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Armstrong CL, Baird AN. Abnormalities of the Scrotum and Testes. Vet Clin North Am Food Anim Pract 2024; 40:69-79. [PMID: 38105174 DOI: 10.1016/j.cvfa.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Abnormalities of the bovine scrotum and testes are an important cause of infertility. Proper evaluation of the male reproductive system is a critical first step in screening for such abnormalities. Excessive periscrotal fat, cutaneous scrotal defects, and unilateral scrotal swelling are common deformities that warrant further investigation. Early diagnosis and surgical intervention are often needed to restore reproductive soundness. This article reviews these conditions and provides therapeutic modalities.
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Affiliation(s)
- Chance L Armstrong
- Auburn University College of Veterinary Medicine, 1500 Wire Road, Auburn, AL 36849, USA.
| | - Aubrey N Baird
- Auburn University College of Veterinary Medicine, 1500 Wire Road, Auburn, AL 36849, USA
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2
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Allred RP, Nguyen J, Agopian AJ, Canfield MA, Shumate CJ. An epidemiologic study of penoscrotal transposition by maternal characteristics using data from the Texas birth defects registry. Birth Defects Res 2024; 116:e2270. [PMID: 37929661 DOI: 10.1002/bdr2.2270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/05/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
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.
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Affiliation(s)
- Rachel P Allred
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Joanne Nguyen
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - A J Agopian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, USA
| | - Mark A Canfield
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, USA
| | - Charles J Shumate
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
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3
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Wang H, Tang D, Yan X. Unilateral Suprainguinal Ectopic Scrotum: Case Report and Literature Review. Urol Int 2023; 107:539-542. [PMID: 37015202 PMCID: PMC10871678 DOI: 10.1159/000529809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/06/2023] [Indexed: 04/06/2023]
Abstract
Ectopic scrotum is an infrequent congenital scrotal anomaly. Different surgical methods of correcting ectopic scrotum have been used, but none have produced optimal cosmetic results for all types. We describe a case of left ectopic suprainguinal scrotum in a 14-month-old boy who had an undescended left testicle and a left-sided scrotal skin tag. Single-stage rotational flap scrotoplasty and unilateral orchiopexy were performed; however, we modified the surgical technique of scrotal rotation by excising the intervening longitudinal skin. Eight months after surgery, the repositioned scrotum had a better appearance, and the affected testicle was similar in size to the contralateral one. In comparison with other surgical methods, pedicle flap rotation of the ectopic scrotal skin with excision of the intervening longitudinal skin may produce a better cosmetic outcome.
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Affiliation(s)
- Hengyou Wang
- Department of Urology, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, The Children's Hospital, Hangzhou, China,
| | - Daxing Tang
- Department of Urology, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, The Children's Hospital, Hangzhou, China
| | - Xiang Yan
- Department of Urology, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, The Children's Hospital, Hangzhou, China
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4
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吴 永, 胡 杨, 王 寿, 徐 波, 徐 延, 陈 海. [Effectiveness of penis up transfer method for penoscrotal transposition in children]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2022; 36:776-780. [PMID: 35712938 PMCID: PMC9240851 DOI: 10.7507/1002-1892.202201010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the effectiveness of penile up transfer method in the treatment of penoscrotal transposition (PST) in children. METHODS A clinical data of 46 children with PST admitted between January 2015 and March 2021 and met selective criteria was retrospectively analyzed. The M-shaped scrotal flap method was adopted in 21 cases (group A), and the penile up transfer method was adopted in 25 cases (group B). There was no significant difference in age and PST typing between the two groups ( t=0.491, P=0.626; χ 2=0.710, P=0.790). The operation time and postoperative complications of the two groups were recorded and compared, and the correction effect of PST was evaluated. RESULTS All operations were successfully completed, and no urethral injury occurred during operation. The operation time was significantly less in group B than in group A [(70.36±9.76) minutes vs. (96.62±13.18) minutes; t=7.553, P=0.000]. All children were followed up 6-33 months (mean, 13.2 months). There were 5 cases (23.8%) of skin necrosis and 6 cases (28.6%) of scar hyperplasia in group A, and 1 case (4.0%) of skin necrosis and 1 case (4.0%) of scar hyperplasia in group B. The incidence of complication was significantly lower in group B than in group A ( χ 2=3.949, P=0.047; χ 2=5.341, P=0.021). In the evaluation of PST correction at 6 months after operation, there were 15 cases of complete correction and 6 cases of incomplete correction in group A, 24 cases of complete correction and 1 case of incomplete correction in group B, and the difference was significant ( χ 2=5.341, P=0.021). CONCLUSION The penis up transfer method is not only easy to correct PST, but also can correct scrotal separation at the same time, with fewer postoperative complications and satisfactory correction effect of penile scrotal appearance.
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Affiliation(s)
- 永隆 吴
- 厦门大学附属妇女儿童医院(厦门市妇幼保健院)小儿外科(福建厦门 361003)Department of Pediatric Surgery, Affiliated Women and Children’s Hospital, Xiamen University, Xiamen Fujian, 361003, P. R. China
| | - 杨 胡
- 厦门大学附属妇女儿童医院(厦门市妇幼保健院)小儿外科(福建厦门 361003)Department of Pediatric Surgery, Affiliated Women and Children’s Hospital, Xiamen University, Xiamen Fujian, 361003, P. R. China
| | - 寿福 王
- 厦门大学附属妇女儿童医院(厦门市妇幼保健院)小儿外科(福建厦门 361003)Department of Pediatric Surgery, Affiliated Women and Children’s Hospital, Xiamen University, Xiamen Fujian, 361003, P. R. China
| | - 波 徐
- 厦门大学附属妇女儿童医院(厦门市妇幼保健院)小儿外科(福建厦门 361003)Department of Pediatric Surgery, Affiliated Women and Children’s Hospital, Xiamen University, Xiamen Fujian, 361003, P. R. China
| | - 延波 徐
- 厦门大学附属妇女儿童医院(厦门市妇幼保健院)小儿外科(福建厦门 361003)Department of Pediatric Surgery, Affiliated Women and Children’s Hospital, Xiamen University, Xiamen Fujian, 361003, P. R. China
| | - 海琛 陈
- 厦门大学附属妇女儿童医院(厦门市妇幼保健院)小儿外科(福建厦门 361003)Department of Pediatric Surgery, Affiliated Women and Children’s Hospital, Xiamen University, Xiamen Fujian, 361003, P. R. China
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Omil-Lima D, Gupta K, Prunty M, Miyasaka EA, Joyce EL, Nguyen C, Hannick JH. Bladder Agenesis and Bilateral Ectopic Ureters in an Infant Male With Cystic Renal Dysplasia, Imperforate Anus, and Penoscrotal Transposition. Urology 2021; 156:256-259. [PMID: 33689765 DOI: 10.1016/j.urology.2021.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/11/2021] [Accepted: 02/28/2021] [Indexed: 11/19/2022]
Abstract
Bladder agenesis is a rare congenital anomaly infrequently reported in the literature, with an incidence of 1/600,000 patients.1 Commonly associated with other fatal malformations, the condition is often incompatible with life.2 Prior reports estimate that over 90% of living children born with this malformation are female, owing to renal preservation resulting from low pressure drainage of urine into the vagina, uterus, and vestibule.3,4 Herein we report a rare case of an infant male born with penoscrotal transposition and end stage renal disease secondary to bilateral cystic renal dysplasia found to have concurrent bladder agenesis and bilateral ureteral ectopia.
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Affiliation(s)
- Danly Omil-Lima
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Pediatric Urology, University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Karishma Gupta
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Pediatric Urology, University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Megan Prunty
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Pediatric Urology, University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Eiichi A Miyasaka
- Division of Pediatric Surgery, University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Emily L Joyce
- Division of Pediatric Nephrology, University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Christina Nguyen
- Division of Pediatric Nephrology, University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Jessica H Hannick
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Pediatric Urology, University Hospitals, Rainbow Babies & Children's Hospital, Cleveland, OH.
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Kurt D, Sivrikoz TS, Kalelioğlu Hİ, Has R, Ziylan HO, Yüksel A. Prenatal diagnosis of complete penoscrotal transposition with normal scrotum: Two case reports and review of the literature. J Clin Ultrasound 2020; 48:350-356. [PMID: 32319694 DOI: 10.1002/jcu.22834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- Didar Kurt
- Perinatology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | | | | | - Recep Has
- Perinatology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Hasan Orhan Ziylan
- Pediatric Urology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Atıl Yüksel
- Perinatology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
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Kim BR, Han JH, Shin JE, Park MS, Park KI, Namgung R, Lee HJ, Lee JS, Eun HS. Genitopatellar Syndrome Secondary to De Novo KAT6B Mutation: The First Genetically Confirmed Case in South Korea. Yonsei Med J 2019; 60:395-398. [PMID: 30900427 PMCID: PMC6433568 DOI: 10.3349/ymj.2019.60.4.395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 01/13/2023] Open
Abstract
Genitopatellar syndrome (GPS) is a rare disorder characterized by patellar hypoplasia, flexion contractures of the lower limbs, psychomotor retardation and genital and renal anomalies. We report the case of a female infant diagnosed with GPS to a KAT6B gene mutation, which was identified using whole exome sequencing.
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Affiliation(s)
- Byuh Ree Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Ho Han
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Eun Shin
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Park
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kook In Park
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ran Namgung
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Joo Lee
- Division of Clinical Genetics, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sung Lee
- Division of Clinical Genetics, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Sun Eun
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
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8
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Lee KY, Chao HC, Ho SW. Young Boy with Scrotal Pain. J Emerg Med 2018; 55:561-562. [PMID: 30149999 DOI: 10.1016/j.jemermed.2018.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/06/2018] [Accepted: 07/11/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Kun-Yu Lee
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Emergency Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hao-Chien Chao
- Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Sai-Wai Ho
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Emergency Medicine, Chung Shan Medical University, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Adekanye AO, Adefemi SA, Onawola KA, James JA, Adeleke IT, Francis M, Sheshi EU, Atakere ME, Jibril AD. Abnormalities of the external genitalia and groins among primary school boys in Bida, Nigeria. Afr Health Sci 2017; 17:1120-1125. [PMID: 29937883 PMCID: PMC5870298 DOI: 10.4314/ahs.v17i4.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Abnormalities of the male external genitalia and groin, a set of lesions which may be congenital or acquired, are rather obscured to many kids and their parents and Nigerian health care system has no formal program to detect them. Objectives To identify and determine the prevalence of abnormalities of external genitalia and groin among primary school boys in Bida, Nigeria. Methods This was a cross-sectional study of primary school male pupils in Bida. A detailed clinical examination of the external genitalia and groin was performed on them. Results Abnormalities were detected in 240 (36.20%) of the 663 boys, with 35 (5.28%) having more than one abnormality. The three most prevalent abnormalities were penile chordee (37, 5.58%), excessive removal of penile skin (37, 5.58%) and retractile testis (34, 5.13%). The prevalence of complications of circumcision was 15.40% and included excessive residual foreskin, excessive removal of skin, skin bridges and meatal stenosis. Undescended testes were seen in 6 (0.90%) boys, with median age of 9 years and 2 were bilateral. Also, micropenis was detected in 27 (4.07%) of the pupils. Conclusion Inguino-penoscrotal abnormalities are common in our community (36.20%). Screening of pre-school and school children to detect them should be introduced into the school health programs in Nigeria.
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Affiliation(s)
- Adedeji O Adekanye
- Centre for Health & Allied Researches (CHAR), Federal Medical Centre Bida, Nigeria
- Department of Surgery, Federal Medical centre, Bida Nigeria
| | - Samuel A Adefemi
- Centre for Health & Allied Researches (CHAR), Federal Medical Centre Bida, Nigeria
- Department of Family Medicine, Federal Medical centre, Bida Nigeria
| | - Kayode A Onawola
- Centre for Health & Allied Researches (CHAR), Federal Medical Centre Bida, Nigeria
- Department of Surgery, Federal Medical centre, Bida Nigeria
| | - John A James
- Centre for Health & Allied Researches (CHAR), Federal Medical Centre Bida, Nigeria
- Department of Surgery, Federal Medical centre, Bida Nigeria
| | - Ibrahim T Adeleke
- Centre for Health & Allied Researches (CHAR), Federal Medical Centre Bida, Nigeria
- Department of Health Information management, Federal Medical centre, Bida Nigeria
| | - Mark Francis
- Centre for Health & Allied Researches (CHAR), Federal Medical Centre Bida, Nigeria
- Department of Surgery, Federal Medical centre, Bida Nigeria
| | - Ezekiel U Sheshi
- Centre for Health & Allied Researches (CHAR), Federal Medical Centre Bida, Nigeria
- Department of Family Medicine, Federal Medical centre, Bida Nigeria
| | - Moses E Atakere
- Centre for Health & Allied Researches (CHAR), Federal Medical Centre Bida, Nigeria
- Department of Obstetrics & Gynaecology, Federal Medical centre, Bida Nigeria
| | - Abdullahi D Jibril
- Centre for Health & Allied Researches (CHAR), Federal Medical Centre Bida, Nigeria
- Department of Obstetrics & Gynaecology, Federal Medical centre, Bida Nigeria
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Abstract
In this pictorial essay the authors review the normal sonographic gray-scale and Doppler appearance of the pediatric scrotum with an emphasis on technique. The authors present an update on ultrasound diagnosis and outcomes in testicular torsion and differentiation from other acute scrotal processes, as well as sonographic imaging of testicular microlithiasis and uncommon or atypical scrotal masses including splenogonadal fusion, polyorchidism, meconium peritonitis and epidermoid cyst. Further, the authors discuss testicular neoplasms in the context of testicular microlithiasis.
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Affiliation(s)
- Noor A Alkhori
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital at Stanford, 725 Welch Road, Room 1890, Stanford, CA, 94304-5913, USA
| | - Richard A Barth
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital at Stanford, 725 Welch Road, Room 1890, Stanford, CA, 94304-5913, USA.
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Swartz JM, Ciarlo R, Denhoff E, Abrha A, Diamond DA, Hirschhorn JN, Chan YM. Variation in the clinical and genetic evaluation of undervirilized boys with bifid scrotum and hypospadias. J Pediatr Urol 2017; 13:293.e1-293.e6. [PMID: 28215832 PMCID: PMC5483185 DOI: 10.1016/j.jpurol.2017.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 01/04/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Bifid scrotum and hypospadias can be signs of undervirilization, yet boys presenting with these findings often do not undergo genetic evaluation. In some cases, identifying an underlying genetic diagnosis can help to optimize clinical care and improve guidance given to patients and families. OBJECTIVES The aim of this study was to characterize current practice for genetic evaluation of patients with bifid scrotum, and to identify approaches with a good diagnostic yield. METHODS A retrospective study of the Boston Children's Hospital electronic medical records (1993-2015) was conducted using the search term "bifid scrotum" and clinical data were extracted. Data were abstracted into a REDCap database for analysis. Statistical analysis was performed using SPSS, SAS, and Excel software. RESULTS The search identified 110 subjects evaluated in the Urology and/or Endocrinology clinics for bifid scrotum. Genetic testing (including karyotype, microarray, or targeted testing) was performed on 64% of the subjects with bifid scrotum; of those tested, 23% (15% of the total cohort of 110 subjects) received a confirmed genetic diagnosis. Karyotype analysis, when performed, led to a diagnosis in 17% of patients. Of the ten instances when androgen receptor gene sequencing was performed, a pathogenic mutation was identified 20% of the time. CONCLUSION This study demonstrated that the majority of individuals with moderate undervirilization resulting in bifid scrotum do not receive a genetic diagnosis. Over a third of the analyzed subjects did not have any genetic testing, even though karyotype analysis and androgen receptor (AR) sequencing were both relatively high yield for identifying a genetic etiology. Increased utilization of traditional genetic approaches could significantly improve the ability to find a genetic diagnosis.
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Affiliation(s)
- J M Swartz
- Department of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
| | - R Ciarlo
- Department of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - E Denhoff
- Clinical Research Center, Boston Children's Hospital, Boston, MA, USA
| | - A Abrha
- Department of Endocrinology, Boston Children's Hospital, Boston, MA, USA
| | - D A Diamond
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - J N Hirschhorn
- Department of Endocrinology, Boston Children's Hospital, Boston, MA, USA; Program in Medical and Population Genetics, Cambridge, MA, USA
| | - Y-M Chan
- Department of Endocrinology, Boston Children's Hospital, Boston, MA, USA
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12
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Tang Y, Li Y, Yang Z, Zhao M, Ma N, Wang W, Feng Z, Xu L, Ma T. [Plasty method for penoscrotal transposition]. Zhonghua Zheng Xing Wai Ke Za Zhi 2016; 32:351-353. [PMID: 30066992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the plasty method for penoscrotal transposition and its efficacy. METHODS The adhesion between penis tunica albuginea and scrotum sheath capsule was separated to return the testis and their sheath capsule to the abdomen side of penis. Also, the scrotum skin was also transferred to the abdomen side of penis. The normal anatomic position of penis and scrotum was returned. RESULTS Between Jan 2004 to Oct 2015,34 cases were treated.5 scrotum fascia skin flaps underwent ischemia at the flap tip with delayed healing. All the other flaps survived with primary healing and good appearance. CONCLUSIONS Adhesion between penis tunica albuginea and scrotum sheath capsule should be separated to return the testis and their sheath capsule, as well as scrotum skin to the abdomen side of penis. It' s an optional method for penoscrotal transposition.
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13
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Loynachan AT, Jackson CB, Harrison LR. Complete Diphallia, Imperforate Ani (Type 2 Atresia Ani), and an Accessory Scrotum in a 5-Day-Old Calf. J Vet Diagn Invest 2016; 18:408-12. [PMID: 16921886 DOI: 10.1177/104063870601800418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 5-day-old Angus calf was submitted to the necropsy service at the University of Kentucky Livestock Disease Diagnostic Center. At birth, the calf was noted to have 2 scrota. Five days post-calving the calf developed severe tenesmus and an umbilical infection. Clinical examination revealed atresia ani. At necropsy, complete diphallus, imperforate ani (type 2 atresia ani), and remnants of 2 scrota were identified. This report describes the gross pathologic appearance of a rare case of complete diphallia, imperforate ani (type 2 atresia ani), and an accessory scrotum in a 5-day-old calf.
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Affiliation(s)
- Alan T Loynachan
- University of Kentucky Livestock Disease Diagnostic Center, College of Agriculture, Lexington, KY 40511-4125, USA.
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Barrett ES, Parlett LE, Sathyanarayana S, Redmon JB, Nguyen RHN, Swan SH. Prenatal Stress as a Modifier of Associations between Phthalate Exposure and Reproductive Development: results from a Multicentre Pregnancy Cohort Study. Paediatr Perinat Epidemiol 2016; 30:105-14. [PMID: 26576028 PMCID: PMC4749428 DOI: 10.1111/ppe.12264] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prenatal phthalate exposure is associated with altered male reproductive tract development, and in particular, shorter anogenital distance (AGD). AGD, a sexually dimorphic index of prenatal androgen exposure, may also be altered by prenatal stress. How these exposures interact to impact AGD is unknown. Here, we examine the extent to which associations between prenatal phthalate exposure and infant AGD are modified by prenatal exposure to stressful life events (SLEs). METHODS Phthalate metabolites [including those of diethylhexyl phthalate (DEHP) and their molar sum (ΣDEHP)] were measured in first trimester urine from 738 pregnant women participating in The Infant Development and the Environment Study (TIDES). Women completed questionnaires on SLEs, and permitted infant AGD measurements at birth. Subjects were classified as 'lower' and 'higher' stress (0 first trimester SLEs vs. 1+).We estimated relationships between phthalate concentrations and AGD (by infant sex and stress group) using adjusted multiple regression interaction models. RESULTS In the lower stress group, first trimester ΣDEHP was inversely associated with two measures of male AGD: anoscrotal distance (AGD-AS; β = -1.78; 95% CI -2.97, -0.59) and anopenile distance (AGD-AP; β = -1.61; 95% CI -3.01, -0.22). By contrast, associations in the higher stress group were mostly positive and non-significant in male infants. No associations were observed in girls. CONCLUSIONS Associations between prenatal phthalate exposure and altered genital development were only apparent in sons of mothers who reported no SLEs during pregnancy. Prenatal stress and phthalates may interact to shape fetal development in ways that have not been previously explored.
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Affiliation(s)
- Emily S. Barrett
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Lauren E. Parlett
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21215, USA
| | - Sheela Sathyanarayana
- Departments of Pediatrics and Environmental and Occupational Health Sciences, University of Washington, Seattle, WA; Seattle Children’s Research Institute, Seattle, WA
| | - J. Bruce Redmon
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Ruby H. N. Nguyen
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Shanna H. Swan
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Abstract
We present the case of an infant born with scrotoschisis and evidence of meconium periorchitis and peritonitis. A scrotal defect was noted with exposure of the left testis and spermatic cord. Meconium peritonitis and periorchitis were confirmed on operative exploration. Given the history, cystic fibrosis was suspected, but initial screening and diagnostic tests were negative.
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Affiliation(s)
- S E Schaffer DeRoo
- Department of Pediatrics, Division of Neonatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - K M Lumpkins
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - D E El-Metwally
- Department of Pediatrics, Division of Neonatology, University of Maryland School of Medicine, Baltimore, MD, USA
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16
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Wang Z, Yao HJ, Zheng DC, Li WJ. [Surgical repair and reconstruction of male external genitals]. Zhonghua Nan Ke Xue 2015; 21:579-586. [PMID: 26333217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
One of the challenges in andrology nowadays is the diagnosis and treatment of external genital abnormalities and defects along with the consequent voiding, sexual, and reproductive dysfunctions, for which no guidelines are yet available. Hitherto, surgical repair and reconstruction are efficient for these diseases. The key to these operations is to individualize surgical strategies according to the specific local lesion and dysfunction, usually involving flap and graft techniques. This article presents our experience in the surgical treatment of penile and scrotal abnormalities and defects with urological and andrological techniques and microsurgical strategies, focusing on the external repair and functional reconstruction. Satisfactory treatment outcomes pivot on a precise evaluation of the disease, a rational design of surgical procedures, and an earnest communication with the patient. Some cases are rather complicated and challenging, usually with complications, and therefore deserve further researches for more effective treatment strategies in clinical practice.
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Bresciani C, Parma P, De Lorenzi L, Bigliardi E, Cantoni AM, Morini G, Parmigiani E. A very rare clinical case of a holstein heifer with two vulvae and a scrotum. Sex Dev 2015; 9:105-10. [PMID: 25765525 DOI: 10.1159/000375457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2014] [Indexed: 11/19/2022] Open
Abstract
The physical and gynecological examination of a Holstein heifer single-born with a disorder of sexual development showed anatomical abnormalities such as the presence of a scrotum and 2 vulvae and an anal sphincter that was positioned on the right side of the body. Also, an early pregnancy was diagnosed. Cytogenetic and hormone analysis was requested, and the animal showed normal female metaphases (60,XX) and hormonal profiles. However, in gross anatomy and histological examinations, a structure compatible with a penis, the absence of a uterine body, 2 exophytic structures, and a septum in the vagina were detected.
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18
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Abstract
In this pictorial essay, we review and discuss the varying morphologic characteristics of scrotal appendages and calculi. Characteristic sonograms obtained from patients with coexisting hydrocele are presented, and recent literature is included. Hydrocele greatly facilitates the imaging of these intrascrotal structures, as it acts as a "water path". On the one hand, torsion of a scrotal appendage should always be included in the differential diagnosis of acute scrotum, especially in children. On the other hand, scrotolithiasis may occasionally cause mild discomfort. As a consequence, and given the widespread use of sonography for the evaluation of both acute and chronic conditions of the scrotum, radiologists should be familiar with these entities.
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Affiliation(s)
- Vasileios Rafailidis
- Postgraduate Program in Medical Research Methodology, Aristotle University of Thessaloniki, Thessaloniki, Greece (V.R.); and Department of Radiology, G. Gennimatas General Hospital, Thessaloniki, Greece (D.A., A.C., D.R.).
| | - Dimitrios Apostolou
- Postgraduate Program in Medical Research Methodology, Aristotle University of Thessaloniki, Thessaloniki, Greece (V.R.); and Department of Radiology, G. Gennimatas General Hospital, Thessaloniki, Greece (D.A., A.C., D.R.)
| | - Anna Charsoula
- Postgraduate Program in Medical Research Methodology, Aristotle University of Thessaloniki, Thessaloniki, Greece (V.R.); and Department of Radiology, G. Gennimatas General Hospital, Thessaloniki, Greece (D.A., A.C., D.R.)
| | - Dimitrios Rafailidis
- Postgraduate Program in Medical Research Methodology, Aristotle University of Thessaloniki, Thessaloniki, Greece (V.R.); and Department of Radiology, G. Gennimatas General Hospital, Thessaloniki, Greece (D.A., A.C., D.R.)
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19
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Affiliation(s)
- Naoki Kuninaga
- Department of General Medicine, Kurashiki Central Hospital, Japan
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20
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Abstract
OBJECTIVE Penoscrotal webbing (PSW) is a common reason for deferral of neonatal circumcision. Reports of successful procedures and outcomes in the literature are sparse. We have performed double-V scrotoplasty (DVS), a modification of a V-Y technique, in 138 patients with excellent results. PATIENTS AND METHODS We retrospectively reviewed the charts of boys who had undergone DVS for PSW since January 2009 by a single surgeon (S.A.A.). The indications, intraoperative findings, concomitant procedures, outcomes, and complications were recorded. RESULTS A total of 138 DVSs were performed. Concomitant genital surgeries included 81 hidden penis repairs and 10 other (hernia, hypospadias, chordee, orchidopexy). The median age at the time of surgery was 9.6 months (6.1 months-9.8 years). Patients were evaluated about 1 month postoperatively. In seven cases (5%), minor skin separation occurred at the penoscrotal junction but all healed completely. Superficial skin infection occurred in one patient. None required reoperation and cosmetic results were subjectively excellent. CONCLUSIONS PSW has been corrected in 138 patients without significant complications and with excellent results. This is the largest known peer-reviewed series evaluating a surgical technique for congenital PSW repair. We believe our technique is simple, reproducible, and, with no diverging suture lines lateral to the median raphe, improves cosmesis.
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Affiliation(s)
- Daryl J McLeod
- Division of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Seth A Alpert
- Division of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University Medical Center, Columbus, OH, USA
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21
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Fernández Fernández JA, Parodi Hueck L, Carrasco Fermín J. [Exstrophy of rectal duplication associated with anorectal malformation and penoscrotal transposition with perineal hypospadias. A case report]. Invest Clin 2014; 55:168-172. [PMID: 24974632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We present the case of a male patient who required treaatment due to anorectal agenesis with recto urethral fistula and penoscrotal transposition with perineal hypospadias, associated with a perineal tumor. The perineal tumor was found strongly adhered and contiguous to the rectum which makes it compatible with an exstrophy of rectal duplication. Surgical reconstruction of the birth defect was performed in stages until acceptable biological function and esthetic results were obtained.
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22
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Fahmy MAB, El Shennawy AAA, Edress AM. Spectrum of penoscrotal positional anomalies in children. Int J Surg 2014; 12:983-8. [PMID: 25110332 DOI: 10.1016/j.ijsu.2014.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/17/2014] [Accepted: 08/01/2014] [Indexed: 02/05/2023]
Abstract
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.
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Affiliation(s)
- Mohamed A Baky Fahmy
- Al Azher Faculty of Medicine for Girls, Al Azher University, Cairo 12411, Egypt.
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23
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Abstract
OBJECTIVE To evaluate the extent of genital median raphe (GMR) anomalies and their relation to other genitourinary anomalies, as well as the impact on performing ritual circumcision. PATIENTS AND METHODS This prospective study was designed to collect data from neonates coming for ritual circumcision in order to detect any associated congenital anomalies in their genitalia, particularly in the genital raphe. 2880 babies aged from 1 day to 7 weeks were examined, from 2006 to 2011. All doubtful cases were reevaluated and cases with GMR anomalies were investigated for detection of other congenital anomalies and enrolled in the study. RESULTS 57 cases of GMR anomalies were detected with an overall incidence of 2%; 18 of them had hypospadias, 5 had renal anomalies and 3 had limb anomalies. Circumcision was postponed in 37 cases where further investigations were done, but routine circumcision was carried out in the remaining 20. CONCLUSION It is crucial to examine every baby coming for circumcision to detect obvious or hidden congenital genital anomalies. Congenital anomalies of GMR are not so rare as thought, and some of these anomalies may necessitate surgical correction, and are commonly accompanied by urinary tract anomalies.
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24
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Abstract
AIM To document the incidence of complete testicular epididymal dissociation (CTED) in the cryptorchid testis and evaluate its operative outcome. METHODS The presence of CTED was noted prospectively in cases of undescended testis and the operative findings were studied. RESULTS CTED was encountered in 11 testes in 10 boys out of 29 intra-abdominal testes among the 142 undescended testes (8%) operated. Ages of patients varied from 18 months-14 years (median 4.5 years). All 11 testes were intra-abdominal. In 5 out of 11 testes, the dissociation was associated with a wide separation of the epididymis and testis. The dissociated epididymis was in the scrotum attached to the gubernaculum while the testis was intra-abdominal. One case had bilateral CTED. Successful subdartos orchidopexy was done for 8 testes, 6 after Prentiss maneuver. Two gonads were fixed just below the pubic tubercle. Orchiectomy was done in one case with a small sized testis with a short gonadal vessel. CONCLUSION CTED was encountered in 8% of cases of cryptorchidism. A palpable nubbin-like tissue in the scrotal sac in the presence of CTED may suggest a descended dissociated epididymis with an intra-abdominal testis. Successful subdartos orchidopexy was possible in 73% of testes with CTED.
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Affiliation(s)
- Shilpa Sharma
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Dr RML Hospital, New Delhi, India.
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25
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Messina MF, Aversa T, Mamì C, Briuglia S, Panasiti I, De Luca F, Lombardo F. Ambiguous genitalia in a 48, XXYY newborn: a casual relationship or a coincidence? J Pediatr Endocrinol Metab 2013; 26:921-3. [PMID: 23729609 DOI: 10.1515/jpem-2013-0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 04/22/2013] [Indexed: 11/15/2022]
Abstract
48, XXYY is a very rare sex chromosome aneuploidy, characterized by both an extra X and Y chromosome with a prevalence of 1:18,000-1:40,000. Most patients are diagnosed prenatally by cytogenetic examination of amniotic fluid, or during the first years of life because of severe developmental delay, cognitive impairment and behavioural disorders. This syndrome shares two findings with Klinefelter syndrome, namely tall stature and hypergonadotropic hypogonadism but at this time no genital anomalies have been reported in patients with this tetrasomy. We describe a 48, XXYY neonate and a clinical picture characterized by small penis, bifid scrotum, scrotal hypospadias and testes palpable in the labioscrotal folds.
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27
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Campeau PM, Lu JT, Dawson BC, Fokkema IFAC, Robertson SP, Gibbs RA, Lee BH. The KAT6B-related disorders genitopatellar syndrome and Ohdo/SBBYS syndrome have distinct clinical features reflecting distinct molecular mechanisms. Hum Mutat 2012; 33:1520-5. [PMID: 22715153 DOI: 10.1002/humu.22141] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Accepted: 06/03/2012] [Indexed: 01/29/2023]
Abstract
Genitopatellar syndrome (GPS) and Say-Barber-Biesecker-Young-Simpson syndrome (SBBYSS or Ohdo syndrome) have both recently been shown to be caused by distinct mutations in the histone acetyltransferase KAT6B (a.k.a. MYST4/MORF). All variants are de novo dominant mutations that lead to protein truncation. Mutations leading to GPS occur in the proximal portion of the last exon and lead to the expression of a protein without a C-terminal domain. Mutations leading to SBBYSS occur either throughout the gene, leading to nonsense-mediated decay, or more distally in the last exon. Features present only in GPS are contractures, anomalies of the spine, ribs and pelvis, renal cysts, hydronephrosis, and agenesis of the corpus callosum. Features present only in SBBYSS include long thumbs and long great toes and lacrimal duct abnormalities. Several features occur in both, such as intellectual disability, congenital heart defects, and genital and patellar anomalies. We propose that haploinsufficiency or loss of a function mediated by the C-terminal domain causes the common features, whereas gain-of-function activities would explain the features unique to GPS. Further molecular studies and the compilation of mutations in a database for genotype-phenotype correlations (www.LOVD.nl/KAT6B) might help tease out answers to these questions and understand the developmental programs dysregulated by the different truncations.
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Affiliation(s)
- Philippe M Campeau
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA.
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Wang Y, Cai A, Sun J, Li T, Wang B, Li J. Prenatal diagnosis of penoscrotal transposition with 2- and 3-dimensional ultrasonography. J Ultrasound Med 2011; 30:1397-1401. [PMID: 21968491 DOI: 10.7863/jum.2011.30.10.1397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
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.
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Affiliation(s)
- Yanhai Wang
- Department of Ultrasound, Affiliated Shengjing Hospital of China Medical University, 36 Sanhao Rd, Heping District, 110004 Shenyang, Liaoning, China.
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Gu SL, Luo XS, Hu LW. [Koyanagi technique for repairing proximal hypospadias with penoscrotal transposition]. Zhonghua Zheng Xing Wai Ke Za Zhi 2011; 27:269-272. [PMID: 22097313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To investigate the application of Koyanagi technique for repairing proximal hypospadias with penoscrotal transposition. METHODS Koyanagi procedure was used for repairing proximal hypospadias with penoscrotal transposition in 26 boys (mean age 4.2 years) between July 2005 and June 2010. RESULTS Primary healing was achieved in 22 cases. Three patients suffered from urinary fistula and the external urethral orifice in one patient was retracted to penis coronary sulcus, who were re-operated successfully. Two cases showed slight penile ventral curvature. Slight stricture of the urethral external orifice was noted in one case, which relieved after one to two times of urethral sounding every week for eight months. 20 patients were followed up for 6-36 months (mean 10.5 months) with good cosmetic result and normal urethra function. The penoscrotal transposition was also corrected. CONCLUSIONS The original Koyanagi procedure might be one of the simple and effective method for repairing proximal hypospadias with penoscrotal transposition.
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Affiliation(s)
- Sheng-li Gu
- Department of Paediatric Surgery, Zunyi Women and Children' s Hospital, Zunyi 563000, China
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Patra R, Mukhopadhyay B, Goswami SM, Mukhopadhyay M, Patra S. Complete diphalia with renal agenesis. J Indian Med Assoc 2011; 109:120. [PMID: 21888179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Rishavdeb Patra
- Department of Paediatric Surgery, Institute of Postgraduate Medical Education & Research, Kolkata 700020
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31
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Abudusaimi A, Tang LF, Ruan SS, Wang X. [Surgical correction of penoscrotal transposition with hypospadias: experience with 83 cases]. Zhonghua Nan Ke Xue 2011; 17:143-145. [PMID: 21404712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To investigate the techniques of surgical correction of penoscrotal transposition with hypospadias. METHODS We retrospectively studied 83 cases of penoscrotal transposition with hypospadias treated by surgery from January 2003 to June 2009, and analyzed the surgical techniques and follow-up results. RESULTS The patients underwent urethroplasty with simultaneous or staged surgical correction of penoscrotal transposition. Postoperative follow-up was conducted for 0.5-5 years. Eighty-one of the patients were satisfied with the appearance of the reconstructed penis and scrotum, and satisfactory outcomes were achieved in the other 2 with severe hypospadias after a second surgical correction of penoscrotal transposition. CONCLUSION Urethroplasty with simultaneous or staged surgical correction of penoscrotal transposition is recommendable for its resultant penile straightness, desirable penoscrotal appearance, good surgical prognosis and few postoperative complications.
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Affiliation(s)
- Abudureyimu Abudusaimi
- Department of Pediatric Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830001, China.
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de Graaf GW, van den Haak A. [A man with a swollen scrotum]. Ned Tijdschr Geneeskd 2011; 155:A2191. [PMID: 21902845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 32-year-old man was referred to our hospital with a painless left-sided scrotal mass present since infancy. Physical examination showed 2 small ovoid masses in the left hemiscrotum and 1 testis on the right side. Ultrasound showed a supernumerary testis with fusion of epididymis. The diagnosis was: polyorchidism.
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33
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American Institute of Ultrasound in Medicine, American College of Radiology, Society of Radiologists in Ultrasound. AIUM practice guideline for the performance of scrotal ultrasound examinations. J Ultrasound Med 2011; 30:151-5. [PMID: 21193719 DOI: 10.7863/jum.2011.30.1.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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van der Zanden LFM, van Rooij IALM, Feitz WFJ, Vermeulen SHHM, Kiemeney LALM, Knoers NVAM, Roeleveld N, Franke B. Genetics of hypospadias: are single-nucleotide polymorphisms in SRD5A2, ESR1, ESR2, and ATF3 really associated with the malformation? J Clin Endocrinol Metab 2010; 95:2384-90. [PMID: 20215396 DOI: 10.1210/jc.2009-2101] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Hypospadias is a common congenital malformation of the male external genitalia with a multifactorial etiology. Little is known about the genes involved in hypospadias. A few genetic associations have been reported but mainly in studies of small sample size. Most of these associations have not been replicated. OBJECTIVE The aim of this study was to investigate whether previously reported associations for four single-nucleotide polymorphisms (SNPs) in genes involved in hormonal pathways could be replicated in a large Dutch hypospadias sample. The SNPs investigated are rs523349 in steroid-5 alpha-reductase (SRD5A2), rs6932902 in estrogen receptor 1 (ESR1), rs2987983 in ESR2, and rs11119982 in activating transcription factor 3 (ATF3). DESIGN, PARTICIPANTS, AND METHODS We genotyped 620 Caucasian hypospadias cases and 596 controls for these SNPs using TaqMan-based genotyping. RESULTS We did not replicate the associations of the SNPs in SRD5A2 and ESR1 with hypospadias. The SNPs in ESR2 and ATF3 were borderline associated with hypospadias [odds ratios 0.9 (95% confidence interval 0.7-1.0) and 1.2 (95% confidence interval 1.0-1.4), respectively] but in the opposite direction compared with earlier publications. Stratification according to localization of the urethral opening produced comparable results in the subgroups. CONCLUSIONS The lack of consistency between our and previously performed studies might represent spurious results or chance findings in our or the earlier studies, differences in criteria used to select the study populations, or a real difference between populations, i.e. different genes contributing to disease risk. These results once again confirm the importance of replication in genetic association approaches.
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Affiliation(s)
- Loes F M van der Zanden
- Department of Epidemiology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Ashrafian H, Ahmed K, Mayer E. An ancient case of bifid scrotum. Urol Int 2010; 84:112. [PMID: 20173380 DOI: 10.1159/000273477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 08/25/2009] [Indexed: 11/19/2022]
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Lasfar W, van den Bosch RTA, Pot DJ, Klijn AJ, de Wildt MJAM, Gratama JWC. [Transverse testicular ectopia confirmed by ultrasonography]. Ned Tijdschr Geneeskd 2010; 154:A155. [PMID: 20170567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Two newborn boys aged 2 and 3 months with unilateral inguinal hernia and a contralateral impalpable, non-scrotal testis, and a third boy aged 2.5 years with an impalpable non-scrotal testis were found to have transverse testicular ectopia. This is an uncommon abnormality in which both gonads migrate toward the same hemiscrotum. We illustrate that unilateral cryptorchidism and a contralateral inguinal hernia may indicate the presence of a rare type of male pseudohermaphroditism: persistent müllerian duct syndrome (PMDS). This syndrome is characterized by the presence of a uterus and fallopian tubes associated with abdominal testes and frequently inguinal hernia in a phenotypically and genotypically normal male. This syndrome is often discovered during repair of inguinal hernia or non-descended testes (cryptorchidism). Pre-operative ultrasonography in children with impalpable non-scrotal testis and a contralateral inguinal hernia (patent processus vaginalis) may enable an early diagnosis of transverse testicular ectopia and proper surgical planning. Surgical orchidopexy was carried out and in the first two patients resection of the müllerian duct remnant (utriculus masculinus).
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Affiliation(s)
- Wafae Lasfar
- Gelre Ziekenhuizen, Afd Radiologie, Apeldoorn, The Netherlands
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Abstract
Hypospadia is the most common congenital malformation of the urinary tract. It is a malformation with the opening of the urethra proximally from the usual site. The meatal opening can be anywhere alone the shaft of the penis, or in more severe forms, within the scrotum, or in the perineum. Consequently the hypospadias can be distal, medial and proximal. The proximal ones can be penoscrotal (PS), scrotal (SC) and perineal (PE). The cause of hypospadias is largely unknown; however, current epidemiology and laboratory studies have shed new light into the etiology of hypospadias. With recent advancements in molecular biology, microarray technology, it appears that hypospadias is potentially related to disrupted gene expression. Currently, the only available treatment is surgery. The aim of this study was to present our results of the surgical correction of hypospadias and methods used to answer the clinical dilemmas about the gender. Authors have used two methods for a surgical resolution of the hypospadia - one-step operation suggested by Snodgrass and two-step operation, employing free graft suggested by Bracka. Clinical dilemmas regarding the gender were answered using cytogenetic assessment through lymphocyte cultivation method, suggested by Seabright. The cytogenetic assessment was carried in 23 patients with proximal hypospadia (penoscrotal, scrotal and perineal). Characteristic male cariotype (46, XY) was found in 22 patients. In one patient, with scrotal hypospadia, we found the characteristic female cariotype. This patient had testicles. The patient with female cariotype had a TDG gene that determines the differentiation of the testicles. Although surgery remains the only therapy for the treatment of the hypospadias, better understanding of the molecular and hormonal mechanisms behind the diseases may contribute to the prevention and the decrease in the incidence of the malformation. Cytogenetic testing in patients with unclear gender is important in planning further treatment.
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Affiliation(s)
- Hasan Ahmeti
- University Clinical Center of Kosova, Clinic of Pediatric Surgery, Prishtina, Kosovo
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Harada M, Udagawa A, Yoshimoto S, Ichinose M. A case of accessory scrotum with perineal lipoma. J Plast Reconstr Aesthet Surg 2008; 62:e108-9. [PMID: 19083282 DOI: 10.1016/j.bjps.2008.06.081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 06/15/2008] [Accepted: 06/16/2008] [Indexed: 11/16/2022]
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39
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Tao L, Li S. [A modified penile elongation method and observation of its postoperative complications]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2008; 22:1409-1411. [PMID: 19137876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To introduce a modified penile elongation method and observe its postoperative complications. METHODS From January 1993 to December 2007, 130 patients with congenital short and small penis were divided into 2 groups: the routine group and the modified group, with 65 patients in each group. In the routine group, the patients were 18-55 years old (39.6 on average), and the penile length during erection was (4.9 +/- 1.4) cm. In the modified group, the patients were 20-56 years old (35.4 on average), and the penile length during erection was (5.0 +/- 1.5) cm. There was no significant difference between the two groups (P > 0.05). On the basis of scrotal flap which was transferred to cover the prolonged cavernous body of penis, the "+" shaped incision at the root of the penis was made in the routine group, and the incision was shifted upward by 1.5 cm in the modified group. And V-Y incision was made for the penises with more than 4 cm prolonged length. In order to compare the conditions in the two groups, no physical therapy was applied in 30 days after the operation. RESULTS All the 130 patients' incisions obtained healing by the first intention, and all flaps survived successfully. Postoperative hydrophallus appeared differently between both groups. In the routine group, obvious hydrophallus appeared on the 3rd day after the operation and lasted for (15.11 +/- 2.71) days, with 3 cases (4.62%) suffering from refractory hydrophallus. In the modified group, hydrophallus appeared on the 3rd day after the operation and lasted for (6.65 +/- 0.29) days without any refractory hydrophallus. There was significant difference between the two groups in the duration of hydrophallus (P < 0.05). All patients were followed up for 6-8 months. After the operation, the shape and function of the penis were found good. The prolonged length was (4.9 +/- 1.4) cm in the routine group and (5.0 +/- 1.5) cm in the modified group. There was no significant difference between the two groups (P > 0.05). The satisfaction rate (according to the patients' self-rating) was 95% and 98% in the routine group and the modified group, respectively. CONCLUSION The method using the scrotal flap transferred to cover the prolonged cavernous body of the penis is safe and of low complication rate. The modified method is more effective to abate postoperative hydrophallus.
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Affiliation(s)
- Ling Tao
- Department of Plastic and Cosmetic Surgery, South-West Hospital of the Third Military Medical University, Chongqing 400038, PR China
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41
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Abstract
PURPOSE To use sonography to detect scrotal abnormalities in infertile men. MATERIAL AND METHODS Two hundred thirty-four infertile men, including 176 oligospermic (sperm count < 10 x 10(6)/ml), 58 azoospermic, and 150 normospermic men (control group) were evaluated prospectively for the presence of intra- and extratesticular abnormalities using high-frequency transducers and color Doppler imaging. Medical and surgical history, testicular volume, semen parameters, and hormonal levels were recorded. RESULTS A statistically significant increase in the prevalence of abnormal scrotal findings detected with sonography was observed in the study group compared with controls. These included varicocele in 35.5% versus 16% (p < 0.01), hydrocele in 16.7% versus 8.7% (p < 0.05), testicular microlithiasis in 9.8% versus 2% (p < 0.01), epididymal enlargement in 9% versus 2.6% (p < 0.05), and epididymal cyst in 7.7% versus 2% (p < 0.05). Testicular tumor was not seen in either group. A statistically significant decrease in testicular volume, sperm concentration, normal morphology, and forward motility of the sperm was noted in the study group compared with controls (p < 0.01). CONCLUSION The various intra- and extratesticular abnormalities were demonstrated in infertile men. Sonography should be used routinely in the work-up of male infertility.
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Margulis A, Maizels M, Bauer BS, Kaplan W. Sawtooth flaps to release penoscrotal tethering in proximal hypospadias. Plast Reconstr Surg 2007; 119:766-8. [PMID: 17230138 DOI: 10.1097/01.prs.0000254929.82523.bf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- John F Redman
- Department of Urology, University of Arkansas College of Medicine and Arkansas Children's Hospital, Little Rock, Arkansas 72205-7199, USA.
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47
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Aliefendioglu D, Bademci G, Keskil S, Somuncu S, Misirlioglu E, Cakmak AM. VACTERL-H associated with central hypothyroidism: a case report. Genet Couns 2007; 18:331-335. [PMID: 18019375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The VACTERL-H syndrome is a rare combination of vertebral anomalies, anal atresia, congenital heart defects, tracheo-esophageal fistula, abnormalities of kidneys and limb anomalies together with hydrocephalus. This condition is recognized as a hereditary entity with poor prognosis. We present a newborn weighing 3400 g, born by cesarean section to a 27 years old mother who had had an irregular antenatal follow-up. The patient had severe hydrocephalus, proximal esophageal atresia and distal tracheoesophageal fistula, gastric outlet obstruction, imperforated anus and recto-urethral fistula, patent ductus arterious, a bifid scrotum, a vertebral defect, sacral dimple and central hypothyroidism. The patient had no limb defects. The association of central hypothyroidism and VACTERL-H has previously not been reported.
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Affiliation(s)
- D Aliefendioglu
- Department of Neonatology, University of Kirikkale, Faculty of Medicine, Kirikkale, Turkey
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48
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van Beurden A, Schlejen PM. [Diagnostic image (305). A boy with a painful and swollen scrotum]. Ned Tijdschr Geneeskd 2006; 150:2870. [PMID: 17319218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Left double testis was diagnosed in a 12-year-old boy with a painful and swollen scrotum.
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49
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Abstract
A 1-year-old child with complete duplication of penis presented with continuous dribbling of urine. Examination revealed hypospadias of 1 penis and a duplicated scrotum with 2 normal testes. Cystourethrogram revealed a single bladder with a normal urethra in the dorsally placed phallus and ectopic insertion into the bladder of the ventral urethra. Abnormality was corrected by excision of the ventrally located penis bearing the ectopic urethra. The preputial skin of this ventral penis was used to repair the hypospadias of the dorsal penis. The case is being reported in view of its rarity and the successful surgical correction.
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Affiliation(s)
- H Sanjay Bhat
- Department of Urology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala 682 026, India.
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50
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Abaci A, Atas A, Bober E, Ates O, Hakgiider G, Büyükgebiz A. Complex urogenital malformation associated with female pseudohermaphroditism: caudal dysgenesis syndrome. J Pediatr Endocrinol Metab 2006; 19:1171-4. [PMID: 17128566 DOI: 10.1515/jpem.2006.19.9.1171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Caudal dysgenesis syndrome is a rare cause of female pseudohermaphroditism. This syndrome consists of absent perineal and anal openings in association with ambiguous genitalia, urogenital, colonic, and lumbosacral anomalies. We report a case of caudal dysgenesis syndrome in an infant who had non-palpable testes, bifid scrotum, a phallus-like structure and urethral atresia. Radiological evaluation revealed bilateral hydronephrosis, bifid uterus, cervix and vagina. Caudal dysgenesis syndrome should be considered in any female infant presenting with bilateral streak ovaries, and Müllerian and genito-urinary anomalies.
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Affiliation(s)
- Ayhan Abaci
- Division of Endocrinology, Faculty of Medicine, Department of Pediatrics, Dokuz Eylul University, Izmir, Turkey.
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