Genital abnormalities

1. GENITAL ABNORMALITIES
IN
CHILDREN

2. INTRODUCTION
• Hypospadiasis
• Phimosis
• Paraphimosis
• Undescended Testis
• Hernia
• Hhydrocele
• Ambiguous Genitalia
• Infections

3. HYDROCELE
• Hydrocele is a common painless swelling of the scrotum
• About one in 10 male infants has a hydrocele at birth, but most
hydroceles disappear without treatment within the first year of life.
• In India and other tropical countries the incidence is much higher due
to the high prevalence of filarial infections. In one review of 500 cases
of hydrocele from India almost 43% were due to filarial infections.
• At birth, around 80-90% of term male infants possess a patent
processus vaginalis. This figure declines steadily to settle at
approximately 25-40% at two years of age.

4. Risk Factors:
1. Breech presentation
2. IUGR/Low birth weight
3. Gestational Progestin use
DIAGNOSTIC CRITERIA(diagnosed on clinical grounds):
1. Non communicating Fluid filled swelling of the scrotum
2. Larger during the day and small in the morning
3. Transilluminating test positive
Investigations
Usg – Helpful in evaluating and diagnosing hydrocele

5. HYPOSPADIASIS
• Hypospadiasis is urethral opening on the ventral side of the penile
shaft affecting 1 in 250 male new borns
65%
25%
10%

6. • Risk Factors: The incidence is increasing due to in utero exposure to
estrogenic or androgenic endocrine disrupting chemicals
• 1. Phytoestrogens
• 2. Poly chlorobiphenyls
Associsated Features:
1. Dorsal hood
2. Chordae
3. Fish mouth meatus
4.10% also have undescended testis and inguinal hernias

7. CHORDEE without Hypospadiasis
• This is a mild or moderate ventral penile curvature (chordee) and
incomplete development of foreskin( dorsal hood)
• Diagnostic criteria: Insufficient ventral penile skin
• Normal urethral meatus
• Inelastic ventral bands of dartos fascia that prevents straight erection
• Surgical repair is recommended at age 6-12 montha

8. Phimosis and Paraphimosis
• Phimosis is the inability to retract the prepuce
• Paraphimosis occurs when foreskin cannot be pulled back over the
glans
• At birth, phimosis is physiological over time the adhesions between
the prepuce and glans lyse and distal phimotic ring loosens
• In 80% of uncircumcised males the prepuce is retractable by 3 yrs of
age
• Diagnosis : Ballooning of glans while urinating
• hypopigmented lesions of the glans and prepuce( balanitis xerotica
obliterans)
• Meatal stenosis

10. INCONSPICUOS PENIS
• Penis that appears to be small
• A webbed penis is a condition where the scrotal skin extends on to
the ventral penile shaft, after routine circumcision penis can retract
into the scrotum resulting in secondary phimosis(trapped penis)
• A hidden or concealed or buried penis is a normally developed penis
which is camouflaged by suprapubic fat
• Risk factors are congenital, iatrogenic after circumcision and result of
obesity
• Clinical features : UTI, urinary retention

11. MICRO PENIS
• Normally formed penis that is at least 2.5 SD below the mean in size
• Risk factors :
• Hormonal abnormality after 14 weeks of gestation
• Hypo/hyper gonadotrophic hypogonadism, failure of hypothalamus to
release GnRh
• Growth hormone deficiency – kallmanns syndrome, Prader willi
syndrome, Lawrence - Moon- Bardet- Biedl syndrome
• Diagnosis : less than 1.9 cm size

12. STRETCHED PENILE LENGTH The penis was stretched as much as
comfortably possible and length was measured up to the accuracy of 1
mm from pubic symphysis to the tip of the glans.

13. CRYPTORCHIDISM
• The absence of palpable testis in scortum
• It is the most common disorder of sexual dysfunction in males
• At birth 4.5% of males have undescended testis(30% in premature male
infants and 3.4% in term babies
• As many as 50% of congenital undescended testes descend spontaneously
during the first 3 months of life and by 6 months the incidence decreases to
1.5%
• 10% of cases are bilateral
• Diagnosis : Absent Testes in the scrotal region, Pain abdomen
Palpable abdominal mass, hernia, Torsion testis, Seminoma
Risk of germ cell malignancy ( seminoma ) – 1 in 80 for unilateral, 1 in 40 for
bilateral