Anatomic penile abnormalities

Congenital and acquired conditions that affect the male genitalia; some may require emergency evaluation and treatment.

Diagnosis 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 failed 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 genitalia. Phimosis is the inability to retract the foreskin (distal prepuce) proximally over the glans penis. Congenital 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 retracts proximal to the coronal sulcus (glans penis) and becomes fixed in position.

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. It can occur in conjunction with hypospadias or in isolation.

Hypospadias is a common birth defect where the urethra is located in an abnormal position on the ventral surface of the penis. Severity can range from the distal form (i.e., the urethral meatus is located in the glans or distal shaft and typically occurs with incomplete prepuce), to the less common proximal form (i.e., the urethral meatus is located from the perineum to the proximal shaft; typically occurs with ventral curvature, a cleft scrotum, and incomplete prepuce). 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 seems 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;18:668-672. http://www.ncbi.nlm.nih.gov/pubmed/12598960?tool=bestpractice.com Congenital buried penis, also called congenital megaprepuce, is a rare condition that often presents as a genital mass present with urination in the newborn. It is characterized by excessive inner preputial skin with a tight phimotic ring, leading to severe ballooning of the penile skin and scrotum with urination. [Figure caption and citation for the preceding image starts]: Pathologic phimosis in a patient with balanitis xerotic obliterans From the collection of Nicol Corbin Bush, MD [Citation ends]. [Figure caption and citation for the preceding image starts]: Paraphimosis From the collection of Nicol Corbin Bush, MD [Citation ends]. [Figure caption and citation for the preceding image starts]: Early paraphimosis From the collection of Nicol Corbin Bush, MD [Citation ends]. [Figure caption and citation for the preceding image starts]: Congenital penile curvature (congenital chordee) From the collection of Nicol Corbin Bush, MD [Citation ends]. [Figure caption and citation for the preceding image starts]: Infant with distal hypospadias. The urethral meatus is located in the glans or distal shaft and prepuce is typically incomplete From the collection of Nicol Corbin Bush, MD [Citation ends]. [Figure caption and citation for the preceding image starts]: Infant with proximal hypospadias. The urethral meatus is located from the perineum to the proximal shaft From the collection of Nicol Corbin Bush, MD [Citation ends]. [Figure caption and citation for the preceding image starts]: Congenital buried penis From the collection of Nicol Corbin Bush, MD [Citation ends]. [Figure caption and citation for the preceding image starts]: Congenital buried penis: abundant inner preputial skin with paucity of shaft skin From the collection of Nicol Corbin Bush, MD [Citation ends]. [Figure caption and citation for the preceding image starts]: Congenital buried penis From the collection of Warren T. Snodgrass, MD [Citation ends]. [Figure caption and citation for the preceding image starts]: Repaired congenital buried penis (with bilateral hernia repair and scrotoplasty) From the collection of Warren T. Snodgrass, MD [Citation ends]. [Figure caption and citation for the preceding image starts]: Congenital buried penis From the collection of Nicol Corbin Bush, MD [Citation ends]. [Figure caption and citation for the preceding image starts]: Repaired congenital buried penis From the collection of Nicol Corbin Bush, MD [Citation ends].