Transposition of external genitalia and associated malformations

An epidemiologic study of penoscrotal transposition by maternal characteristics using data from the Texas birth defects registry

BACKGROUND

Penoscrotal transposition (PST) is an uncommon urogenital malformation in which the penis is mal-positioned to be inferior to the scrotum. The purpose of this study was to explore PST risk by maternal characteristics and to describe co-occurring congenital abnormalities in the Texas Birth Defects Registry (TBDR).

METHODS

We conducted a population-based descriptive study examining occurrence of PST in the TBDR between 1999 and 2019. The primary outcome variable was PST diagnosis during infancy. Descriptive variables included maternal age, education, and race/ethnicity. Prevalence ratios (PRs) were calculated within each maternal variable category using Poisson regression. Counts and percentages of cases with select co-occurring congenital abnormalities were also calculated.

RESULTS

Overall, 251 infants had PST, providing a prevalence of 0.61/10,000 live male births (95% CI: 0.53-0.68). PST prevalence was significantly lower among infants of mothers who had lower educational attainment (high school), who were younger (<25 vs. 25-34), and who were Hispanic (vs. non-Hispanic White) and was significantly higher among older mothers (35+ vs. 25-39). Hypospadias was the most common co-occurring genitourinary anomaly, affecting close to 70% of cases.

CONCLUSIONS

To our knowledge, this is the first investigation exploring the prevalence of PST in a population-based birth defects registry. Our findings help to understand the risk for PST among select maternal demographic characteristics and may assist in generating hypotheses about the underlying etiology of this condition for future work.

Prenatal diagnosis of complete penoscrotal transposition with normal scrotum: Two case reports and review of the literature

Complete penoscrotal transposition is an extremely rare congenital anomaly and is usually associated with other urinary system abnormalities. Prenatal diagnosis is feasible by demonstrating perineal anatomy and its relation with scrotum and phallus. We describe two prenatal cases presenting with oligohydramniosis and megacystis due to lower urinary tract obstruction. Postnatal diagnosis was confirmed in both cases. Considering the dismal perinatal outcome, an accurate prenatal diagnosis is required for counseling the parents and preparing for postnatal care.

Spectrum of penoscrotal positional anomalies in children

BACKGROUND

The normal relationship between the scrotum and penis during fetal development is controlled by several genetic and hormonal factors, and impairment of this positional relation results in a wide spectrum of positional congenital anomalies.

OBJECTIVE

This a cohort study analysing 63 cases of penoscrotal anomalies (PSAs) according to severity and other associated malformations to provide a simple classification for recognising, describing and categorizing cases that may require surgical correction.

DESIGN AND SETTING

Between 2005 and 2013, 63 diverse cases of penoscrotal positional anomaly were detected and analysed based on their hormonal profile and other associated anomaly.

RESULTS

A wide variety of PSAs were included in the study, 11 cases were of major PST with complete penoscrotal transposition in three, incomplete in eight, and minor degree in 45 cases, which are symmetrical (bilateral) in 29, sixteen are asymmetrical, 4 had midline scrotlisation, and 3 had wide penoscrotal distance. Associated genitourinary anomalies were detected in 29 babies. Sex hormonal assays showed no significant differences between the PSA patients and controls (P < .05), and no gross chromosomal anomalies were detected in any cases.

CONCLUSION

Penoscrotal positional anomalies include the previously described penoscrotal transposition, and the variants of a central penile scrotalisation, and wide penoscrotal distance. A simple classification for these anomalies adopted herein.

Prenatal diagnosis of penoscrotal transposition with 2- and 3-dimensional ultrasonography

OBJECTIVES

The purpose of this study was to determine the prenatal diagnostic accuracy of 2-dimensional ultrasonography (2DUS) alone versus 2DUS in combination with 3-dimensional ultrasonography (3DUS) for penoscrotal transposition.

METHODS

Fetuses suspected of having penoscrotal transposition on the basis of ultrasonographic findings or a family history were examined by 2DUS and then 3DUS.

RESULTS

Of a total of 22 fetuses, 14 had penoscrotal transposition at birth. The combination of 2DUS and 3DUS correctly identified more of the penoscrotal transposition cases than 2DUS alone (90.9% versus 63.6%; P < .05).

CONCLUSIONS

The combination of 2DUS and 3DUS improved the prenatal detection rate for penoscrotal transposition compared with 2DUS alone.