|Year : 2010 | Volume
| Issue : 2 | Page : 66-67
Complete penoscrotal transposition
Sandeep Hambarde, Pradnya Bendre
Department of Pediatric Surgery, BJ Wadia Children Hospital, Parel, Mumbai - 400 012, India
|Date of Web Publication||24-Mar-2011|
c/o Dr. Pradnya Bendre, Department of Pediatric Surgery, BJ Wadia Children Hospital, Parel, Mumbai - 400 012
Source of Support: None, Conflict of Interest: None
| 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
| Introduction|| |
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. 
| Case Report|| |
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]. ,
| Discussion|| |
Penoscrotal transposition was first reported by Apple by in 1923.  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.  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.  This method was also used by Glenn and Anderson.  The technique was later modified by Dresner in 1982.  In 2000, Mark and his colleagues  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. 
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,  reported 38% complications in their work; Glassberg et al,  reported 50% complications and Koyanagi et al,  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|| |
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[Figure 1], [Figure 2]