Prenatal diagnosis of a rare variant of hypospadias and review of the literature

Sonographic measure techniques of fetal penile length

Postnatal penile length is a reliable, standardized, and widely used marker for the diagnosis of genitourinary pathology, as well as genetic and hormonal disorders. In contrast, prenatal diagnosis has not been developed equally and there is a lack of relevant literature. Our objective is to review the studies on fetal penile length, and apply findings to clinical practice. Although the most used technique is the outer penile length, there is no consensus regarding the appropriate technique for prenatal measurement. Several reports have provided reference data with high correlation. However, important issues like poor correlation with post-natal measures or presence of confounding variables are still present. Diagnosis of both a micropenis and macropenis can indicate related pathologies, and this information may benefit parental counseling and facilitate fetal management. Therefore, it is necessary to carry out prospective studies that provide reliable normative data.

Prenatal diagnosis of penoscrotal hypospadias and review of the literature

Urinary tract abnormalities are frequently detected during obstetrical ultrasonography (US). However, hypospadia is often missed on prenatal US, despite it being the most common congenital defect of the male external genitalia. The prenatal recognition of hypospadias is important because it will alert the physician to order karyotyping and to look for any possible associated dysmorphic syndromes. Here, we present a case of a penoscrotal hypospadia mimicking female genitalia and describe our experience of applying two-dimensional and three-dimensional US in the prenatal diagnosis of hypospadia. Prenatal ultrasound scans should include a study of the genitals and should not only be used for sex determination.

Prenatal diagnosis of penoscrotal hypospadia in third trimester by two- and three-dimensional ultrasonography: a case report

Hypospadia is an abnormal development of the corpus spongiosum, that involves cavernosa urethra, as a result of an inadequate fusion of the urethral folds. The incidence ranges from 0.2 to 4.1 per 1,000 live births. Among the markers of hypospadia, isolated ventral or lateral curvature of the penis associated with shortening are the most important markers and, in severe cases, can result in the classic “tulip sign.” The diagnosis of hypospadia is uncommon unless there is a routine of detailed analysis of fetal genitalia morphology. The prenatal diagnosis is of great importance for genetic counseling and allows better planning of postnatal treatment. The three-dimensional ultrasonography (3DUS) in rendering mode enables better comprehension of the pathology by parents, facilitating postnatal planning. We report a case of penoscrotal hypospadia diagnosed at 33 weeks of gestation, suspected due to the absence of testicles in the scrotum and difficulty of penis visualization. We emphasize the findings of 3DUS and its importance in the pathology compression by parents.

Acrania-anencephaly associated with hypospadias. Prenatal ultrasound and MRI diagnosis and molecular folate metabolism pathway analysis

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.

Sonographic measurement of corpus spongiosum in male fetuses

OBJECTIVE

To establish a nomogram of the corpus spongiosum dimensions in male fetuses and to evaluate its correlation with penile length. These references can be useful when fetal genital anomalies are suspected, particularly to distinguish micropenis from concealed penis cases.

METHOD

A cross-sectional prospective study was conducted on 486 fetuses of normal singleton pregnancies between 18 and 40 weeks. Corpus spongiosum length, penile length, penile diameter and scrotal diameter were measured by one operator. All measurements were analyzed according to gestational age.

RESULTS

The four measurements were studied as a function of gestational age. Median values, 3(rd) and 97(th) percentiles were determined using regression curves. A correlation between penile length and corpus spongiosum length (r(2) = 0.845) was observed.

CONCLUSION

We established measurements of the length of fetal corpus spongiosum and a correlation between the former and the penile length. These references can be useful when fetal genital anomalies are suspected.

Hypospadias mimicking female genitalia on early second trimester sonographic examination

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.

Recent advances in external genitalia

In the last decade, significant progress in the knowledge and management of external genital anomalies has been achieved, including an improved understanding of epidemiology and pathophysiology of these anomalies, the identification of etiologic genetic defects, and significant improvements in surgical approaches that have decreased complications and improved cosmetic outcomes. We highlight the most clinically important advances of the commonly encountered external genital anomalies.