Male and female aphallia associated with severe urinary tract dysplasia
Autor: | Edward F. Reda, Ariella A. Friedman, Lane S. Palmer, Paul Zelkovic, Israel Franco |
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Rok vydání: | 2015 |
Předmět: |
0301 basic medicine
Male medicine.medical_specialty Aphallia Urology 030232 urology & nephrology Vesicoureteral reflux Severity of Illness Index Clitoris 03 medical and health sciences 0302 clinical medicine Ureter Bilateral Renal Dysplasia medicine Humans Abnormalities Multiple Hydronephrosis Bladder diverticulum business.industry Infant Newborn medicine.disease 030104 developmental biology Urethra medicine.anatomical_structure Dysplasia Urogenital Abnormalities Pediatrics Perinatology and Child Health Female business Penis |
Zdroj: | Journal of pediatric urology. 12(4) |
ISSN: | 1873-4898 |
Popis: | Summary Introduction Aphallia is exceedingly rare (1/30 million births). Previous reports have provided limited detail on associated urinary tract findings. Objective We reviewed urinary tract anomalies in two boys with aphallia (patients 1 and 2) and a girl with urinary tract dysplasia, a similar external appearance and lack of corporal tissue (patient 3), also consistent with aphallia. Case reports (Figure) Patients 1 and 2 both had a 46XY karyotype, bilateral descended testes in well-formed scrotums, and posterior skin tags containing rudimentary urethras. Patient 1 had a focal area of urethral narrowing; a posterior bladder diverticulum, which drained a ureter; bilateral grade 5 vesicoureteral reflux, with a right partial renal duplication; and hydronephrosis of all moieties. Patient 2 had posterior urethral valves and a bladder diverticulum. Right ureterovesical junction obstruction required a tapered reimplant and later conversion to right-to-left transureteroureterostomy. Patient 3 had a 46XX karyotype and fused, well-formed labia majora. A posterior skin tag was associated with a stenotic urogenital sinus, beyond which were a vagina posteriorly and a right refluxing ureter anteriorly. The left ureter was absent, and a miniscule pouch represented a maldeveloped or absent bladder. Laparoscopy revealed ovaries and normal Mullerian structures. Bilateral renal dysplasia necessitated renal transplant and the creation of an ileocecal neobladder and Mitrofanoff channel. Corporal tissue was diminutive or absent in all. Discussion We see from these three patients that corporal tissue absence can occur in both male and female patients. We propose that the term aphallia can apply to both sexes, as it is the absence of corporal tissue that defines this condition. This is the only report to include and characterize findings in both male and female aphallia patients. Labioscrotal folds develop with a smooth appearance, and, posteriorly, a urethral orifice or Urogenital (UG) sinus with skin tag may be seen. Obstruction at the level of the urethra was common. Severe urinary tract dysplasia was seen in all, a finding not consistently seen or characterized in previous reports. Conclusion In girls with severe urinary tract dysplasia and characteristic genital ambiguity, aphallia should be considered. Co-occurrence of aphallia and severe urinary tract dysplasia warrants further urinary tract imaging in all aphallia patients, including voiding cystourethrography, renal bladder ultrasound, and serum creatinine level. Urinary tract reconstruction may be performed without hampering future penile reconstruction, due to modern phallic reconstructive techniques. Download : Download high-res image (514KB) Download : Download full-size image Figure . Aphallia in two male patients (left, middle) and one female patient (right). |
Databáze: | OpenAIRE |
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