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Uygur L, Sivrikoz TS, Kalelioglu IH, Has R, Isguder CK, Oktar T, Basaran S, Yuksel A. Predictive value of ultrasound in prenatal diagnosis of hypospadias: hints for accurate diagnosis. J Perinat Med 2023; 51:932-939. [PMID: 37144940 DOI: 10.1515/jpm-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/22/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES This study aims to assess the diagnostic accuracy of targeted ultrasound examination in prenatal diagnosis of hypospadias and to evaluate the predictive values of defined ultrasonographic findings of hypospadias. METHODS The cases diagnosed with hypospadias in our fetal medicine center were identified on an electronic database. The ultrasound reports, images and hospital records were reviewed retrospectively. The predictive value of prenatal ultrasound diagnosis and the predictive values of each sonographic finding were assessed according to the postnatal clinical examinations. RESULTS Thirty-nine cases were diagnosed with hypospadias on ultrasound during the 6 years. Nine fetuses with missing postnatal examination records were excluded. Twentytwo of the remaining fetuses had their prenatal diagnosis of hypospadias confirmed in postnatal examinations, indicating a 73.3 % positive predictive value. Normal external genitalia was detected in postnatal examinations of three fetuses. Five fetuses were diagnosed with other external genital abnormalities, including micropenis (n=2), clitoromegaly (n=2), and buried penis with bifid scrotum (n=1) in postnatal examinations. The positive predictive value of prenatal ultrasound for any external genital abnormality was 90 %. CONCLUSIONS Although the positive predictive value of ultrasound for genital anomalies is satisfying, it is slightly lower for the specific diagnosis of hypospadias. This reflects overlapping ultrasound findings of different external genitalia anomalies. Standardized, systematic evaluation of the internal and external genital organs, karyotyping and genetic sex determination are essential to achieve a precise prenatal diagnosis of hypospadias.
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Affiliation(s)
- Lutfiye Uygur
- Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children Health Research Hospital, Division of Maternal & Fetal Medicine Istanbul, Istanbul, Türkiye
| | - Tugba Sarac Sivrikoz
- Department of Obstetrics and Gynecology, Istanbul University, Istanbul Faculty of Medicine, Division of Maternal & Fetal Medicine, Istanbul, Türkiye
| | - Ibrahim Halil Kalelioglu
- Department of Obstetrics and Gynecology, Istanbul University, Istanbul Faculty of Medicine, Division of Maternal & Fetal Medicine, Istanbul, Türkiye
| | - Recep Has
- Department of Obstetrics and Gynecology, Istanbul University, Istanbul Faculty of Medicine, Division of Maternal & Fetal Medicine, Istanbul, Türkiye
| | - Cigdem Kunt Isguder
- Department of Obstetrics and Gynecology, Istanbul University, Istanbul Faculty of Medicine, Division of Maternal & Fetal Medicine, Istanbul, Türkiye
| | - Tayfun Oktar
- Department of Urology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Seher Basaran
- Department of Medical Genetics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Atil Yuksel
- Department of Obstetrics and Gynecology, Istanbul University, Istanbul Faculty of Medicine, Division of Maternal & Fetal Medicine, Istanbul, Türkiye
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López Soto Á, Bueno González M, Urbano Reyes M, Carlos Moya Jiménez L, Beltrán Sánchez A, Garví Morcillo J, Velasco Martínez M, Luis Meseguer González J, Martínez Rivero I, García Izquierdo O. Imaging in fetal genital anomalies. Eur J Obstet Gynecol Reprod Biol 2023; 283:13-24. [PMID: 36750003 DOI: 10.1016/j.ejogrb.2023.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/15/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Genital anomalies are a heterogeneous group of congenital pathologies that have become increasingly relevant since the Chicago Consensus of 2005. Their postnatal diagnosis has developed significantly in the last two decades, while prenatal diagnosis seems to be underdeveloped, with few protocols available, fragmented scientific literature, and low diagnostic rates. This review aims to examine the current status of this subspecialty from the perspective of prenatal imaging. Indications for the evaluation of fetal genitalia can be divided into medical and non-medical reasons. Medical reasons include sex-linked disorders, detection of other anomalies, relevant family history, or multiple pregnancy. Non-medical reasons include parental request for sex disclosure. Disclosure of fetal sex may be associated with ethical, legal, and medical issues. The main imaging technology used is 2D ultrasound, although there are other complementary techniques such as 3D, MRI, or Color Doppler. Regarding working methodology, several authors have drawn attention to the lack of standardized protocols and guidelines. Most guidelines tend to limit their recommendations to study indications and ethical issues. Technical proposals, measurements, or working methods have not yet been standardized. Fetal sex determination is usually divided into early and late gestation. Early gestation is based on the sagittal sign. Late gestation is based on direct visualization. There are several measurements to describe male and female genitalia, such as penile length, bilabial diameter, or scrotal diameter. Prenatal diagnosis of genital pathologies presents some particularities such as the wide spectrum of phenotypes, the high frequency of associated deformities, or the time of diagnosis. Some of the most frequent pathologies are ambiguous genitalia, fetal sex discordance, hypospadias, micropenis, clitoromegaly, ovarian cysts, hydro(metro)colpos, and cloacal anomalies. Higher-quality studies and direction from scientific societies through the implementation of clinical guidelines are needed.
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Affiliation(s)
- Álvaro López Soto
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain.
| | | | - Maribel Urbano Reyes
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
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4
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Goncalves LF, Hill H, Bailey S. Prenatal and postnatal imaging techniques in the evaluation of disorders of sex development. Semin Pediatr Surg 2019; 28:150839. [PMID: 31668296 DOI: 10.1016/j.sempedsurg.2019.150839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Imaging of the reproductive tract is challenging and requires a general knowledge of congenital variations in anatomy. The anatomy of the developing fetus, whether a male phenotype or female phenotype, is also a dynamic process with many changes occurring during gestation. Families may ask details about the genitalia during prenatal imaging and when variations in what is thought to be normal are present, further investigation is sometimes needed to make sense of what is seen. This overview will describe categories of disorders of sex development (DSD), whether chromosomal or structural or both, and the current state of imaging of these anomalies.
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Affiliation(s)
- Luis F Goncalves
- Director of Fetal Imaging, Division of Pediatric Radiology, Phoenix Children's Hospital, Phoenix, AZ, United States.
| | - Halsey Hill
- St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Smita Bailey
- Division of Pediatric Radiology, Phoenix Children's Hospital, Phoenix, AZ, United States
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5
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Fuchs F, Borrego P, Amouroux C, Antoine B, Ollivier M, Faure JM, Lopez C, Forgues D, Faure A, Merrot T, Boulot P, Jeandel C, Philibert P, Gaspari L, Sultan C, Paris F, Kalfa N. Prenatal imaging of genital defects: clinical spectrum and predictive factors for severe forms. BJU Int 2019; 124:876-882. [PMID: 30776193 DOI: 10.1111/bju.14714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To report the clinical spectrum of genital defects diagnosed before birth, identify predictive factors for severe phenotypes at birth, and determine the rate of associated malformations. PATIENTS AND METHODS A retrospective study (2008-2017) of 4580 fetuses, identified prenatally with abnormalities evaluated by our Reference Center for Fetal Medicine, included cases with fetal sonographic findings of abnormal genitalia or uncertainty of fetal sex determination. Familial, prenatal and postnatal data were collected via a standardised questionnaire. RESULTS In all, 61 fetuses were included. The positive predictive value (PPV) of the prenatal diagnosis of genital defects was 90.1%. Most cases were 46,XY-undervirilized boys, 42 cases (68.8%), which included 29 with mid-penile or posterior hypospadias, nine with anterior hypospadias, and epispadias, micropenis, scrotal transposition, and buried penis (one each). In all, 46,XX-virilized girls were identified in seven cases (11.5%), which included four with congenital adrenal hyperplasia, two with isolated clitoromegaly, and one with ovotestis. Other defects included prune belly syndrome and persistent cloaca (six cases). Early detection during the second trimester (58.1% vs 18.8%, P = 0.03), intra-uterine growth restriction (IUGR) (45.2% vs 9.1%, P = 0.06), and curvature of the penis (38.7% vs 0%, P = 0.02), were more frequently related to severe defects in male newborns. Associated malformations (14 cases, 22.9%) and genetic defects (six) were frequent in undervirilized boys. CONCLUSION Prenatal imaging of genital defects leads to a wide range of phenotypes at birth. Its PPV is high and extra-urinary malformations are frequent. Early diagnosis during the second trimester, associated IUGR, and curvature of the genital tubercle, should raise suspicion of a severe phenotype and may justify delivery near a multidisciplinary disorders/differences of sex development team.
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Affiliation(s)
- Florent Fuchs
- Service de Gynécologie-Obstétrique, Hôpital Arnaud de Villeneuve - CHU Montpellier
| | - Paula Borrego
- Unité de Chirurgie Viscérale et Urologique Pédiatrique, Hôpital Lapeyronie - CHU Montpellier, Montpellier, France.,Université de Montpellier, Montpellier, France
| | - Cyril Amouroux
- Université de Montpellier, Montpellier, France.,Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital Arnaud de Villeneuve - CHU Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
| | - Benoît Antoine
- Service de Gynécologie-Obstétrique, Hôpital Arnaud de Villeneuve - CHU Montpellier
| | - Margot Ollivier
- Unité de Chirurgie Viscérale et Urologique Pédiatrique, Hôpital Lapeyronie - CHU Montpellier, Montpellier, France.,Université de Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
| | - Jean-Michel Faure
- Service de Gynécologie-Obstétrique, Hôpital Arnaud de Villeneuve - CHU Montpellier
| | - Christophe Lopez
- Unité de Chirurgie Viscérale et Urologique Pédiatrique, Hôpital Lapeyronie - CHU Montpellier, Montpellier, France.,Université de Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
| | - Dominique Forgues
- Unité de Chirurgie Viscérale et Urologique Pédiatrique, Hôpital Lapeyronie - CHU Montpellier, Montpellier, France.,Université de Montpellier, Montpellier, France
| | - Alice Faure
- Service de Chirurgie Pédiatrique, Hôpital La Timone, APHM, Marseille, France
| | - Thierry Merrot
- Service de Chirurgie Pédiatrique, Hôpital La Timone, APHM, Marseille, France
| | - Pierre Boulot
- Service de Gynécologie-Obstétrique, Hôpital Arnaud de Villeneuve - CHU Montpellier
| | - Claire Jeandel
- Université de Montpellier, Montpellier, France.,Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital Arnaud de Villeneuve - CHU Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
| | - Pascal Philibert
- Université de Montpellier, Montpellier, France.,Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital Arnaud de Villeneuve - CHU Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
| | - Laura Gaspari
- Université de Montpellier, Montpellier, France.,Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital Arnaud de Villeneuve - CHU Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
| | - Charles Sultan
- Université de Montpellier, Montpellier, France.,Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital Arnaud de Villeneuve - CHU Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
| | - Françoise Paris
- Université de Montpellier, Montpellier, France.,Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital Arnaud de Villeneuve - CHU Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
| | - Nicolas Kalfa
- Unité de Chirurgie Viscérale et Urologique Pédiatrique, Hôpital Lapeyronie - CHU Montpellier, Montpellier, France.,Université de Montpellier, Montpellier, France.,National Reference Network DSD DevGen, Centre Constitutif Sud. - CHU Montpellier, Montpellier, France
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Epelboym Y, Estrada C, Estroff J. Ultrasound diagnosis of fetal hypospadias: Accuracy and outcomes. J Pediatr Urol 2017; 13:484.e1-484.e4. [PMID: 28389178 DOI: 10.1016/j.jpurol.2017.02.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/23/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the positive predictive value of a prenatal ultrasound diagnosis of hypospadias when compared with postnatal diagnosis based on physical exam. METHODS We retrospectively identified all pregnant women between 2004 and 2014 who were either referred to our fetal care center carrying a fetus with an ultrasound diagnosis of possible hypospadias or who had a new diagnosis of hypospadias after imaging in our center. RESULTS A total of 32 cases of possible hypospadias were identified, with our fetal center ultrasound suggesting hypospadias in 25 of the 32 cases (78%). Of the 25 cases, 18 infants were confirmed to have hypospadias on postnatal physical exam (Table), reflecting a positive predictive value of 72%. Twenty-one of twenty-five cases with suggested hypospadias on ultrasound were found to have either hypospadias or another penile anomaly on postnatal physical exam, reflecting a positive predictive value for any genital anomaly of 84%. Infants with confirmed hypospadias often had several associated GU anomalies on postnatal clinical exam. CONCLUSIONS Our single center experience with the fetal ultrasound diagnosis of hypospadias demonstrates a high positive predictive value for a penile anomaly (21/25, 84%), and a moderately high positive predictive value for the specific diagnosis of hypospadias (18/25, 72%) when compared with the postnatal diagnosis.
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Metwalley KA, Farghaly HS. X-linked congenital adrenal hypoplasia associated with hypospadias in an Egyptian baby: a case report. J Med Case Rep 2012; 6:428. [PMID: 23272655 PMCID: PMC3537693 DOI: 10.1186/1752-1947-6-428] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 10/16/2012] [Indexed: 11/10/2022] Open
Abstract
Introduction X-linked congenital adrenal hypoplasia is a rare developmental disorder of the human adrenal cortex and is caused by deletion or mutation of the dosage-sensitive sex reversal adrenal hypoplasia congenita critical region of the X chromosome, gene 1 (DAX-1) gene. Most affected children present with failure to thrive, salt wasting and hypoglycemic convulsions in the first months of life. Hypospadias affects approximately one in 250 live male births. Mutations in the mastermind-like domain-containing 1 (MAMLD1) gene have been implicated as one of the causes of hypospadias in children. To the best of our knowledge, an association between congenital adrenal hypoplasia due to a DAX-1 mutation and hypospadias due to mutation of the MAMLD1 gene has not previously been reported in the literature. Case presentation A 35-day-old male Egyptian baby was referred to our institution for the evaluation of a two-week history of recurrent vomiting associated with electrolyte imbalance. On examination, our patient was found to have hypotension and dehydration. A genital examination showed distal penile hypospadias with chordee and normal testes. He had hyponatremia, hyperkalemia, hypoglycemia and metabolic acidosis. Endocrinological investigations revealed low levels of cortisol, 17-hydroxyprogesterone and aldosterone, with a high level of adrenocorticotrophic hormone. A provisional diagnosis of congenital adrenal hypoplasia associated with hypospadias was made. A molecular genetics study confirmed the diagnosis of X-linked congenital adrenal hypoplasia due to DAX-1 mutations and hypospadias due to MAMLD1 mutation. He was started on hydrocortisone and fludrocortisone treatment. After three weeks of treatment, his symptoms improved and his blood sugar, sodium, potassium and cortisol levels normalized. Conclusions We report the case of an Egyptian baby with an association of congenital adrenal hypoplasia due to DAX-1 mutation and hypospadias due to MAMLD1 mutation. Early diagnosis of this association and determining its optimal treatment are vital in helping to avoid its fatal course.
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Affiliation(s)
- Kotb Abbass Metwalley
- Pediatric Endocrinology Unit, Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt.
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Tonni G, Centini G, Bonasoni MP, Ventura A, Pattacini P, Cavalli P. Acrania-anencephaly associated with hypospadias. Prenatal ultrasound and MRI diagnosis and molecular folate metabolism pathway analysis. Fetal Pediatr Pathol 2012; 31:379-87. [PMID: 22443204 DOI: 10.3109/15513815.2012.659403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acrania may occur as a single isolated malformation or associated with extracranial defects. Hypospadias is one of the most common congenital abnormalities of the genitalia frequently missed on prenatal sonograms. Second trimester two- and three-dimensional ultrasound and MRI diagnosis with necropsy and folate metabolism pathway analysis. The mechanisms leading to closure of both neural and urethral tubes, are far from being demonstrated, and molecular studies of this very rare association are lacking although it might be based on a common genetic mechanism, leading to a disturbed development pathway at the molecular level.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics & Gynecology, Guastalla General Hospital, AUSL Reggio Emilia, Guastalla, Italy.
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9
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Bamberg C, Brauer M, Degenhardt P, Szekessy DP, Henrich W. Prenatal two- and three-dimensional imaging in two cases of severe penoscrotal hypospadias. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:539-543. [PMID: 21538377 DOI: 10.1002/jcu.20832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 03/07/2011] [Indexed: 05/30/2023]
Abstract
We present the prenatal two- and three-dimensional (3D) ultrasound (US) findings in two cases of severe penoscrotal hypospadias. 3D sonography was used for better definition of ambiguous genitalia. The images were compared with postnatal clinical features. Despite hypospadias being the most common urogenital anomaly of male neonates, the diagnosis is often missed before birth. Performing prenatal ultrasound should include the study of genitals, not only determining the sex.
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Affiliation(s)
- Christian Bamberg
- Department of Obstetrics, Charité University Hospital, Berlin, Germany.
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10
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Nemec SF, Kasprian G, Brugger PC, Bettelheim D, Nemec U, Krestan CR, Rotmensch S, Rimoin DL, Graham JM, Prayer D. Abnormalities of the penis in utero--hypospadias on fetal MRI. J Perinat Med 2011; 39:451-6. [PMID: 21631398 DOI: 10.1515/jpm.2011.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To demonstrate the visualization of penile abnormalities on fetal magnetic resonance imaging (MRI). METHODS This retrospective study included five fetuses (25+0 to 31+6 gestational weeks) with penile abnormalities, positively depicted on fetal MRI, using prenatal ultrasonography (US) as a standard of reference. On MRI, the penis, as well as the scrotum and testicles, were evaluated. All fetal organs were reviewed to define penile abnormalities as isolated or in association with other anomalies. Furthermore, US and MRI findings were compared. RESULTS Posterior hypospadias were demonstrated in all five fetuses, and abnormal testicular descent in two. Associated anomalies were present in all five fetuses on MRI, including abdominal/urogenital pathologies in four; brain pathologies in three; and craniofacial, cardiac, musculoskeletal, pathologies each in one fetus, and intrauterine growth retardation in one fetus. Compared to US, additional MRI findings were shown in four of five fetuses. CONCLUSIONS Our MRI results demonstrate the visualization of fetal penile abnormalities and associated pathologies, which may provide information for perinatal management. MRI may show additional findings compared to prenatal US in certain cases.
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Affiliation(s)
- Stefan F Nemec
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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11
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Raga F, Bonilla F, Bonilla-Musoles F, Castillo JC. 3D, Vocal and Tomographic Ultrasound Image in Prenatal Diagnosis of Hypospadias. ACTA ACUST UNITED AC 2011. [DOI: 10.5005/jp-journals-10009-1217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
We report a case of anterior hypospadias, diagnosed at 26th week in a 37 years-old primigravida with normal 46XY kariotype through amniocentesis carried out at 16th week.
Sonographic examination with 2D showed a short and curved penis. The use of three orthogonal planes, Tomographic Ultrasound Image (TUI) and VOCAL allowed an exact prenatal diagnostic, showing the “tulip” sign and defining localization, situation and extension of the urethral orifice.
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12
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13
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Odeh M, Ophir E, Bornstein J. Hypospadias mimicking female genitalia on early second trimester sonographic examination. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:581-583. [PMID: 18431748 DOI: 10.1002/jcu.20481] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Female fetal sex was assigned based on downward direction of the genital tubercle at 14 weeks' gestation. Subsequently, amniocentesis performed due to the finding of an echogenic focus in the left ventricle revealed a male karyotype. Sonographic examination at 22 weeks' gestation revealed a markedly curved penile shaft. Power Doppler at that time demonstrated a urine jet emanating from the penile base, verifying the diagnosis of penoscrotal hypospadias. We therefore suggest that female fetal sex assignment should be based on the demonstration of the 2 or 4 parallel lines representing the labial folds and not only upon the demonstration of the downward direction of the genital tubercle.
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Affiliation(s)
- Marwan Odeh
- Department of Obstetrics and Gynecology, Western Galilee Hospital, Rappaport Faculty of Medicine, Technion, Nahariya 22100, Haifa, Israel
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Fang KH, Wu JL, Chen M, Yeh GP, Chou PH, Hsu JC, Hsieh CTC. Prenatal Sonographic Features of Hypospadia: Two- and Three-Dimensional Findings. Taiwan J Obstet Gynecol 2006; 45:53-5. [PMID: 17272209 DOI: 10.1016/s1028-4559(09)60191-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To present our experience of applying three-dimensional ultrasonography in prenatal diagnosis of hypospadia. CASE REPORT A 28-year-old woman, gravida 1, para 0, visited our hospital at 17 weeks' gestation. No gross anomaly was found on the scan at 21 weeks' gestation. Fetal growth was appropriate for gestational age on two-dimensional (2D) ultrasonography at 27 weeks' gestation, but an abnormally curved and shortened fetal penis was found incidentally. Three-dimensional (3D) imaging in surface-rendered mode was used to reconstruct the fetal penis. Multiplanar and surface-rendered images were obtained in the midsagittal, axial, and coronal planes to precisely delineate the ventral curvature of the penis. At 39 weeks' gestation, a term newborn was delivered by vacuum extraction. On examination, the fetus was confirmed to have hypospadia. Karyotyping revealed 46,XY. CONCLUSION 2D ultrasonography could only give indirect clues of hypospadia that was later more precisely delineated by 3D ultrasonography in surface-rendered mode.
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Affiliation(s)
- Kung-Hong Fang
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
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15
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Boopathy Vijayaraghavan S. Sonography of fetal micturition. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 24:659-663. [PMID: 15476295 DOI: 10.1002/uog.1755] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To describe the sonographic visualization of fetal micturition and its role in the diagnosis of posterior urethral valves and hypospadias. METHODS This was a prospective study of 25 male fetuses (21 with bilateral pyelectasis, one whose bladder was being studied because of ureterocele and three with hypospadias), and five female fetuses (with bilateral pyelectasis). A midline sagittal scan of the fetal pelvis, perineum and external genitalia was obtained and observed continuously during fetal micturition. RESULTS In 19 of the 21 male fetuses and the five female fetuses with bilateral pyelectasis micturition was normal, with visualization of urinary bladder contraction, slight fluid distention of the urethra and a urinary stream from the external urethral meatus. In three male fetuses, two with bilateral pyelectasis and the one with ureterocele, the posterior urethra was normal at rest and it ballooned out during micturition, diagnostic of posterior urethral valves. In the three male fetuses with hypospadias the ventral jet of the urinary stream was visualized. CONCLUSION Fetal micturition can be visualized on sonography. It may be of value in the diagnosis of posterior urethral valves and hypospadias.
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Aslan H, Karaca N, Basaran S, Ermis H, Ceylan Y. Prenatal diagnosis of Wolf-Hirschhorn syndrome (4p-) in association with congenital hypospadias and foot deformity. BMC Pregnancy Childbirth 2003; 3:1. [PMID: 12546710 PMCID: PMC149368 DOI: 10.1186/1471-2393-3-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2002] [Accepted: 01/24/2003] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Wolf-Hirschhorn syndrome is caused by distal deletion of the short arm of chromosome 4 (4p-). We report a case in which intrauterine growth restriction, hypospadias and foot deformity were detected by prenatal ultrasound examination at 29 weeks of gestation. CASE PRESENTATION: A 31-year-old gravida 2 partus 1 woman was referred at 29 weeks' gestation with suspicion of intrauterine growth restriction. Sonographic examination revealed deformity of the right lower limb and undescended testes with an irregular distal penis. A cordocentesis was performed and chromosome analysis revealed a 46,XY,del(4)(p14) karyotype. CONCLUSION: The prenatal detection of intrauterine growth restriction, hypospadias and foot deformity should lead doctors to suspect the presence of Wolf-Hirschhorn syndrome.
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Affiliation(s)
- Halil Aslan
- Department of Perinatology, SSK Bakirkoy Maternity and Children Hospital, Istanbul, Turkey
| | - Nilay Karaca
- Department of Obstetric and Gynecology, SSK Vakif Gureba Hospital, Istanbul, Turkey
| | - Seher Basaran
- Department of Genetics (PRETAM), Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hayri Ermis
- Department of Obstetric and Gynecology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yavuz Ceylan
- Department of Perinatology, SSK Bakirkoy Maternity and Children Hospital, Istanbul, Turkey
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17
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Cafici D, Iglesias A. Prenatal diagnosis of severe hypospadias with two- and three-dimensional sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:1423-1426. [PMID: 12494986 DOI: 10.7863/jum.2002.21.12.1423] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Daniel Cafici
- Department of Ultrasound and Prenatal Diagnosis, Clínica Privada Santa Ana, Buenos Aires, Argentina
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18
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Meizner I, Mashiach R, Shalev J, Efrat Z, Feldberg D. The 'tulip sign': a sonographic clue for in-utero diagnosis of severe hypospadias. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:250-253. [PMID: 11896945 DOI: 10.1046/j.1469-0705.2002.00648.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To describe a unique sonographic sign for prenatal detection of severe penoscrotal hypospadias. METHODS Ultrasound findings of hypospadias diagnosed in the second trimester of pregnancy in seven patients were compared with postnatal clinical features. All patients were recruited from routine sonographic examinations performed for various obstetric indications. RESULTS In six of the seven cases with hypospadias, a severe form of peno-scrotal hypospadias was found. In all six cases, a unique ultrasound feature was observed represented by extreme ventral angulation of the penis, with or without chordee, in a form resembling a tulip flower. This 'tulip' is formed by the ventrally bent penis located between the two scrotal folds. In all six patients, the postnatal pictures of the newborns' genitalia corresponded perfectly to the prenatal sonograms. Associated anomalies occurred in two cases, with Nager syndrome in one case and mild renal hydronephrosis in the other case. CONCLUSIONS The 'tulip sign' is a specific ultrasonic finding of severe hypospadias. The recognition of this may help to distinguish between severe hypospadias and other genital abnormalities (e.g. ambiguous genitalia).
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Affiliation(s)
- I Meizner
- Ultrasound Unit, Women's Health Center, Rabin Medical Center, Petah-Tikva, Israel.
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Lin SK, Lee YH, Pong HC, Ho ES. Prenatal diagnosis of a rare variant of hypospadias and review of the literature. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2001; 18:678-680. [PMID: 11844216 DOI: 10.1046/j.0960-7692.2001.00522.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We present a case of a variant of hypospadias, diagnosed prenatally at 21 weeks' gestation, in which the penis and scrotum appeared normal but there was a cyst-like lesion and a urethrocutaneous fistula on the ventral side of the penis. Detailed sonographic examination and karyotyping confirmed this was an isolated lesion and helped the parents to decide on continuation of the pregnancy.
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Affiliation(s)
- S K Lin
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, 160, Section 3, Taichung-Kang Road, Taichung 407, Taiwan, Republic of China.
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