Anatomic penile abnormalities

Anatomic penile abnormalities are congenital and acquired conditions that affect the male external genitalia; some may require emergency evaluation and treatment.

Diagnosis is based on clinical findings identified in a wide variety of age groups from newborn to adult.

Localized occurrences of inflammation and infection are amenable to medical treatment; surgery with varying degrees of reconstruction may be required.

Inadequate, untimely, and unsuccessful treatment may have long-term consequences of sexual dysfunction or cosmetic deformity of the penis.

Anatomic penile abnormalities encompass a variety of disorders of the soft tissues of the male external genitalia.

Phimosis is the inability to retract the foreskin (distal prepuce) proximally over the glans penis. Congenital (physiologic) phimosis is expected in children younger than 3 years of age, and may be a normal finding up until the age of puberty. Acquired (pathologic) phimosis is the inability to retract the foreskin proximally over the glans penis in postpubertal males, or in patients in whom scarring has developed from chronic infection and inflammation (balanoposthitis), or as a result of repeated forced retraction of congenital phimosis.

Paraphimosis is a condition in which the foreskin of the penis has been retracted proximal to the coronal sulcus (glans penis) and is unable to be reduced; this may cause compromised blood flow to and from the penis distal to the retracted prepuce.

Congenital penile curvature, sometimes called congenital chordee, is a condition where the penis is curved, typically either ventrally or to one side. Rarely, dorsal curvature is noted. Congenital penile torsion can also occur, typically in a counter-clockwise direction (to the patient's left side). It can occur in conjunction with hypospadias or in isolation.

Hypospadias is a common birth defect where the urethra is located in an abnormally ventral position on the penis. Severity can range from the distal form (i.e., the urethral meatus is located in the glans or distal shaft), to the less common proximal form (i.e., the urethral meatus is located from the perineum to the proximal shaft). The prepuce is often incomplete in patients with hypospadias, though it may be intact in some cases of distal hypospadias. Penile curvature is also common, particularly in patients with proximal hypospadias. Patients with proximal hypospadias may also have a cleft scrotum. Megameatus with intact prepuce (a mild variant of distal hypospadias) can occur with an intact prepuce, and is only noted at the time of circumcision or retraction of the prepuce at an older age.

A concealed penis is a normally developed penis that visually appears short because it is buried in prepubic fat tissue, enclosed in scrotal tissue, or trapped due to scar formation after circumcision.[1]Radhakrishnan J, Razzaq A, Manickam K, et al. Concealed penis. Pediatr Surg Int. 2002 Dec;18(8):668-72. http://www.ncbi.nlm.nih.gov/pubmed/12598960?tool=bestpractice.com Congenital buried penis, also called congenital megaprepuce, is a rare condition characterized by excessive inner preputial skin with a tight phimotic ring in newborns, leading to urine entrapment appearing visually as severe ballooning of the penile skin and scrotum with urination.