Prepenile scrotum (PPS) also known as penoscrotal transposition (PT) is a rare anomaly of external genitalia(1}. It is usually associated with severe hypospadias and other congenital anomalies(2,3). Such a case associated with high anorectal malformation and coronal hypospadias seen recently by us is reported.

Case Report

A 6-month-old male child presented with abdominal distension. The child was operated previously for ARM. Examination revealed averagely built child. Abdomen was distended and gut loops were visible. There was a healed scar in the left lower abdomen. The penis was of normal size. The prepuce was hooded and the uretheral meatus was subcoronally located. Scrotum was prepenile and both the testes were felt within the scrotum (Fig. 1). Neoanus was normal and there was a well healed scar in the infracoccygeal region. Rest of the physical as well as systemic examination was normal. Hemogram, urianalysis and X-ray chest were normal, X-ray abdomen in erect position revealed multiple air fluid levels. Ultrasonographically both kidneys and bladder were normal. Patient was managed conservatively as a case of postoperative adhesive obstruction and responded very well. The patient is presently awaiting surgery for scrotal transposition.

Fig. 1. Clinical photograph showing prepenile scrotum with well developed penis and the neo-anus.

Discussion

PT is a rare anomaly characterized by malposition of penis in relation to scrotum(1). Embryologically it results from either delay, failure or incomplete migration of labioscrotal folds cauded to penis(2,4,5). PT may be complete or partial. In complete transposition the scrotum covers the penis which emerges from the perinuem. In incomplete transposition the penis lies in the middle of the scrotum(1).

Complete transposition with full development of penis and scrotum is rare and only 10 cases have been reported so far(6). Both forms of transposition are associated with severe degree of hypospadias(1). Sometimes very severe type of congenital malformation like caudal regression syndrome(2,3) may be associated with PT. Diagnosis of PT is quite apparent at birth. But it may be associated with other urogenital, lumbosacral and ano-rectal malformations which may require urgent attention(4).

These patients should be evaluated for other severe associated malformations at birth. Some of these may be incompatible with life and prognosis explained accordingly. Other patients can be taken up for reconstructive surgery at 2-3 years age. Both multistage(4,5) and single(1,7) procedures for correction of PT and associated genital anomalies have been described. In severe cases transposition should be corrected pre-ferably prior to urethroplasty for better results.

References

1. Parovic S, Vukadinovic V. Penoscrotal transposition with hypospadias: One stage repair. J Urol 1992; 148: 1510-1513.

2. Lage JM, Driscoll SG, Bieber FR. Transposition of the external genitalia associated with caudal regresssion. J Urol 1987; 138: 387-389.

3. Miller SF. Transposition of the external genitalia associated with the syndrome of caudal regression. J Urol 1972; 108: 818-820.

4. Glenn JF, Anderson EE. Surgical correction of incomplete penoscrotal transposition. J Urol 1973; 110: 603-605.

5. Mori Y, Ikoma F. Surgical correction of incomplete penoscrotal transposition associated with hypospadias. J Pediatr Surg 1986; 21: 46-48.

6. Cohan-Added N, Zarafu IW, Hanna MK. Complete penoscrotal transposition. Urology 1985; 26: 149-150.

7. Erlich RM, Scardino PT. Surgical correction of scrotal transposition and perineal hypospadias. J Pediatr Surg 1982; 17: 175-177.