks. Four cases from the literature were reported with features suggestive of a similar and recognizable clinical entity. We hypothesize that MAB21L1 should be the culprit gene in these patients.
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Affiliation(s)
- A-L Bruel
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), Centre Hospitalier Universitaire Dijon, Dijon, France.,Génétique des Anomalies du Développement, Université de Bourgogne, Dijon, France
| | - A Masurel-Paulet
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), Centre Hospitalier Universitaire Dijon, Dijon, France.,Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Inter-région Est, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - J-B Rivière
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), Centre Hospitalier Universitaire Dijon, Dijon, France.,Génétique des Anomalies du Développement, Université de Bourgogne, Dijon, France
| | - Y Duffourd
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), Centre Hospitalier Universitaire Dijon, Dijon, France.,Génétique des Anomalies du Développement, Université de Bourgogne, Dijon, France
| | - D Lehalle
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), Centre Hospitalier Universitaire Dijon, Dijon, France.,Génétique des Anomalies du Développement, Université de Bourgogne, Dijon, France.,Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Inter-région Est, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - C Bensignor
- Service de Pédiatrie, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - F Huet
- Service de Pédiatrie, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - J Borgnon
- Chirurgie Pédiatrique, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - F Roucher
- Endocrinologie Moléculaire et Maladies Rares, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Bron, France
| | - P Kuentz
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), Centre Hospitalier Universitaire Dijon, Dijon, France.,Génétique des Anomalies du Développement, Université de Bourgogne, Dijon, France
| | - J-F Deleuze
- CEA/Institut de Génomique, Centre National de Génotypage, Evry, France
| | - C Thauvin-Robinet
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), Centre Hospitalier Universitaire Dijon, Dijon, France.,Génétique des Anomalies du Développement, Université de Bourgogne, Dijon, France.,Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Inter-région Est, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - L Faivre
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), Centre Hospitalier Universitaire Dijon, Dijon, France.,Génétique des Anomalies du Développement, Université de Bourgogne, Dijon, France.,Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Inter-région Est, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - J Thevenon
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), Centre Hospitalier Universitaire Dijon, Dijon, France.,Génétique des Anomalies du Développement, Université de Bourgogne, Dijon, France.,Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Inter-région Est, Centre Hospitalier Universitaire Dijon, Dijon, France
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5
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Kayserili H, Altunoglu U, Yesil G, Rosti RÖ. Microcephaly, dysmorphic features, corneal dystrophy, hairy nipples, underdeveloped labioscrotal folds, and small cerebellum in four patients. Am J Med Genet A 2016; 170:1391-9. [PMID: 27075597 DOI: 10.1002/ajmg.a.37652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/30/2016] [Indexed: 11/08/2022]
Abstract
Pontocerebellar hypoplasia (PCH) can occur as an isolated entity or part of a syndrome. PCH has been reported with facial dysmorphism, ocular anomalies, and genital anomalies, but the co-occurrence of all four has not been previously described. We report on four patients, born to two consanguineous families that are not related to one another, with distinctive facial features (short forehead, laterally extended, medially flared eyebrows), corneal dystrophy, underdevelopment of labioscrotal folds, and nonprogressive PCH. In addition, the patients show hair extruding from the lactiferous ducts, which to our knowledge has not been described before. The parental consanguinity, affected siblings of both genders, and absent manifestations in parents, indicate an autosomal recessive pattern of inheritance as most likely. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hülya Kayserili
- Department of Medical Genetics, Koç University, School of Medicine (KUSoM), Istanbul, Turkey.,Department of Medical Genetics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Umut Altunoglu
- Department of Medical Genetics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Gozde Yesil
- Department of Genetics, Bezmialem Vakıf University, School of Medicine, Istanbul, Turkey
| | - Rasim Özgür Rosti
- Department of Medical Genetics, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.,Department of Neurosciences, Laboratory for Pediatric Brain Diseases, University of California San Diego, La Jolla, California
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6
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Corona-Rivera JR, Acosta-León J, León-Hernández MÁ, Martínez-Macías FJ, Bobadilla-Morales L, Corona-Rivera A. Co-occurrence of hemiscrotal agenesis with cutis marmorata telangiectatica congenita and hydronephrosis affecting the same side of the body. Am J Med Genet A 2013; 164A:199-203. [PMID: 24243754 DOI: 10.1002/ajmg.a.36210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/29/2013] [Indexed: 11/09/2022]
Abstract
To our knowledge, there are nine previous reports of patients with congenital scrotal agenesis (CSA), seven of which were bilateral, and unilateral in two, also named as hemiscrotal agenesis (HSA). Here, we report a male infant with the previously undescribed co-occurrence of HSA with cutis marmorata telangiectatica congenita (CMTC), and hydronephrosis due to vesicoureteral reflux, all of them on the left side. CMTC is a segmental vascular malformation usually attributed to mosaicism of a postzygotic mutation, whereas the mechanisms in the CSA involve a failure on the labioscrotal fold (LSF) development due to a localized 5α-reductase deficiency and/or androgen insensitivity. Since the skin with HSA was affected also by CMTC and by the fact that it exhibited lack of response to the topical testosterone treatment, all this suggests to us an androgen insensitivity mosaicism in our patient restricted to the left LSF, because skin with intact androgen receptors normally shows some type of response. Since CSA and/or HSA have been also seen in patients with PHACES, popitleal pterygium syndrome, or as part of a recently proposed familial entity with CSA (or agenesis of labia majora as its female counterpart), developmental delay, visual impairment, and moderate hearing loss, further reports could confirm this manifest genetic heterogeneity, highly evocative of somatic mosaicism in our patient.
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Affiliation(s)
- Jorge Román Corona-Rivera
- Servicio de Genética, División de Pediatría, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, Mexico; Instituto de Genética Humana "Dr. Enrique Corona-Rivera", Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
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7
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Silay MS, Yesil G, Yildiz K, Kilincaslan H, Ozgen IT, Armagan A. Congenital Agenesis of Scrotum and Labia Majora in Siblings. Urology 2013; 81:421-3. [DOI: 10.1016/j.urology.2012.10.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 10/01/2012] [Accepted: 10/12/2012] [Indexed: 12/21/2022]
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8
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Yilmaz E, Afşarlar CE, Karaman I, Özgüner IF, Karaman A, Hızli F. Congenital hemiscrotal agenesis: report of a rare entity. J Pediatr Urol 2013; 9:e76-7. [PMID: 23044375 DOI: 10.1016/j.jpurol.2012.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 09/13/2012] [Indexed: 02/07/2023]
Abstract
Congenital scrotal agenesis is the rarest anomaly of scrotal development disorder and is characterized by the absence of scrotal rugae in the perineum between the penis and anus. We report here a case of hemiscrotal agenesis in a 2-year-old boy. To the best of our knowledge, our patient is the second reported case of hemiscrotal agenesis in the English literature.
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Affiliation(s)
- Engin Yilmaz
- Bakirköy Dr. Sadi Konuk Training and Research Hospital, Department of Pediatric Surgery, İstanbul, Turkey
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9
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Flum AS, Chaviano AH, Kaplan WE. Hemiscrotal agenesis: new variation in a rare anomaly. Urology 2011; 79:210-1. [PMID: 21820704 DOI: 10.1016/j.urology.2011.05.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 05/14/2011] [Accepted: 05/21/2011] [Indexed: 02/07/2023]
Abstract
Scrotal agenesis is a rarely encountered developmental anomaly of the scrotum, with only 6 cases of complete agenesis reported in published studies. We report, to our knowledge, the first case of hemiscrotal agenesis. The specific embryologic basis of scrotal agenesis is unknown but is likely multifactorial, involving localized androgen insensitivity, localized 5α-reductase deficiency, and/or failure of labioscrotal fold formation.
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Affiliation(s)
- Andrew S Flum
- Division of Pediatric Urology, Children's Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, Illinois 60614-3363, USA
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10
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Mohan PP, Woodward MN, Chandran H, Parashar K. Topical testosterone in scrotal agenesis. Pediatr Surg Int 2006; 22:565-6. [PMID: 16518594 DOI: 10.1007/s00383-006-1659-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2006] [Indexed: 02/07/2023]
Affiliation(s)
- P P Mohan
- Department of Paediatric Surgery, Birmingham Children's Hospital., 73 City View, Erdington, B23 6GP, Birmingham, UK.
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11
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Janoff DM, Skoog SJ. CONGENITAL SCROTAL AGENESIS: DESCRIPTION OF A RARE ANOMALY AND MANAGEMENT STRATEGIES. J Urol 2005; 173:589-91. [PMID: 15643265 DOI: 10.1097/01.ju.0000151136.56430.53] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel M Janoff
- Division of Urology, Department of Surgery, Oregon Health and Sciences University, Portland, Oregon 97239-3098, USA
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