The application of penile base staggered flap in the operation of severe hypospadias with penoscrotal transposition / 中华整形外科杂志

Objective@#To explore the application of penile base staggered flap in the operation of severe hypospadias with penoscrotal transposition.@*Methods@#Twenty-three cases with severe hypospadias with penoscrotal transposition were corrected by urethroplasty and staggered flap plasty in our department from May 2013 to June 2016. After urethroplasty, the skin at the junction of the penile base and scrotum was transversely cut by 1.5-2.0 cm, and then sutured with Z-plasty to reconstruct the angle of the penis and scrotum.@*Results@#After the operation, infection and cracking at the suture of the staggered flap occurred in one child and was cured after dressing change and symptomatic treatment. Two cases suffered from urine leakage at the suture of the staggered flap. One of the cases realized self-healing and the other received a repair operation for urinary fistula. Three children suffered coronary sulcus fistula and was cured by urethroplasty. All the patients were followed up from 10 to 30 months with normal penis scrotal position and satisfactory appearance.@*Conclusions@#The application of penile base staggered flap can be used for severe hypospadias in one stage with penoscrotal transposition surgery. It is a simple and satisfactory method for the treatment of hypospadias with penoscrotal transposition.

Prenatal ultrasonographic diagnosis and differential diagnosis of fetal penoscrotal transposition / 中华医学超声杂志（电子版）

Objective To study the ultrasonographic features and differential diagnosis of fetal penoscrotal transposition.Two dimensional and three dimensional ultrasound were applied in the diagnosis of fetal penoscrotal transpositionto improve the detection rate. Methods Twenty cases of suspected penile scrotal transposition of the fetus in Shengjing Hospital affiliated to China Medical University fromJanuary 2015 to February 2017were included in present study. The ultrasound findings, fetal chromosome examination and clinical follow-up outcome were retrospectively summarized. Results Among the 20 suspected cases of penile scrotal transposition, 17 cases were diagnosed correctly. All the 17 cases were partial type of penile scrotal transposition. In the remaining 3 cases, 2 caseswere hermaphroditism with the karyotype of 46-XX, and the other 1 case was confirmed as normal female fetusesby clinical follow-up after birth. The ″tulip″signwas the typical ultrasonographic features offetal penoscrotal transposition. Conclusion 2D combined with 3D ultraosound is useful in diagnosis and differential diagnosis of fetal penile scrotal transposition.

Duplicación rectal extrofiada asociada a malformación anorrectal y transposición pene-escrotal con hipospadias perineal: Reporte de un caso clínico / Exstrophy of rectal duplication associated with anorectal malformation and penoscrotal transposition with perineal hypospadias: A case report

Se presenta el caso de un paciente masculino quien requirió tratamiento por agenesia anorrectal con fístula rectouretral y transposición pene-escrotal con hipospadias perineal, acompañados de una masa perineal. La tumoración perineal se encontró íntimamente adherida y en continuidad al recto, lo que la hace compatible con una duplicación rectal extrofiada. La reconstrucción quirúrgica de la anomalía se realizó en etapas hasta lograr resultados funcionales y estéticos aceptables.

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.

Transposição penescrotal / Penoscrotal transposition

Transposição de pênis e escroto no ser humano é uma rara anomalia da genitália externa, caracterizada pela má posição do pênis em relação ao escroto, podendo ser na forma incompleta (parcial) ou completa. Frequentemente a transposição de pênis está associada a anomalias do genital (hipospadia, uretra curta), sistema renal, esquelético, gastrointestinal, cardiovascular e, ocasionalmente, a síndrome de regressão caudal. A reconstrução da transposição penescrotal, com prioridade a correção do ?chordee?, deverá produzir resultados satisfatórios, em termos estético e funcional, desde que o escroto e o pênis sejam colocados em suas posições anatômicas verdadeiras, evitando assim efeitos psicogênicos adversos.

A Case of del(13)(q22) with Multiple Major Congenital Anomalies, Imperforate Anus and Penoscrotal Transposition

"13q-"syndrome is known to have widely variable manifestations, including retinoblastoma, mental and growth retardation, malformation of brain and heart, anal atresia, and anomalies of the face and limbs. Here we report a case of del(13)(q22) with multiple major congenital anomalies for the first time in Korea. The patient was born at 36+4 weeks of pregnancy by caesarian section. Birth weight was 1490g. On examination the following features were noted: - imperforate anus, ambiguous genitalia (bifid scrotum, penoscrotal transposition, hypospadia), syndactyly of toes, absence of thumbs, abnormal facies (dolichocephaly, telecanthus, large low set ears, saddle nose, high arched palate, micrognathia). Neurocranial ultrasonography showed atrophy of the corpus callosum and multiple calcifications. He died at 14 days. Post-mortem autopsy findings showed cholestasis and fatty metamorphosis of liver, abnormal lobulation (Rt:2, Lt:1) and lymphangiectasis of the lung, VSD, ASD, PDA of heart, and acute tubular necrosis of kidney. Cytogenetic studies was confirmed to 46,XY,del(13) (q22) by Giemsa banded chromosomes from peripheral blood lymphocytes.

Correction of penoscrotal transposition: buttonhole technique

Transposition of the penis was performed in 13 patients, in that 11 patients were repaired hypospadias first. A suprapubic buttonhole is created in an anatomically correct of location for the penis. The shaft skin is mobilized. The penis is then passed through a tunnel of subcutaneous tissue, delivered into this buttonhole. All 13 patients have had an excellent cosmetic outcome. There have been no cases of vascular compromise to the shaft or scrotal skin. Because of simplicity and superior be used in all cases of penoscrotal transposition.

Surgical Outcome of Proximal Hypospadias with Penoscrotal Transposition / 대한비뇨기과학회지

PURPOSE: Penoscrotal transposition is found in cases with severe form of hypospadias. In those cases, severe chordee generally coexists and a long length of urethra may be necessary for its correction. We evaluated the clinical outcome of surgical repairs for 12 patients of proximal hypospadias with penoscrotal transposition. MATERIALS AND METHODS: Out of 12 cases, there were 2 with penoscrotal type, 7 with scrotal type and 3 with perineal type hypospadias. All cases had moderate to severe chordee. Five cases were treated with one-stage repair and seven cases with multi-stage repair. We analysed operative methods, postoperative complications and those managements between the cases of one-stage and multi-stage repairs. RESULTS: For one-stage repair, we used transverse preputial island flap method in 3 cases and urethroplasty using scrotal skin flap in 2 cases. For multi-stage repair, we performed Thiersh-Duplay urethroplasty in 2 cases, bladder mucosal graft in 2 cases and Belt-Fugua urethroplasty in 3 cases. Correction of penoscrotal transposition was performed successfully in all cases. In all cases, a paucity of skin was the most difficult problem. The overall complication rate was 50.0%. In cases treated with one-stage repair, there were two cases with urethrocutaneous fistulas. However, in cases treated with multi-stage repair, there were four cases with complications such as urethral strictures, urethrocutaneous fistulas with or without large skin defect. Overall the complications in cases with multi-stage repair were more severe than those in cases with one-stage repair. CONCLUSIONS: Our experience suggests that multi-stage operation may be not superior to one-stage operation in cases with proximal hypospadias associated with penoscrotal transposition. Thus we recommand one-stage repair in those cases despite a paucity of foreskin.

Experiences in Surgical Correction of Incomplete Penoscrotal Transposition / 대한비뇨기과학회지

Penoscrotal transposition is one of the rare congenital anomalies. We experienced 12 cases of incomplete penoscrotal transposition during the period from January 1978 to September 1983. The obtained results were as follows: 1. The age distribution ranged from 5 to 33 years old, and the average was 15 years old. The n. umber of patients whose age was below 10 years was 5. 2. The associated anomalies were as follows; hypospadia in all cases, undescended testis in 3 cases, utriculus masculine in 3 cases, hydrocele in 1 case and double corpus spongiosum in 1 case. 3. We performed the chordectomy and the scrotoplasty simultaneously as 1st staged operation, and the urethroplasty as 2nd staged operation. In the 1st staged operation, Glenn-Anderson's method was applied in 7 cases, and the combined technique of Glenn-Anderson's method and Byars chordectomy method was applied in 5 cases. 4. The postoperative complications were as follows; Of the 7 cases of Glenn-Anderson's method, 1 case was complicated by ventral curvature of the penis due to scar formation after 1st staged operation, and 2 cases were complicated by urethral fistula after 2nd staged operation. Of the 5 cases of the combined technique of Glenn-Anderson's method and Byars chordectomy method, no complications were found in all cases after 1st and 2nd staged operations.