Split median raphe: a cause of concern?

[Abnormalities of the male median raphe]

INTRODUCTION

Abnormalities of the male median raphe can either be detected during postnatal examination or appear later during childhood or adulthood. They can be isolated or sometimes associated with severe congenital genitourinary malformations.

METHODS

A literature review was performed on the Medline database, considering the articles listed until April 2015 dealing with abnormalities of the male median raphe using the following keywords: male, median raphe and abnormalities. Papers were selected according to their language (English and French) and their relevance.

RESULTS

Forty-one articles related to male median raphe abnormalities were listed. Five of them were selected for their relevance. We describe frequent median raphe abnormalities (hyperpigmentation, deviation, division, cyst, canal and sinus), emphasizing the clinical aspects, the explorations, the risk of associated genitourinary abnormalities and the treatment.

DISCUSSION

Male raphe abnormalities should be known by the urologists since functional, infectious and aesthetic complications could lead patients to consultation.

Split median raphe: case series and brief literature review

We describe three cases of split median raphe of the penis (SMR) from our hospital newborn records from 2004 to 2013. One case was associated with median raphe cyst, one with skin hypochromia, and one with a scar-like aspect of the region of interest. SMR is thought to be the result of defective fusion of ectodermal tissue in the urethra and scrotum area or of defective growth of the perineal mesoderm around the urethra during gestation. Although SMR associated with other major penile congenital defects (epispadias, hypospadias, penile torsion, bifid scrotum, chordee) is common, isolated SMR is probably an underdiagnosed (although not rare) malformative condition. Recognizing SMR in a newborn may be of educational value to neonatologists because it leads to the search for and exclusion of the above-mentioned pathologic conditions.