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Table of Contents
CASE REPORT
Year : 2010  |  Volume : 4  |  Issue : 2  |  Page : 66-67

Complete penoscrotal transposition


Department of Pediatric Surgery, BJ Wadia Children Hospital, Parel, Mumbai - 400 012, India

Date of Web Publication24-Mar-2011

Correspondence Address:
Sandeep Hambarde
c/o Dr. Pradnya Bendre, Department of Pediatric Surgery, BJ Wadia Children Hospital, Parel, Mumbai - 400 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-3131.78276

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   Abstract 

Penoscrotal transposition may be partial or complete, resulting in variable degrees of positional exchanges between the penis and the scrotum. Repairs of penoscrotal transposition rely on the creation of rotational flaps to mobilize the scrotum downward or transpose the penis to a neo hole created in the skin of the mons-pubis.

Keywords: Complete, Glenn-Anderson technique, penoscrotal, transposition


How to cite this article:
Hambarde S, Bendre P. Complete penoscrotal transposition. Ann Nigerian Med 2010;4:66-7

How to cite this URL:
Hambarde S, Bendre P. Complete penoscrotal transposition. Ann Nigerian Med [serial online] 2010 [cited 2019 Sep 23];4:66-7. Available from: http://www.anmjournal.com/text.asp?2010/4/2/66/78276


   Introduction Top


Penoscrotal transposition is a rare anomaly of the external genitalia, characterized by malposition of the penis in relation to the scrotum. In complete transposition, the scrotum covers the penis, which emerges from the perineum. In incomplete transposition, which is more common, the penis lies in the middle of the scrotum. Both forms are most often associated with severe forms of hypospadias. [1]


   Case Report Top


An 18-month-old boy presented with complete transposition of penis and scrotum and penoscrotal hypospadias. Testes were bilaterally descended and there were no other anomalies [Figure 1]. Routine investigations were normal and karyotype was male. Modification of Glenn-Anderson technique using scrotal flaps was used to correct transposition. Postoperative appearance was excellent with good functional outcome at 6 months follow-up [Figure 2]. [2],[3]
Figure 1: Complete Penile Transposition

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Figure 2: Post-Operative Appearance

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   Discussion Top


Penoscrotal transposition was first reported by Apple by in 1923. [4] Patients with penoscrotal transposition often have accompanying urological abnormalities such as chordee, hypospadias and vesicoureteric reflux.

Mcllvoy and Harris first performed surgery to move the penis into a more cranial position through a subcutaneous tunnel beneath the prepenile scrotum. [5] Forshall and Rickham used a different technique in two patients in whom the cranially located scrotal flaps were elevated, rotated medially and caudally and sutured beneath the penis. [6] This method was also used by Glenn and Anderson. [2] The technique was later modified by Dresner in 1982. [7] In 2000, Mark and his colleagues [8] presented a radically divergent view of penoscrotal transposition, stating that the penis and not the scrotum is malpositioned. They transferred the penis after straightening into a button hole designed in the skin of the mons-pubis.

Complications after surgery for penoscrotal transposition include urethral and testicular injury, urinary fistula, flap necrosis and penile edema. Circular incision at the root of the penis partially compromises lymphatic drainage, which may interfere with healing of the neourethra. [9]

Observation of patients corrected by the Glenn-Anderson technique showed gross edema that persists for long periods (6-9 months) and, after resolution, leaves the penile skin dusky and darkly pigmented, appearing as the scrotal skin.

Arena et al, [10] reported 38% complications in their work; Glassberg et al, [11] reported 50% complications and Koyanagi et al, [12] reported 48% complications in their work. All of them used the same technique in the correction of penoscrotal transposition.

Modification of the Glenn-Anderson technique, as used in our case, is the best method to correct complete penile transposition with an excellent cosmetic and functional outcome.

 
   References Top

1.Peroviæ S, Vukadinoviæ V. Penoscrotal transposition with hypospadias: 1-stage repair. J Urol 1992;148:1510-3.   Back to cited text no. 1
    
2.Glenn JF, Anderson EE. Surgical correction of incomplete penoscrotal transposition. J Urol 1973;110:603-5.   Back to cited text no. 2
    
3.Snodgrass W. Tubularized, incised plate urethroplasty for distal hypospadias. J Urol 1994;151:464.   Back to cited text no. 3
    
4.Appleby LH. An unusual arrangement of the external genitalia. Can Med Assoc J 1923;13:514-6.   Back to cited text no. 4
    
5.McIlvoy DB, Harris HS. Transposition of the penis and scrotum: Case report. J Urol 1955;73:540-3.   Back to cited text no. 5
    
6.Forshall I, Rickham Pp. Transposition of the penis and scrotum. Br J Urol 1956;38:250-2.   Back to cited text no. 6
    
7.Kolligian ME, Franco I, Reda EF. Correction of penoscrotal transposition: A novel approach. J Urol 2000;164:994-7.  Back to cited text no. 7
    
8.Dresener ML. Surgical revision of scrotal engulfment. Urol Clin North Am 1982;9:305-10.  Back to cited text no. 8
    
9.Germiyanoðlu C, Ozkardeþ H, Altuð U, Erol D. Reconstruction of penoscrotal transposition. Br J Urol 1994;73:202-3.  Back to cited text no. 9
    
10.Arena F, Romeo C, Manganaro A, Arena S, Zuccarello B, Romeo G. Surgical correction of penoscrotal transposition associated with hypospadias and bifid scrotum: Our experience of two-stage repair. J Pediatr Urol 2005;1:289-94.  Back to cited text no. 10
    
11.Glassberg KI, Hansbrough F, Horowitz M. The Koyanagi-Nonomura 1-stage bucket repair of severe hypospadias with and without penoscrotal transposition. J Urol 1998;160:114-7.  Back to cited text no. 11
    
12.Koyanagi T, Nonomura K, Yamashita T, Kanagawa K, Kakizaki H. One-stage repair of hypospadias: Is there no simple method universally applicable to all types of hypospadias? J Urol 1994;152:1232-7.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]



 

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