Non-hormonal Clitoromegaly due to Clitoral Priapism Caused by Appendicitis/Appendectomy

Clitoromegaly usually develops due to hyperandrogenism. There are a few cases of clitoromegaly described without clinical and biochemical hyperandrogenism. Clitoromegaly due to clitoral priapism and clitoral priapism after appendectomy have not been reported previously. A 7-year-old girl was referred for enlargement of the clitoris. She reported having a mild, pulsating clitoral pain starting three days after an appendectomy operation. Subsequently, painful swelling and an increase in the size of the clitoris was observed. Her growth and physical examination were otherwise normal. Causes of the clitoromegaly due to androgen excess were excluded after a comprehensive work-up. Color Doppler ultrasound revealed a high peak systolic velocity and resistance in the cavernosal artery, consistent with clitoral priapism. The clitoromegaly and associated symptoms improved significantly with oral pseudoephedrine and intracavernosal aspiration. This unique case illustrates that clitoral priapism is a rare, non-hormonal cause of clitoromegaly and may occur after appendectomy. Pseudoephedrine treatment is helpful in alleviating the symptoms.

Do preoperative leukocyte and neutrophil levels have a predictive value on the complications of hypospadias repair in children?

OBJECTIVE

Surgeons observed that the outcomes after the same repair technique in the same type of hypospadias performed by the same surgeon may be different. There may be some indeterminate factors that influence the results such as subclinical inflammation. Our study evaluated the predictor values of inflammatory hematologic parameters on the complications after hypospadias repair.

MATERIALS AND METHODS

We retrospectively reviewed the data of patients who underwent hypospadias repair between January 2016 and January 2019 in our clinic. Age at surgery, hypospadias type, repair technique, complications were recorded. Patients who underwent Snodgrass repair by a single surgeon were included in the study while patients who underwent different techniques or procedures that were performed by other surgeons were excluded. The levels of white blood cell, neutrophil, lymphocyte, platelet and monocyte, the mean platelet volumes were recorded from blood test that were performed one day before surgery. Neutrophil-lymphocyte ratio (NLR), plateletlymphocyte ratio (PLR), and other parameters were analyzed to determine their relationship with complications after hypospadias surgery.

RESULTS

WBC and neutrophil levels were statistically higher in patients with complications (p = 0.006 and 0.017 respectively). Other hematological parameters were not different between patients with or without complications. To predict the complications, the WBC cutoff was 9500/mm3, the neutrophil cutoff was 3000/mm3.

CONCLUSIONS

WBC and neutrophil values were statistically significant in predicting the complications after Snodgrass repair in patients with hypospadias. Our result determined no relation between complications and NLR, PLR.