Sexually Transmitted Diseases - I. I. Mavrov 2005

Anomalies of the Urogenital System
Anomalies of the Penis

They are characterized by A wide variety of anatomical and functional disorders.

Congenital aphallia is an extremely rare anomaly usually accompanied by other severe malformations that are incompatible with life. If this anomaly is observed in viable infants, their Urethra opens into the rectum or onto the Perineum. This anomaly creates significant difficulties in determining the child's sex at birth. Some newborns are assigned female, an error that is subsequently reinforced by upbringing. The absence of corpora cavernosa and an inappropriate psychosexual orientation established by upbringing make surgical correction extremely difficult. The presence of at least remnants of the corpora cavernosa and a male psychosexual orientation allows for such correction, enabling the creation of a Penis and urethra.

Congenital absence of the glans penis is an extremely rare anomaly. Surgical intervention (myotomy) is indicated only if narrowing of the external urethral meatus is detected.

Concealed penis is a developmental anomaly in which the penis lacks its own Skin coverage and is largely hidden within excessively developed subcutaneous adipose tissue in the Pubic Symphysis region, rarely in the scrotal or perineal regions. Surgical intervention involving penile mobilization followed by plastic surgery is recommended at the age of 6-8 years.

Penile ectopia is an anomaly in which the penis is located posterior to the Scrotum. Treatment consists of relocating it to the appropriate site via surgery. Cases of The Development of an accessory penis in such unnatural locations as the sacral, dorsal, and HEAD regions have been described (K. I. Yakovleva, 1963).

Duplication of the penis (diphallia) is a rare anomaly that can be complete or partial; sometimes only duplication of the glans is noted. As a rule, both Organs are located parallel to each other, but they may also be situated one above the other. Complete duplication is characterized by the presence of corpora cavernosa and a urethra in each organ; one of the penises may be underdeveloped. Sometimes they are enclosed in a common skin sheath that extends to the glans. Both urethras may unite in the prostatic part, but they can also remain separate. In this case, as a rule, a single bladder is observed. In partial duplication, two glans penises and two urethral openings are located on the shaft of a single organ.

Micropenis is an underdeveloped male external genitalia. It is observed in infantilism and Hypogenitalism associated with congenital endocrine disorders (see hypogonadism). In children with this defect, the scrotum and Testes are small, the prostate is atrophied, and there is age-inappropriate excessive fullness along with a somewhat feminine appearance. Treatment with gonadotropic Hormones or testosterone can lead only to a temporary enlargement of the penis.

Megalopenis is an excessively large penis; it can reach sizes that make sexual intercourse impossible. This anomaly is among the manifestations of precocious Puberty associated with endocrine disorders, specifically the presence of adrenal or pituitary tumors. Sometimes a temporary enlargement of the penis occurs due to the administration of gonadotropic hormones (e.g., in the treatment of cryptorchidism).

Webbed penis is an anomaly in which the skin of the scrotum originates not from the Base of the penis, but from the middle of the pendulous part or even from the area adjacent to the glans. If the penis is pulled upward, a triangular skin fold forms that impedes erection. Treatment is surgical. Plastic surgery with appropriate repositioning of skin flaps is recommended.

Short frenulum of the penis is a defect in which, even with a sufficiently wide outer ring of the prepucial sac, the glans may remain covered at all times. A short frenulum prevents the retraction of the foreskin, promotes the accumulation of smegma in the prepucial sac, and upon reaching puberty, interferes with erection. The main Complaints are deviation of the glans and painful erections. During vigorous sexual intercourse, rupture of the frenulum may occur, accompanied by bleeding. Treatment consists of a transverse incision of the frenulum followed by longitudinal suturing of the wound.

Phimosis is a pathological narrowing of the foreskin that prevents it from being retracted to expose the glans penis; it is the most frequent anomaly of the male genital organ. Phimosis can be congenital (physiological) or acquired. In newborn boys, phimosis—narrowing of the outer ring of the prepucial sac—is a physiological phenomenon. In congenital phimosis, adhesion of the foreskin to the glans penis occurs. This adhesion (expressed to one degree or another in almost all infants) is caused by loose adhesions between the glans and the inner layer of the foreskin. Subsequently, when the foreskin is retracted past the glans, both congenital phimosis and the adhesions between the layers resolve on their own.

Acquired phimosis develops mainly on The basis of Inflammatory Diseases of the penis leading to cicatricial narrowing of the foreskin ring, as well As a result of trauma to it.

Acquired phimosis is subdivided into hypertrophic (the foreskin is elongated and protrudes forward like a trunk) and atrophic (the skin tightly embraces the glans). In rare cases, Connective Tissue adhesions exist from birth or form later between the foreskin and the glans.

The main danger of phimosis lies in its complications. In severely pronounced phimosis in infants, dilation of the Urinary Tract segments can develop, leading to Hydronephrosis and Pyelonephritis. Significant narrowing of the foreskin obstructs urination up to Acute Urinary Retention.

Stagnation of urine and the decomposition of smegma within the cavity of the prepucial sac provoke the development of Balanitis and Balanoposthitis. Persistent itching and irritation trigger masturbation in children. With prolonged balanitis and balanoposthitis, the inflammatory process spreads to the navicular fossa and the entire glafular part of the urethra, leading to the development of significant strictures that cause difficult urination and chronic urinary retention. The resulting constant tension of the abdominal wall Muscles contributes to the development of hernias, hydrocele, and rectal prolapse, especially in the presence of a predisposition to such conditions.

The Diagnosis of phimosis is based on characteristic patient complaints and typical Changes in the appearance of the penis. Physiological phimosis requires no treatment, but if spontaneous opening of the prepucial cavity does not occur by 4 years of age, attempts are made to free the glans penis from the foreskin by gently pulling it by hand toward the base of the penis. An absolute indication for surgery is significant narrowing of the foreskin causing difficulty in urination. Evidence of the latter is a thin stream of urine and ballooning of the foreskin during urination. An indication for surgery is also frequently recurring balanoposthitis (due to relative narrowing of the foreskin), in which urination may not be difficult, yet all conditions exist for the accumulation of smegma in the prepucial sac and the onset of an inflammatory process. The main surgical method is circumcision (circumcisio).

Paraphimosis is the entrapment of the glans penis in the area of the corona glandis by a narrowed transitional fold of the foreskin. It develops more often as a complication of phimosis, when the foreskin retracted behind the glans fails to return to its normal position, creating a constricting ring that causes edema of the glans and foreskin with impaired Blood Circulation, potentially leading to Necrosis of the glans.

Treatment of paraphimosis consists of reducing the glans. Moreover, reduction presents no difficulty During the first 1-2 days, which is why paraphimosis therapy is classified as an urgent measure. Edema is eliminated by puncturing the edematous ring in several places with a thick needle, after which the fluid is squeezed backward toward the base of the penis. The reduction itself is performed as follows: the fingers of both hands, excluding the thumbs, grasp the constricting ring and pull it over the glans, which is then pushed through the ring using the thumbs of both hands. Following the reduction of the glans, treatment is carried out using compresses and warm baths with potassium permanganate, rivanol, or furacilin until the edema disappears.

In cases where severe edema develops not only in the foreskin but also in the glans, and reduction is impossible, it is necessary to longitudinally incise the constricting ring in 3-4 places. Following the incision, the edema subsides quite rapidly. Subsequent treatment is conducted using standard anti-inflammatory Methods.