Penile Research Articles

Summary of surgical experience of 14 cases hermaphroditism

Objective To evaluate the surgical therapy for hermaphrodites.Methods Retrospective analysis the clinical data of 14 cases of different types of hermaphrodites treated in our hospital from Jan.1995 to Dec.2012,including 4 cases of female pseudohermaphrodite,2 cases of male sex reversal syndrome,3 cases of male pseudohermaphrodite and 5 cases of true hermaphrodites.The gender selection and the following surgical treatment were provided according to patients' protopathy,age,social gender,their desires and their parents' wishes.Results Out of 14 cases,10 cases were operated to women (4 cases of female pseudohermaphrodite,1 case of male pseudohermaphrodite,5 cases of true hermaphrodites),4 patients were operated to men (2 cases of male sex reversal syndrome,2 cases of male pseudohermaphrodite).The operation is relatively easy for the patients who are operated to female,and they all have well developed secondary sexual characteristics and satisfied sexual function after 3 to l0 years of follow-up.For the 4 patients who were operated to male,their penis and testicles are well developed,and 1 case had already entered adolescent period,whose morning erection can be seen normally but no spermatorrhea detected.Further observation is necessary to decide whether he has reproductive function.Conclusions The diagnosis and treatment for children external genitalia malformations should be taken as early as possible.A reasonable choice of gender,the appropriate surgical correction,and hormone replacement therapy in some cases,are feasible treatment with satisfactory effect. Key words: Hermaphroditism; Surgical procedures, elective

Clinical application and single factor analysis of onlay island flap urethroplasty

Objective To investigate the indications and complications of onlay island flap urethroplasty in hypospadias. Methods Retrospective analysis 51 cases who received the onlay urethroplasty from Mar.2005 to Sep.2012 at the First Affiliated Hospital of Guangxi Medical University.Their ages were from 2 years to 12 years, the median age was 4 years and 3 months.Forty-three cases received the operation for the first time, 8 cases were re-operation.The prepuce island flaps were implemented in all cases.Factors which contributed to the successful operation ratio were compared, such as the levels of penile curvature, the lengths of urethral defects, first operation or reoperation, the size of glans. Results The operation achievement ratio was 82.4%(42/51 cases). There were 7 cases urethrocutaneous fistula(6 cases were then cured by reoperation, 1 case healed naturally). One case had urinary meatus had retraction.There was another case with persisting penile curvature.Some differences in factors had no statistical significance, such as the levels of penile curvature, the lengths of urethral defects, first operation or reoperation(χ2=0.249, 0.287, 1.208; all P>0.05). The difference in glans size had statistical significance(χ2=3.393, P<0.05). Conclusions Onlay urethroplasty was suitable for the cases of coronary sulcus of penis and extremitas anterior penis, but for proximal cases, this therapy must be applied very carefully because of persisting penile curvature.For some reconstruction cases, Onlay urethroplasty was suitable, but the island flap must be designed flexibly.Urethrocutaneous fistula was the most complication, especially in some small flat glans. Key words: Hypospadias; Urethroplasty; Indication; Complication

Benign mast cell hyperplasia and atypical mast cell infiltrates in penile lichen planus in adult men.

Introduction. Lichen planus (LP) is a chronic cytokine-mediated disease of possible auto-immune etiology. 25% of men have anogenital manifestations. Erosive penile LP causes a scarring phimosis of the foreskin in uncircumcised men. Mast cells as potent immune modulators have been implicated in a number of autoimmune and chronic inflammatory diseases, but have not been investigated in LP. Material and Methods. Formalin-fixed tissues of 117 circumcision specimens of adult men affected by LP were evaluated for the extent of mast cell and lymphocyte infiltrates, characterized immunohistochemically with antibodies to CD 3, 4, 8, 20, 21, 25, 30, 117c and human mast cell tryptase. Specimens with dense mast cell infiltrates were analyzed for point mutations of the c-kit gene (D816V). Results. Unaffected skin and modified mucosa of foreskins contained ⟨5 mast cells/mm². The inflammatory infiltrate of LP-lesions displayed ⟨15 mast cells/mm² in 33/117 foreskins, 16-40 mast cells/mm² in 22/117 and ⟩40 mast cells/mm² (average 70, range 40-100) in 62/117 foreskins. Lesional mast cells of 29/117 (24%) foreskins showed aberrant CD25-expression and/or spindled morphology, with 11/29 men having erosive LP, 13/29 a lymphocytic vasculitis and 1/28 a systemic mastocytosis. Neither CD30-expression nor c-kit mutations were identified. Atypical mast cell infiltrates in LP correlated with high disease activity, erosive LP and presence of lymphocytic vasculitis Conclusions. Increased mast cells in penile LP, mostly representing a benign hyperplasia/activation syndrome, suggests them as targets for innovative therapy options for symptomatic LP-patients not responding to corticosteroid therapy. Presently, the biological implications of atypical mast cell infiltrates in penile LP are unknown.

Contrast radiographic study of venous drainage of the corpus cavernosum and the corpus spongiosum of the cat penis.

The aim of this study was to determine the drainage routes of the corpus cvernosum penis and the corpus spongiosum penis in the cat using contrast cavernosography. Five male cats, 1.5-2.5 years old, weighing between 4.5 and 5.5 kg were investigated. The cats were anesthetized and the root and the proximal part of the penis were exposed by an incision on the perineum reaching the scrotum. Each cat was radiographed in lateral and dorsal recumbency before and during injection of contrast medium into the erectile bodies. The corpus spongiosum penis was injected at the bulb of the penis and the corpus cavernosum penis at the root. Injection of contrast media into the cavernous bodies showed that both the external and internal iliac veins drain the erectile bodies into the caudal vena cava. Drainage from the corpus spongiosum penis was from the bulb for the proximal part and from the glans for the distal part. The corpus cavernosum penis was drained only proximally, from the crura. There was a network of veins above the pelvic symphysis and the drainage of erectile bodies where through various routes into the internal and external iliac veins.

Penile metastasis from prostate cancer: a case report.

Metastatic involvement of the penis is rare. About 80% of secondary lesions originate from pelvic primary tumors, mainly bladder and prostate. We present a case of prostatic mucinous adenocarcinoma with penile metastasis symptomatic for pain, which was treated with external-beam radiation (35 Gy/14 fractions; 2.5 Gy daily) combined with androgen deprivation, resulting in complete pain relief and objective response after treatment.

Tunica vaginalis flap cover in hypospadias cripples: Our experience in a tertiary care center in India

Objective: The objective of the following study is to assess the outcome of treatment with tunica vaginalis flap cover in cases of proximal penile hypospadias cripples. Materials and Methods: This retrospective study included cases of proximal penile hypospadias cripples managed by thiersch-duplay urethroplasty. Cases were divided into three groups. Group I included cases with tunica vaginalis flap, group II with dartos flap and group III included staged hypospadias repair on Bracka's principle. All cases were managed by a uniform protocol. Outcome was assessed at day 10 after stent removal and at first follow-up. Urethroplasty was considered successful in case with no leak. P value was considered to be significant if less than 0.05. Results: Out of 67 cases, 18 cases were in group I, 24 cases were in group II and 24 were in group III. They formed the study group. Leak at the time of stent removal was present in 1/18 (5.57%), 4/24 (16.67%), 2/24 (8.33%) cases in group 1, II and III respectively (P = 0.04 and 0.4). Leak at the time of first follow-up was present in 1/18 (5.55%), 5/24 (20.83%) and 3/24 (25%) cases in group I, II and III respectively (P = 0.03 and 0.3). Complete disruption of urethroplasty was present in 1/18 (5.57%), 2/24 (8.83%) and 1/24 (4.16%) cases in group I, II and III respectively (P = 0.1). The overall success rate in group I, II and III were 15/18 (83.83%), 13/24 (54.16%) and 18/24 (75%) respectively (P = 0.01 and 0.1). Conclusions: Tunica vaginalis flap reinforcement in cases of hypospadias cripples is a viable and reliable option. This should be favored over dartos flap.

The role of intrinsic pathway in apoptosis activation and progression in Peyronie’s disease

Peyronie’s disease (PD) is a connective tissue disorder where formation of fibrous plaques in tunica albuginea (TA) and erectile tissue can result in penile deformity, pain, and erectile dysfunction. Fibrosis, its major pathological manifestation, arises from fibroblast proliferation and accumulation of extracellular matrix; PD progresses with formation of plaques or even ectopic calcification having the appearance of scar tissue, which prevent TA expansion during erections. The mechanisms underpinning PD are unclear, and relatively little is known about the disease itself. To date corrective surgery is the sole effective treatment. A greater understanding of PD pathophysiology at the molecular level has the potential to help develop novel medical therapeutic approaches. The aim of this study was to investigate the activation of the apoptotic intrinsic apoptotic pathway in plaques from PD patients. Tunica albuginea from either PD and control patients were assessed for the expression of bax, bcl-2, caspase 9 and 3 using immunohistochemistry, and by measurement of apoptotic cells using TUNEL assay. Bax overexpression was observed in metaplasic bone tissue, in fibroblasts and in myofibroblast of plaques from PD patients. Little or no bcl-2 immunostaining was detected in samples from either patients or controls. Caspase 3 immunostaining was very strong in fibrous tissue, in metaplasic bone osteocytes and in primary ossification center osteoblasts. Moderate caspase 9 immunostaining was seen in fibrous cells plaques and in osteocytes and osteoblasts of primary ossification centers from PD patients. Control samples were negative for caspase 9 immunostaining. In PD patients the TUNEL immunoassay showed intense immunostaining of fibroblasts and myofibroblasts, the absence of apoptotic cells in metaplasic bone tissue and on the border between fibrous and metaplasic bone tissue. Apoptotic cell death occurs in stabilized PD plaques and is partly induced by the intrinsic mitochondrial pathway. The present findings can have clinical implications and may help devise improved treatment strategies. A therapeutic approach aimed at enhancing apoptosis-inducing molecules would at least help delay the progression of PD. Identification of target molecules for gene construct or biological or chemical reagent delivery to target sites could contribute to induce PD plaque stabilization.

Castrati singers: surgery for religion and art.

The act of castration was practiced from ancient times. In countries of Middle and Far East, castration was often done to provide eunuchs as guardians of the harems. In Europe and especially in Italy, it was carried out to preserve the male voice unbroken into adult life. From 16th century till the end of 18th century, castrati singers dominated opera with their supernatural voices. Boys were castrated mainly before the age of 9 years and when they grew up they had feminine characteristics, such as smooth, hairless bodies, breasts, infantile penis. The training procedure to become a castrato singer was very intense and lasted up to ten years. The most common surgical technique was either to sever the spermatic cords or crush the testis with the fingers. The voice of a castrato was the outcome of a larynx the size of a child's combined with the lung volume of an adult male. The castrati singers became superstars who dominated opera, singing both male and female roles for more than 200 years. Castrated for art, the beauty, range and flexibility of their voices raised them to mythical status.

Fracture of Both Rods of a Malleable Penile Prosthesis: A Case Report

DOI: 10.4328/JCAM.753 Received: 18.07.2011 Accepted: 28.08.2011 Printed: 01.03.2014 J Clin Anal Med 2014;5(2): 154-5 Corresponding Author: Berat Cem Ozgur, Libya Cad. 62\17 06650 Kucukesat, Ankara, Turkiye. GSM: +905056893980 E-Mail: bcemozgur@hotmail.com Ozet Literaturde bukulebilir penil protezler ile ilgili sadece birkac olguda mekanik bozukluk bildirilmistir. Altmisalti yasinda AMS 650® (American Medical Systems, Minnesota) marka protezi bes yildir kullanan erkek hasta son birkac haftadir olan cinsel iliskide zorluk sikayeti ile klinigimize basvurdu. Preoperatif goruntuleme ve takiben yapilan cerrahi eksplorasyon ile her iki parcada kirilma tespit edildi. Islev gormeyen protez yeni bir AMS 650® bukulebilir protez ile degistirildi. 12 aylik takibimizde yeni protez ile ilgili herhangi bir problem gozlenmedi.

Anorectal physiology evaluation after male-to-female sex reassignment surgery

Background: Male-to-female sex reassignment surgery (MTF-SRS) is a treatment for gender identity disorders (GID) wherein the penis is removed and an epithelialized neovagina is created in the retroprostatic or rectovesicalspace. This is a space between the double layers of Denonvilliers' fascia that contains motor, sensory, and autonomic nerves to the pelvic organs. Injury to these nerves may lead to anorectal dysfunction. However, there has been no objective study of anorectal physiologic changes after SRS. Objectives: To compare anorectal physiological parameters, before and after, male-to-female sex reassignment surgery (SRS) and to evaluate the effects of SRS on anorectal physiology. Methods: In 10 patients with MTF GID who underwent SRS at King Chulalongkorn Memorial Hospital, anorectal manometry was performed using a water perfused catheter (Mui Scientific, Ontario, Canada) and a state-of-the-art anorectal manometry system (Medtronic, Minneapolis, MN, USA) at the Gastrointestinal Motility Research Unit at 2 weeks before and 3 months after the SRS. Data were analyzed using PolygramNet software. Anal sphincter pressures (mmHg) with volume used to elicit rectal sensation (mL). Results: There was no significant change in the resting anal sphincter pressure, anal sphincter squeezing pressure, sustained squeezing pressure, and duration of squeeze, rectal sensation, and threshold of the desire to defecate affected by SRS. Cough reflex and rectoanal inhibitory reflex were normal both before and after SRS in all patient participants. Conclusions: Sex reassignment surgery seems to produce no effect on clinical anorectal functions. This was proven by absence of clinically significant changes in anorectal manometry. Keywords: Anorectal manometry, anorectal physiology, anorectal sphincter, gender identity disorders, sexreassignment surgery, sex reassignment surgical technique

COMPLETE PENILE DISASSEMBLY FOR ISOLATED EPISPADIAS REPAIR WITH MITCHELL-CAIONE TECHNIQUE: TWO CASES

Isolated male epispadias defect is present in 10% of cases of epispadias-exstrophy complex. Many surgical technique have been described for repair of male epispadias. The aim of surgical repair is to get cosmetically acceptable and functional penis with a ventrally located urethra opening at the tip of the glans and moreover to give the patient a urinary continence. Surgical repair of epispadias malformation remains debatable as evident by the different techniques adopted. We present two cases of our experience where we used the complete penile disassembly tecnique by Mitchell-Caione in wich we acts on the voluntary control of urination by the reapproximation of the muscular plane of pelvic diaphragm and elevator muscle around the posterior urethra reconstructed. Epispadias repairs was performed on two incontinent male epispadias patient, aged 2 to 3 years. Both cases were untreated. Complete disassembly of penil components was performed to the corporal attachments down to the horizontal branches of pubic bones. The corporal bodies and the glans were split on the sagittal plane according to Grady-Mitchell. The central portion of the urethral plate was preserved intact. An electric stimulator was used to identify and reapproximate at the midline the muscular fibers that constitute the periurethral muscular complex, as a part of the anterior perineal membrane. “Z plasties” were necessary according to initial urethral length and width: the urethra was reconstructed over a double catheters, using 5/0 polyglicolic acid interrupted sutures in a single layer. In one patient we sutured symphisis pubis opened precedently, using 1/0 polyglicolic acid. The urethra was placed ventrally in the reconstructed shaft under the two corpora as Mitchell technique. Glanduloplasty was then performed. Patients were followed up for one month (June 2012). The penis of the two patients had a satisfactory cosmetic appearance with no dorsal chordee. Morover, our patients obtained urinary continence. The limitation of our study was the low follow-up. The electric stimulator used to identify pelvic muscle components in the sagittal plane for reapproximate the posterior tabularized urethra to form the periurethral muscle complex and the “Z-plasties” that elongated the urethra significantly.This procedure seems to be satisfactory for the repair of cases of isolated male epispadias because we have good results in cosmetic appearance and in urinary continence. Our study is a preliminary report and a longer follow-up with a larger number of cases is needed to document further the success of the procedure.

Neuroprotective effect of lycium barbarum polysaccharides after cavernous nerve crush injury in a rat model

Objective To investigate the feasibility of erectile function recovery by repairing crushed cavernous nerves (CN) with lyceum barbarum polysaccharides (LBP).Methods Twenty-one male Sprague-Dawley rats were randomly divided into 3 groups:sham group,LBP group,and control group.Erectile function was assessed by cavernous nerve electrostimulation at 3rd month after operation and nerve regeneration was assessed by toluidine blue staining of CN and nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase staining of penile tissue.Results The peak ICP/MAP ratio in LBP group (0.44 ± 0.05) was significantly higher than in control group (0.26 ± 0.03,P ＜ 0.05),but lower than in sham group (0.68-± 0.08,P ＜ 0.05).The LBP group had more myelinated axons of CNs (106.8 ± 17.9) than the control group (64.9 ± 13.9,P ＜ 0.05),but fewer than the sham group (180.9 ± 15.3,P ＜ 0.05).The LBP group had more NOS diaphorase positive nerve (164.2 ± 12.2) than the control group (85.6 ±14.7,P＜0.05),but fewer than the sham group (263.3 ± 15.0,P＜0.05).Conclusion The application of LBP after CN crush injury promotes nerve regeneration and erectile function recovery. Key words: Lyceum barbarum polysaccharide; Erectile dysfunction; Cavernous nerve

Assessment and management of 46, XY disorders of sexual development

Micropenis is one of clinical manifestations of 46, XY disorders of sex development.Due to the complex etiology, the limitation of diagnostic methods, it is difficult to define the causes in some complicated cases.The abnormality in any part of the hypothalamic pituitary gonadal axis, androgen synthesis and function will influence the development of penis.Based on the statistical data of penis in comparison, trying to find the reference data for clinical application, used in the diagnosis of micropenis.For the patient raise a boy, the treatment including medicine and operation to improve the size of penis.Exogenous androgen and human chorionic gonadotrophin(HCG) treatment are the main methods in present, it can effectively promote the micropenis to increase in size.But it is debatable when to start the treatment, dosage and the duration.The potential side effects are unknown.Operation treatment can improve the hypospadias induced abnormal appearance and reconstruction of urethra.Treatment of gonadotropin can be applied to the patients who want to acquire fertility.For patients reared as female, male gonads must be removed, and estrogen replacement administered after adolescent. Key words: 46, XY disorders of sex development; Micropenis; Etiology; Diagnosis

Effect and mechanism of heme oxygenase-1 alleviating rat bile duct ischemia-reperfusion injury

Objective To explore the effect and mechanism of heme oxygenase-1 (HO-1) in rat bile duct ischemia-reperfusion injury.Methods 128 SD rats were randomly divided into a saline group (Saline),empty virus group (Adv),induced group (Adv-HO-1),and inhibition group (HO-1 siR-NA).Rats were injected using 0.5ml of saline,empty adenovirus,HO-1 adenovirus,and siRNA adenovirus (2× 109 TU/rat) via the dorsal penile vein 24 h before surgery.Liver function and bile composition was analyzed at 1 h,24 h,7d,and 14 d after reperfusion.The liver's histopathological changes and infiltration of inflammatory cells to the bile duct were examined,and the expression of HO-1,multidrug resistance protein (Mrp2),sodium taurocholate cotransporting polypeptide (Ntcp),and bile salt export pump (Bsep) protein were detected.Results Liver function was significantly reduced in the induced group after surgery,and hepatocytes and bile duct injury was attenuated.In comparison to the Adv-HO-1 group,abundant inflammatory cells and irregular configuration of bile ducts were seen in liver tissues of the HO-1 siRNA group.The expression of HO-1,Mrp2,Ntcp,and Bsep were significantly higher in the induced group than the suppressed group.However,serum conjugated bile salts,total bilirubin,and bile salt/phospholipid in the suppressed group was significantly higher than that in the induced group.Conclusions HO-1 can prevent biliary ischemia-reperfusion injury and reduce the accumulation of inflammatory cells around the bile duct.The inhibition of HO-1 enhanced the bile salt/phospholipid ratio aggravating cholangitis and cholestasis. Key words: Heme oxygenase-1; Biliary tract; Reperfusion injury

A crusted lesion on the penis

A crusted lesion on the penis

Clinical research with inverted L-shaped penis pedicle flap treatment of complicated long segment anterior urethral stricture

Objective To explore the therapeutic effect of using inverted L-shaped penis pedicle flap to treat complicated long segment anterior urethral stricture.Methods From June 2008 to November 2011,12 male patients with long segment anterior urethral stricture were treated in our hospital.The length of urethral stricture was from 8 cm to 14 cm (mean 10 cm).The age was from 28 to 72 years (mean 56 years).In our operation,we cut through the urethral stricture segment to the point that was 1 cm to the normal urethral mucosa.We gained the L-shaped flap from penile ventral that was longitudinal and was transverse extension to the Coronal Sulcus.Two apices of the L-shaped flap were sutured to the proximal and distal apices of the urethrotomy with 5-0 polyglactin interrupted stitches.The margins of the opened urethra were sutured to the L-shaped flap with 5-0 polyglactin running sutures.Results The patients were followed up for 6-38 months postoperatively (mean 21 months).Of the 12 cases,10 cases voided well and the urinary peak flows ranged from 17.0 to 24.5 ml/s (mean 19.8 ml/s).Urinary fistula occurred in 1 case,and the patient was cured after the second repair operation 6 months later.Only 1 case had urethral stricture in navicular fossa 6 months after the operation and was cured by cold knife incision treatment.Conclusions Inverted L-shaped penis flap is easy to get and the operation is not complicated.So inverted L-shaped penis flap is a good material in the treatment of complicated long segment anterior urethral stricture. Key words: Urethral stricture; Surgical flaps; Foreskin; Surgical procedures, operative

Urethroplasty with circular fasciocutaneous flap in the treatment of complex anterior urethral strictures

To summarize the experience of urethral reconstruction using circular fasciocutaneous flap for the treatment of complex anterior urethral strictures. The circular fasciocutaneous flap was harvested from the distal penile shaft or foreskin. Then the circular configuration was converted into longitudinal strip of skin which was rotated to ventral side to repair the exposured urethral strictures using the ventral onlay method. The surveillance protocol after urethroplasty was urination observation, regularly uroflowmetry and urethrography examination. From Nov. 2006 to Oct. 2012, 15 cases were treated. The mean age was 45 years (20-76 years) and mean follow-up period was 18 months(3 months-3 years). Stricture was caused by chronic urethritis in 4 cases, long-term urethral catheterization in 3 cases, transurethral perfusion chem other aphy in 3 cases, transurethral prostatectomy in 3 cases and hypospadias after surgery in 2 patients. The mean stricture length was 7.0 cm (3.5-12.0 cm). The overall success rate was 80.0% (12/15). Recurrence stenosis was noted in 2 cases and diverticulum formation in 1 case. The penile circular fasciocutaneous flap can be used for anterior urethral stricture in nearly any length. The flap has the characteristics of hairless, adequate mobile and length, well-vascularized pedicle and easy to harvest. The onlay reconstruction provides excellent cosmetic results, less trauma, higher success rate. Therefore it should be one of the preferred techniques for complex anterior urethral stricture repair.

Etiology and clinical characteristics of 30 children with tumor-associated precocity

Objective To analyze the etiology and clinical characteristics of children with tumor-associated precocity. Methods Thirty children with tumor-associated precocity hospitalized in Department of Surgery of Beijing Children's Hospital Affiliated to Capital Medical University from Jan. 2006 to Mar. 2012 were selected as research subjects. The causes, clinical characteristics and treatment situation of the patients were retrospectively studied. Results The group of patients included 14 boys and 16 girls, with average age of (3.74±2.44)years. Twenty-two patients(73.3%) were younger than 5 years old, and their etiological distributions listed as follows: 8 cases were hypothalamic hamartoma(HH), 2 cases were hypothalamic germinoma, 1 case was arachnoid cyst, 7 cases were adrenocortical tumor(in which 1 case was adenoma and 6 cases were adenocacinoma respectively), 5 cases were ovarian cyst, 2 cases were ovarian tumor (in which 1 case was endodermal sinus tumor and 1 case was sex cord-stromal tumor respectively), 2 cases were MuCune-Albright syndrome, and 1 case was mediastinal teratoma, 1 case was penis primitive neuroectoderm tumor, and 1 case was Leydig cell proliferation accompanied with neoplasma. Eleven patients(36.7%) suffered central precocious puberty, with HH(n=8) being the most common causes. Four patients with HH presented with gelastic epilepsy. Precocious puberty caused by HH patients could be safely controlled by gonadotropin-releasing hormone agonists. Nineteen patients(63.3%) suffered peripheral precocious puberty, with adrenocortical tumor being the most common cause for the boys and ovarian cyst being the most common cause for the girls. Besides that, the onset symptom of a patient with adenocacinoma was facial acne accompanied with hypertrichiasis and another patient with ovarian tumor had intermittent abdominal pain, and the onset symptoms of all the boys were external genital development and those of the girls were mammary development or colporrhagia, respectively. Conclusions Tumors are one of the most causes of precocious puberty in children. During the process of diagnosis and treatment of precocious puberty, imaging examinations on pituitary, gonad and adrenal gland should be paid great attention to and seldom occurred tumors should also be consi-dered. For ovarian cyst patients with precocious puberty attention shall be paid attention to the differentiation from MuCune-Albright syndrome. Key words: Precocious puberty; Hypothalamic hamartoma; Adrenocortical tumor; Ovarian cyst; MuCune-Albright syndrome; Teratoma

Penile pearls: a westward traveling phenomenon

Penile pearls: a westward traveling phenomenon

Prepenile scrotum- an extreme form of penoscrotal transposition.

A full-term newborn male baby was brought with abnormal genitalia. The baby was a product of non-consanguinous marriage and the antenatal checkups and sonography were unremarkable. The boy had passed urine and meconium before arrival. Baby was warm, pink and active. There was no abnormal facies. Limbs and spine were normal. Local examination (Fig. 1) revealed a normal phallus with meatus at the tip of glans but it was positioned in the perineum between the scrotum and anus. The hemiscrotums were well developed and contained testis on either side. The anus was patent and its site was normal. Sonography of spine,cranium and urinary tracts showed no pathology. Echocardiogram was also normal.