Penile

Anomalies
 Eka Deviany Widyawaty NIM. 011524653001
 Eka Fitriani NIM. 01152465300

- PATOLOGI REPRODUKSI PRIA

 Anatomy Penis
 Anomali Penile

Prepuce Abnormal Penile Inconspicuous Abnormal Penile

Micropenis Penile Masses
(Foreskin) Number Penis Orientation

1. Campbell-Walsh Urology Vol 1. 10th ed. Philadelphia: Elsevier. 2012

 Prepuce (Foreskin)

PHIMOSIS PARAPHIMOSIS

1. Campbell-Walsh Urology Vol 1. 10 th ed. Philadelphia: Elsevier. 2012

 Phimosis  inability to retract the
prepuce 1

Etiology :1
 Epithelial Debris
 Intermittent Penile Erections

Sign :
 Sulit berkemih
 Pancaran air kencing berkurang
Management : 1
 Topical corticosteroid creams
 Topical betamethasone 2x1 21d side effect : candidal dermatitis
 Circumcision

1. Campbell-Walsh Urology Vol 1. 10th ed. Philadelphia: Elsevier. 2012

 Paraphimosis  entrapment of the
prepuce behind the glans penis1

Etiology :
tindakan menarik prepusium ke proksimal
dan lupa di kembalikan ke posisi semula
saat buang air kecil
Sign 1 :
 edema of the foreskin
Management :
 Reduction of the paraphimotic ring  manual compression of the glans
(application of an iced glove for 5 minutes), application of granulated
sugar for 1 to 2 hours, and placement of multiple punctures in the
edematous skin1
 Second circumcision2
1. Campbell-Walsh Urology Vol 1. 10 th ed. Philadelphia: Elsevier. 2012
  Circumcision Complication

Penile Skin Complication

1. Campbell-Walsh Urology Vol 1. 10th ed. Philadelphia: Elsevier. 2012

 Circumcision Complication

Meatal Complication

1. Campbell-Walsh Urology Vol 1. 10th ed. Philadelphia: Elsevier. 2012

Penile Skin Complication  The amount of penile skin excised
 Excessive skin excision can result in penile chordee, torsion, and
lateral deviation.
 Management : penile skin flaps or Z-plasty for closure.

Meatal Stenosis (Normal urethral meatus is 10 Fr before 4 yo)

 Symptoms : (1) typical urinary stream deviation in an
upward direction
(2) a narrow, high-velocity stream
(3) penile pain at the initiation of micturition
 Meatal Stenosis
 Management : Meatotomy or meatoplasty (urethral mucosa to
the glans)

The most serious complications associated with circumcision are

penile trauma, including urethral injury, excision of the glans and/or
penile shaft, and penile necrosis.
2. Abnormal Penile Number

APHALLIA DIPHALLIA
 Aphallia  failure of development of
the genital tubercle

 Karyotype  46 XY, well-developed

scrotum with descended testes and
an absent penile shaft

 80% of patients had presphincteric

urethral communications and there
was a 36% neonatal mortality rate
Management :
 Check Karyotipe, malformations of the urinary tract
 MRI  determining the severity of the defect
 Consequently, the recommendation to perform gender
reassignment should be made carefully and only after full
evaluation by an ambiguous genitalia assessment team and
parental counseling.

 Some of these patients have a male gender identity despite

reconstruction as a female, presumably because of in utero or
postnatal sex steroid imprinting
 Diphalia  Duplication of the penis2

Etiology : anomalies take place in the

process of migration ventrally and fusion
of the paired mesodermal anlagen by the
15th week of gestation 2

Defect : erectil function2

Management : Penis reconstruction2

2. Pande Made Wisnu Tirtayasa,1 Robertus Bebet Prasetyo,2 and Arry Rodjani1 Diphallia with Associated Anomalies: A Case Report and Literature Review .
December 2013
3. Inconspicuous Penis

BURIED PENIS WEBBED PENIS

1. Campbell-Walsh Urology Vol 1. 10th ed. Philadelphia: Elsevier. 2012

4. Micropenis

 Micropenis  normally formed penis

MICROPENIS that is at least 2.5 standard deviations
(SD) below the mean size in stretched
length for age .

 Results from a hormonal abnormality

that occurs after 14 weeks of
gestation.

1. Campbell-Walsh Urology Vol 1. 10th ed. Philadelphia: Elsevier. 2012

 The initial evaluation of a child with micropenis should include a
thorough medical history, physical examination, and a
karyotype at birth.

 Therapy : Androgen
5. Abnormal Penile Orientation

PENILE CURVATURE PENILE TORSION

1. Campbell-Walsh Urology Vol 1. 10th ed. Philadelphia: Elsevier. 2012

 Penile Curvature  may occur along
the vertical (i.e., ventral or dorsal
direction) or horizontal (i.e., lateral
direction) plane of the penis.

Etiology :
 congenital or acquired after penile
surgery (circumcision, hypospadias
repair)
 trauma and has consequences
related to cosmesis
 body image as well as future sexual
difficulties

Wein. Alan J, Kavoussi. Louis R, Partin. Alan W, Peters. Craig A. 2012. CAMPBELL-WALSH UROLOGY, ELEVENTH EDITION . Philadelphia. elsevier
 Penile torsion  rotational deformity of
the penile shaft, usually in the counter
clockwise direction
Penile torsion may also be associated with
 hypospadias
 chordee
 other abnormalities involving the penile
skin shaft
 such as dorsal hood deformity
without a urethral abnormality

Wein. Alan J, Kavoussi. Louis R, Partin. Alan W, Peters. Craig A. 2012. CAMPBELL-WALSH UROLOGY, ELEVENTH EDITION . Philadelphia. elsevier
 A. Torsion, 160° with
glanular hypospadias.
B. Repaired with dorsal
dartos flap, note also
some skin
realignment.

a. Torsion, 150°,
isolated.
b. Appearance
after retraction
c. Repaired with
corporopexy

Elbatarny. A. Mohammed and Ismail. K. Ahmed. 2014. Penile torsion repair in children following a ladder step: Simpler step are ussually sufficient. Journal of Pediatric Urology, 10 : 1187-1192.
6. Penile Masses

Parameatal
Cyst of the Median Raphe
Urethral Cyst

1. Campbell-Walsh Urology Vol 1. 10th ed. Philadelphia: Elsevier. 2012

 Parameatal Urethral Cyst  anomaly and
appears as a small blister in proximity to the
urethral meatus.

Etiology :
 Occlusion of paraurethral ducts
 Faulty preputial separation from the glans
along the coronal sulcus.

Treatment:
Complete excision of the cyst with the patient
under anesthesia, with care taken not to
cause meatal stenosis.

Wein. Alan J, Kavoussi. Louis R, Partin. Alan W, Peters. Craig A. 2012. CAMPBELL-WALSH UROLOGY, ELEVENTH EDITION . Philadelphia. elsevier
  Congenital epidermal cysts tend to
form along the median penile raphe
on the glans or penile shaft,
scrotum, or perineum.

 These congenital lesions may result

from epithelial rests that become
buried during the urethral infolding
process or represent a monodermal
teratoma.

Wein. Alan J, Kavoussi. Louis R, Partin. Alan W, Peters. Craig A. 2012. CAMPBELL-WALSH UROLOGY, ELEVENTH EDITION . Philadelphia. elsevier
6. Penile Masses

Inclusion Cysts

1. Campbell-Walsh Urology Vol 1. 10th ed. Philadelphia: Elsevier. 2012

  The most common acquired cystic
lesion of the penis is entrapped
smegma under the unretractable
prepuce.
 Epidermal inclusion cysts may form
after penile surgery, including
circumcision and hypospadias repair,
Inclusion Cysts owing to islands of epithelium within
the subcutaneous tissue
 Management  Excision of the epidermal inclusion

Wein. Alan J, Kavoussi. Louis R, Partin. Alan W, Peters. Craig A. 2012. CAMPBELL-WALSH UROLOGY, ELEVENTH EDITION . Philadelphia. elsevier
 Congenital Penile Nevi  pigmented lesions
that can form on the glans and penile
shaft.

Classified (location melanocytes):

 dermal (involving only the dermis)
 junctional (involving only the dermal-
epidermal junction)
 compound (involving the dermis and
Congenital
dermal-epidermal junction)
Penile Nevi

Superficial and benign and should be excised

 Juvenile Xanthogranuloma  Uncommon benign, self-limiting
lesion of the penis predominantly seen in infancy or early childhood.

 These lesions appear as solitary or multiple pigmented (yellow,

orange, gold, brown, or red) nodules of rapid onset.

 They measure 2 to 20 mm in diameter and are well demarcated, firm,

and rubbery.

 These lesions can affect the penis or scrotum, with as many as 20%
being present at birth.
 a period of 1 year of
expectant monitoring
is advised to avoid
potentially
unnecessary ablative
genital surgery.
Penile Juvenile Xanthogranuloma
Figure Penile juvenile xanthogranuloma (yellow flat-topped plaque) with
adjacent café-au-lait macule

AlGhamdi. K M, and Al Suwaidan. S N. .2010. Penile juvenile xanthogranuloma and neurofibromatosis type-1: risk association with juvenile myelomonocytic leukaemia? .
TERIMAKASI
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