Micropenis is characterized by a penis that is smaller than 2.5 standard deviations below the average size. It can occur independently or as part of other syndromes and is caused by hormonal abnormalities after the 12th week of gestation. Imaging tests like ultrasound and MRI can help evaluate structural defects, while genetic tests check for chromosomal issues. Treatment involves testosterone therapy, topical DHT gel, or surgery. Buried penis, webbed penis, and penile agenesis are among the differential diagnoses.
Micropenis is characterized by a penis that is smaller than 2.5 standard deviations below the average size. It can occur independently or as part of other syndromes and is caused by hormonal abnormalities after the 12th week of gestation. Imaging tests like ultrasound and MRI can help evaluate structural defects, while genetic tests check for chromosomal issues. Treatment involves testosterone therapy, topical DHT gel, or surgery. Buried penis, webbed penis, and penile agenesis are among the differential diagnoses.
Micropenis is characterized by a penis that is smaller than 2.5 standard deviations below the average size. It can occur independently or as part of other syndromes and is caused by hormonal abnormalities after the 12th week of gestation. Imaging tests like ultrasound and MRI can help evaluate structural defects, while genetic tests check for chromosomal issues. Treatment involves testosterone therapy, topical DHT gel, or surgery. Buried penis, webbed penis, and penile agenesis are among the differential diagnoses.
standard deviations (SD) below the mean • May occur as an independent abnormality by itself or as a clinical finding of many syndromes • Caused by a hormonal abnormality that occurs after Characteristic: small penis and a median the 12th week of gestation raphe, foreskin, as well as normal localization of the urethral meatus opening • May have a retracted or flaccid appearance • The scrotum is present and fused normally, but it may be underdeveloped (hypoplastic) • Testicular volume is also expected to be below normal measurements • There often is no evidence of feminization DDx • Buried penis • Webbed penis • Penile agenesis • Imaging Tests • Pelvic ultrasound : visualize internal genital organs in suspicious cases • MRI: investigate structural midline defects, • such as pituitary stalk dysplasia syndrome, central diabetes insipidus characterized by absence of the pituitary bright spot in the posterior neurohypophysis, and pituitary dysplasia • Genetic Tests • chromosomal analysis or Y-fluorescence in order to determine the sex Treatment • Testosterone Treatment • Topical 5-ɑDihydrotestosterone (DHT) Gel • LH-FSH Applications • Surgical Treatment Buried Penis • congenital anomaly • Classification: • Type 1: congenital • the penis is normal in • Type 2: because of size but appears to be scarring from a small (i.e., the previous surgery external genitalia • Type 3: complex appear small) cases involving excessive obesity
The penis usually has a normal anatomy, but it is
tethered and shortened by abnormal fibrous bands connected to the Dartos Diagnosis • Through inspection • Size of the phallus is normal • DDx: • Micropenis • Hypospadias • Obesity • Congenital adrenal hyperplasia in females and other chromosomal abnomrlalitis Symptoms • Older children • Difficulty maintaining hygiene repeated balanitis and UTI • Difficulty holding the penis during voiding • Embarrassment when naked with peers • Some: ballooning of the foreskin with voiding may be frequently wet if voiding into the preputial sac (megaprepuce) occurs • Adults: • Painful erection • Sexual embarrassment • Difficulty with vaginal penetration Treatment • degloving the penis, dissecting the skin and subcutaneous tissue from the corpora, • releasing any band of dysplastic tissues tethering the penis, • reconstructing the penile skin • Multiple Z-plasties • release of tethering bands from the Dartos through an S-shaped skin incision on the dorsum of the penis Hypospadias • abortive development of the urethral spongiosum and ventral prepuce along with an arrest in the normal embryological correction of penile curvature Treatment • Surgical repair of the anatomical defect • Object of surgical treatment: • Reconstruct a straight penis • To allow a forward- directed stream • Normal coitus Anterior hypospadias • Meatal advancement glansplasty (MAGPI) • The glans approximation procedure (GAP) • The Mathieu or flip-flap • The Snodgrass modification or tubularized incised plate urethroplasty Posterior hypospadias • The urethral plate • Onlay island flap • Two-stage hypospadias repair • Bracka buccal 2-stage repair Epispadias • Failure of the urethral plate to tubularize on the dorsum with the defect ranging from a glandular to a penopubic location • Male and female • Male: additionally demonstrate a dorsal chordee with varying degrees • Female: exhibit a bifid clitoris Diagnosis and initial management • Boys: diagnosed at birth • Appearance of a split dorsal urethra with dorsal chordee and a venral foreskin hood • Phallus: short • Penopubic forms: diastasis of the pubic bone • Female: Outer genitalia displays • incomplete development of labia minora • A nontubularized urethra • Bifid clitoris • A flat appearing mons pubis Surgical reconstruction • Goals • Female: • Attaining continence • Reconstruction of the outer genitalia • Bladder neck surgery • Male: • Bladder neck surgery is not always necessary • Phallic reconstruction • Penopubic: penile lengthening • Tubularization of the urethral plate with placement of the meatus into the glans • Techniques: Cantwell-Ransley technique, Mitchell-Bagli technique Phimosis • Ballooning during urination • inability to withdraw the • Gentle traction: the prepuce puckers narrowed penile foreskin or and the overlying tissue are pink and prepuce behind the glans penis healthy • Pathologic phimosis: • Poor hygiene and recurrent • Pain balanitis (infection of glans • Skin irritation • Local infections penis), posthitis (inflammation • Bleeding of foreskin), or both • Dysuria difficulty in retraction of • Hematuria • Frequent episodes of urinary tract foreskin and consequent true infections phimosis. • Preputial pain • Painful erection • Weak urinary stream Treatment • Topical Steroids • Betamethasone 0.05% applied twice a day over a 4-week period • Dilation and Stretching • Eutectic mixture of local anaesthetics (EMLA) used prior to attempts at release of the preputial adhesions • Surgical • Conservative surgical alternatives: Preputioplasty, Y-plasties, V-plasties • Conventional male circumcision Paraphimosis