Congenital Prepubic Sinus Research Articles

Congenital Prepubic Sinus – A Case Report and Review of Latest Literature

Introduction: Congenital prepubic sinus (CPS) is a rare congenital abnormality in the urinary tract in the form of remnant ducts that extend from skin openings near the pubic symphysis to various areas. Due to its anatomical and pathological variation, the clinical manifestation of this condition has a wide spectrum. This paper shows one of the youngest reported cases of CPS that was successfully treated with surgery. This paper aims to elucidate and provide the current literature review in order to increase awareness towards CPS diagnosis in general practitioners, pediatricians, and surgeons. Case report: Here we present a 2-months-old female baby with a CPS that presented a purulent discharge and recurrent abscess from an opening since birth. Prior to surgery, the patient had visited multiple health care provider until a definitive diagnosis of CPS could be established, which was followed by the administration of topical antibiotic prior to surgery. The condition was diagnosed through abdominal CT imaging and treated with a simple surgical technique aided with methylene blue dye. Conclusion: Clinicians should consider the differential diagnosis of congenital anomaly such as CPS in a patient presenting with purulent discharge or erythema from accessory meatus in the pubic region.

A totally extraperitoneal approach for endoscopic resection of a congenital prepubic sinus through the pubic symphysis

BackgroundA congenital prepubic sinus (CPS) is a rare congenital anomaly in which a duct remnant extends from the skin opening near the pubic symphysis to various parts and the lesions are mostly located in the preperitoneal space. The totally extraperitoneal (TEP) approach is an operational method that provides a good field of view for the preperitoneal space. We report the CPS through the pubic symphysis in which complete resection was achieved by a TEP approach. TEP approach was minimally invasive and achieved satisfactory cosmetic outcome.Case presentationWe herein report the case of a 13-year-old boy with a fistula opening near the dorsal penis. He was admitted to our hospital due to fever and lower abdominal pain. Abdominal ultrasonography and computed tomography revealed an abscess inside a fistula lumen on the posterior surface of the rectus abdominis muscles in the midline of the lower abdomen. Under a diagnosis of CPS, which was located in the preperitoneal space, endoscopic resection was performed by a totally extraperitoneal approach. After making an umbilical incision, the rectus abdominis muscle was excised outward to expose the preperitoneal space. A single-port system was placed in the preperitoneal space. Three 5-mm-port trocars were inserted. As the preperitoneal cavity was expanded, a sinus connecting to the pubic symphysis was confirmed. The pubic symphysis did not connect with the bladder. Because the fistula was penetrated with the pubic symphysis, the remaining caudal fistula was removed from the body surface with a small spindle-shaped incision around the fistula opening. Finally, the sinus was completely resected, with confirmation from both the cranial side and dorsal side of the pubic symphysis. We were able to perform complete resection of the CPS with good visibility and without any peritoneal damage. There were no intraoperative complications. His postoperative course was uneventful during the 1-year follow-up.ConclusionsThe TEP approach may be feasible for the resection of a CPS and may allow safe and secure resection due to good visibility, even in pediatric patients.

Congenital prepubic sinus with dorsal penile curvature: a case report and literature review

BackgroundCongenital prepubic sinus (CPS) is a rare congenital anomaly and widely thought to be a variant of urethral duplication. Histological examination of this case gives a clue to this theory. CPS with dorsal penile curvature has been reported in previous publications, but their procedures to correct the curvature are different from this case.Case presentationA 10-year-old boy complained of the pain in the dorsal base of the penis. Physical examination revealed an accessory meatus located in the midline of the dorsal proximal penis and moderate dorsal penile curvature with deficient dorsal foreskin. Imaging examination showed that the meatus did not communicate with either normal urethra or urinary bladder, and ended blindly at the level of the symphysis pubis. The intact 4-cm-long sinus was completely separated and excised. Penile curvature was corrected after the dorsal proximal fibrous cord was detached. Histological examination confirmed the diagnosis of urethral duplication.ConclusionsThe histological result of this case supports the theory that CPS is a variant of the dorsal urethra. Moreover, this case indicates that the curvature in patients with CPS may be caused by the dorsal fibrous cord at the beginning and the operation should be conducted at an early age to avoid further development of the curvature during puberty.

Ultrasound Evaluation of Dermal Sinuses/Fistulas in Pediatric Patients.

A dermal sinus/fistula is a common condition; the relevant department should be consulted for appropriate treatment. It is important for radiologists to have adequate knowledge of these conditions to provide the correct diagnosis and recommend subsequent management. This review describes the following lesions: preauricular sinus, midline sinus of the upper lip, nasal dermoid sinus cyst, cheek fistula, first branchial cleft anomaly/sublingual branchial cleft anomaly, thyroglossal duct cyst/fistula, lateral cervical sinus/fistula, congenital dermal sinus/fistula of the anterior chest region, congenital skin sinus/fistula with a sternal cleft, and congenital prepubic sinus. On the basis of the skin orifice location and ultrasound images, radiologists can provide useful information to physicians.

Congenital prepubic sinus presenting with purulent discharge after circumcision: a case report

BackgroundCongenital prepubic sinus is a rare anomaly found in the midline of the lower abdomen. Congenital prepubic sinus is usually asymptomatic in neonates, and a diagnosis is often achieved later in life after spontaneous extrusion of purulent material from the pre-existing hole in the pubic region. We present a case of congenital prepubic sinus presenting with purulent discharge after circumcision.Case summaryA 4-year-old Caucasian boy presented to our urology out-patient clinic with purulent discharge from the distal part of the dorsum of his penis. He had a history of circumcision performed at a different center, 6 months ago. His parents stated that although various antibiotics were used, the purulent discharge continued for 6 months and the child had no complaints before circumcision. His condition was reported as superficial dorsal venous thrombosis, known as penile Mondor disease, in magnetic resonance imaging that was performed in the previous hospital. A physical examination revealed a small pinhole lesion at the distal part of his penis and a rigid cylindrical tube extending to the proximal side of his penis. We performed fistulography by injecting contrast material through a small angiocatheter and confirmed the diagnosis of prepubic sinus. Surgical exploration was performed and a long sinus, apparently ending as a fibrous tract at the anterior surface of his pubic symphysis, was found and resected.ConclusionsBefore congenital prepubic sinus surgery, it is critically important to rule out penile Mondor disease and the possibility of a circumcision complication (especially infective complications) mimicking congenital prepubic sinus.

Congenital prepubic sinus (an epispadiac variant of dorsal urethral duplication) with dorsal penile curvature in an adult man: a rare association

Urethral duplication is among a very rare congenital disorder with multiple anatomical variants reported. Urethral duplication of complete type is usually diagnosed during childhood with urinary incontinence or double urinary...

Congenital prepubic sinus: a series of six cases of extremely rare congenital anomaly

Congenital prepubic sinus (CPS) is a very rare congenital anomaly. The baby generally present with discharge from an opening situated in midline below umbilicus to root of penis in male or clitoris in female child. The etiology of this congenital anomaly is not exactly known. There is debate in etiology as one theory support anomalous anterior abdominal wall closure and another support variant of dorsal urethral duplication. Here we are presenting the six cases of CPS with their management and brief discussion on theories that have been proposed for their etiology.

Congenital pre-pubic sinus: An embryological enigma

Abstract Congenital pre-pubic sinus is a rare congenital anomaly of the urinary tract with uncertain etiology. It is one of the variant of dorsal urethral duplication. The presentation is like a sinus tract over the penile skin or at the pre-pubic area. It extends towards the anterior wall of the urinary bladder or umbilicus. We report a case of congenital pre-pubic sinus in a 5 year old boy due to its rarity.

Congenital prepubic sinus: Rare diagnosis with unclear etiology

Abstract The congenital prepubic sinus is a rare type of fistula with a broad range of anatomical and histological diversity. We report the case of an 8-month-old boy with a congenital prepubic sinus where immunohistochemistry studies showed only squamous epithelium and no transitional epithelium. The etiology of this disorder is still unclear and the most recent case reports suggest that the fistula might be a variation of a dorsal urethral duplication. We recommend performing immunohistochemical studies to further clarify the etiology, as the fistula may be caused by different developmental disorders.

Congenital prepubic sinus: A case report and review of the literature

Abstract Congenital prepubic sinus (CPS) is an extremely rare anomaly, which is often associated with purulent discharge from a midline opening overlying the pubis. CPS was first described by Campbell et al. in 1987 and they suggested that it might represent a variation in normal embryological development. Several theories have been proposed regarding the pathogenesis of CPS. However, the etiology of CPS is still unclear because the anatomical and pathological features of CPS often differ from each other. We report a case of CPS and review the literature to improve the global understanding of CPS.

Congenital prepubic sinus: Report of two cases

Congenital prepubic sinus is a rare disorder with fewer than 30 cases reported in the literature. The origin of the sinus and its tract is unclear but urethral duplication, cloacal remnant or midline closure defect are amongst the postulated mechanisms for the development of the sinus. Chronic discharge and infection are the main indications for surgery. Although surgery is the definite way of correction, timing and extend of surgery are not well documented due to the limited number of cases. Here we present two cases with congenital prepubic sinus, a four month old girl and a five years old boy, who were admitted with discharge through the external opening of the prepubic sinus which are shown not to have a connection with urinary system and are managed by limited surgical excision. Postoperative courses were uneventful and no relapse or complications were encountered. Histological examination revealed that the sinus tract is lined with squamous stratified epithelium without any other significant finding. Although the classification and definition of congenital prepubic sinus is not clear, extensive imaging modalities and surgical procedures are not necessary in most conditions as these can create additional burden for the patient and the healthcare system and may cause complications at the cost of nothing.

Congenital prepubic sinus associated with a urachal remnant: report of a case

Congenital prepubic sinus is a rare congenital anomaly situated in the midline of the lower abdomen. We report a case of congenital prepubic sinus, closely associated with a urachal remnant. Preoperative magnetic resonance imaging showed clearly that the sinus tracked the urachus caudally. This finding supports the theory that the anomaly is caused by abnormal remnant tissue originating from the cloacal membrane, which tracks the allantois duct caudally along with fetal longitudinal growth.

Congenital prepubic sinus: A variant of epispadiac dorsal urethral duplication

Congenital prepubic sinus is a tract originating in the skin overlying the base of the penis. Its embryologic basis is still debated. We present a 9-month-old boy with a recurrent muco-purulent discharge from a tiny opening in the midline prepubic area on the base of the penis. Examination revealed a ventrally hooded prepuce, dorsal chordee, penile torsion to the left, and a 3-mm-diameter prepubic sinus 1 cm from the base of the penis. Histology of the excised tract showed a transitional epithelium. We believe our case is an epispadiac variant of dorsal urethral duplication.

P-237 A case of congenital prepubic sinus(Poster Presentation Umbilicus, hernia, testis 1,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

P-237 A case of congenital prepubic sinus(Poster Presentation Umbilicus, hernia, testis 1,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

Congenital prepubic sinus: A case report

Congenital prepubic sinus is an exceptional disorder of uncertain origin. These sinuses may represent a variant of epispadiac duplication or dorsal urethral duplication of the urethra.We present a case of isolated blind ending prepubic congenital sinus in a 5-year-old male child, which revealed transitional epithelium lining proximally, and squamous epithelium distally. This entity presents with either an opening in the prepubic region and/or persistent mucoid discharge. Excision leads to a permanent cure. Keywords :Congenital prepubic sinus, Urethral duplication, Epispadias. African Journal of Paediatric Surgery Vol. 4 (1) 2007: pp. 49-50

Congenital Prepubic Sinus: A Variant of Urethral Duplication

Congenital prepubic sinus (CPS) is a rare congenital anomaly which is associated with discharge from an opening overlying the pubis symphysis. Various names including congenital prepubic sinus, subpubic fistula, prepubic dermoid sinus, and suprapubic dermoid sinus, were us ed to identify these lesions. The etiology of CPS is still controversial. There are 2 theories that have been proposed, including an anomalous anterior abdominal wall closure or variant of dorsal urethral duplica- tion.1-4 To explore the etiology, we performed immuno- histochemical study with 3 cytokeratin antibodies that are known to be specific for differentiation between transitional and squamous epithelium.

P-299B Three cases of congenital prepubic sinus(Chest and abdominal wall, the 44th Annual Meeting of Japanese Society of Pediatric Surgeons)

P-299B Three cases of congenital prepubic sinus(Chest and abdominal wall, the 44th Annual Meeting of Japanese Society of Pediatric Surgeons)

Pseudo-clitoromegaly associated with congenital prepubic sinus

We operated on a 12-year-old girl who had clitoromegaly and a sinus on the midline prepubic area congenitally. The prepubic sinus appeared to point to the clitoris on the preoperative magnetic resonance image, but the relation between the sinus and clitoromegaly was unclear. Gray-brown discharge was emitted at the site of dissection between the prepuce and clitoris and the size of the clitoris became normal. The sinus was excised, revealing a tract 1.5 cm long that extended to the retropubic sinus, and ended in a fibrous tract that was linked to the clitoris. This suggested pseudo-hypertrophy because of the discharge collected in the end of the prepubic sinus.

Congenital prepubic sinus: an epispadiac variant of urethral duplication: Case report and review of literature

Urethral duplication is rare; the duplicated urethra is almost always dorsal to the normal urethra, which contains the sphincteric mechanism. It is very rare to present as a prepubic sinus. Urethral duplication does not represent a uniform entity making it difficult to find an unequivocul and comprehensive classification. A case of epispadiac variant of urethral duplication is reported in which the duplicated urethra presents as a prepubic sinus, with complete cure and normal urinary and sexual functions after maturity.

La duplication urétrale chez le garçon : à propos de 4 cas

Urethral duplication is a rare anomaly, affecting mainly boys. The clinical presentation varies because of the different anatomical patterns of this abnormality. We report 4 cases of urethral duplication in children. An epispadiac duplication was present in 1 case, hypospadiac duplication in 1 case, Y-duplication in 1 case and a congenital prepubic sinus in the last case. The pre-operative probe was based on urethrocystography and fistulography. The surgical management included excision of the duplicated urethra in 3 cases. Transurethral incision of the intra-urethral septum was performed in the case of hypospadiac duplication. The characteristics of male urethral duplication are reviewed.