Diphallus: report on six cases and review of the literature

Diphallus is an extremely rare anomaly. Numerous associated genitourinary, gastrointestinal and other anomalies have been described with diphallus. These patients need several investigations, and finally surgical intervention. In this report we discuss six patients with diphallus which evaluated retrospectively. Five patients had complete diphallia, and one had bifid diphallus. Meatus was normal in 3, hypospadiac in 2, and epispadiac in one patient. The most common associated anomaly was bifid scrotum [5 cases], and other common anomalies consisted of bladder duplication [3 cases], imperforate anus [2 cases], and hypospadias [2 cases]. Phalloplasty was performed for all but one. All the patients with urethral duplication have to be evaluated carefully because of the high incidence of other systemic anomalies

Early exploration in the management of acute scortum in children

Acute scrotal conditions are a common clinical setting that present with pain and swelling of the hemiscrotum. The aim of our study has been to evaluate the findings in boys operated on acute scrotum. A descriptive study was conducted on 100 patients with acute scrotum admitted to Mofid Children's Hospital from March 1993 to March 2007. Data included history, age, primary symptoms, definite diagnosis, side involvement, paraclinical tests, imaging modalities, medical or surgical management and type of the surgery. Diagnosis was made mainly by clinical signs and symptoms and surgical exploration. Torsion of testis [n=31] was the most common cause of acute scrotum followed by incarcerated inguinal hernia [n=30], torsion of testicular appendage [n=27], epididymo-orchitis [n=7], idiopathic scrotal edema [n=4] and hematocele [n=1]. Most [34%] of the patients were in the first year of life and the mean age was 5.4 years. The commonest signs were pain and swelling [62%] followed by pain, swelling and redness [21%] and pain alone [16%]. 83 patients consisting of 31 with torsion of testis, 14 with torsion of testicular appendage, 30 with incarcerated hernia and 7 with epididymo-orchitis underwent surgical exploration after careful physical examination. 10 of 31 patients with torsion of testis had orchiectomy and orchiopexy of contrea-lateral testis and the rest had detorsion and bilateral orchiopexy. 80% of patients were referred to the hospital after 12 hours of clinical onset of symptoms. Early exploration of scrotum based on careful physical examination excludes the risk of misdiagnosis by diagnostic procedures and unnecessary delay by diagnostic techniques. Exploration of scrotum is a relatively safe and simple procedure with good cosmetic results, it also allows an accurate diagnosis to be made