Congenital Anomalies of the Penis

264 Pages·2017·22.04 MB·English

by  Mohamed Fahmy (auth.)

Mohamed Fahmy
Congenital Anomalies
of the Penis
123
Congenital Anomalies of the Penis
Mohamed Fahmy
Congenital Anomalies
of the Penis
Mohamed Fahmy
Pediatric Surgery
Al Azher University
Cairo
Egypt
ISBN 978-3-319-43309-7 ISBN 978-3-319-43310-3 (eBook)
DOI 10.1007/978-3-319-43310-3
Library of Congress Control Number: 2017930623
© Springer International Publishing Switzerland 2017
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, express or implied, with respect to the material
contained herein or for any errors or omissions that may have been made.
Printed on acid-free paper
This Springer imprint is published by Springer Nature
The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
This book is dedicated to my beloved wife Rula for prosperity
she bestowed upon me, continuous tremendous support,
positive energy and awarding me always with hope and love.
Foreword
In Congenital Anomalies of the Penis, Professor Fahmy has brought together
the diverse but interrelated issues associated with these malformations,
thereby providing an understanding of the embryology, the diagnosis, and the
eventual functional and psychological impact of these conditions. This long
overdue book benefits from Professor Fahmy’s long-standing critical interest
and extensive experience that have stimulated an interesting and detailed
evaluation and alternative approaches to the diagnosis, classification, man-
agement, and reconstruction of these anomalies.
This comprehensive exposition should appeal to the student learning the
basics, to the academic with an interest in research and, perhaps most rele-
vantly, to the clinician involved with the child and his family, and with cor-
rective surgical reconstruction towards a better overall experience and
outcome.
This is a stimulating text worthy of serious study.
Adrian Bianchi
Neonatal and Paediatric Reconstructive Surgeon
Manchester, UK
May 2016
vii
Preface
Penis is a miraculous organ; with its remarkable erectile capability has
throughout human history consistently been considered emblematic of mas-
culinity, the penis has been the subject of exhaustive study, and its anatomy is
generally deemed to be well-established.
Each year an estimated six percent of total births worldwide (>8 million
children), including three percent of all live births in the United States (more
than 120,000 babies), are born with a serious birth defect of genetic origin.
Congenital penile anomalies are among the most common human birth
defects; approximately one out of every 1,500 children is born with atypical
genital or reproductive anatomy that raises the question of cosmetic and func-
tional correction.
Many of these anomalies, specially rare one, are not fully investigated and
usually the practitioners and researchers spending a lot of their time and
effort looking in the scientific media to find out the full description and the
proper management of such cases they are facing in the daily practice without
a productive achievement. The extent and complexity of these malformations
require a thoughtful approach to timely surgical management and consistent
care through their transition from childhood to adulthood. The newborn with
abnormal genital development presents a difficult diagnostic and treatment
challenge for the primary care paediatrician. It is important that a definitive
diagnosis be determined as quickly as possible so that an appropriate treat-
ment plan can be established to minimize medical, psychological, and social
complications.
Alongside more than 30 years working in the field of genitourinary anom-
alies, a considerable number of widely variant cases of congenital diseases
affecting penis were collected and it is time now to put all in a text work as a
guide for proper dealing with such anomalies.
Therefore, this textbook will stand to provide a comprehensive but concise
data for almost all congenital diseases and anomalies affecting the penis;
explaining the embryological and anatomical background, incidence, histori-
cal notes, appropriate investigations, imaging and proper management, this
book is packed with colour photographs of the abnormalities of the penis, as
well as abnormalities of the prepuce, and male urethra. These photographs
obviously represent a lifetime’s work and the quality of its colour is excellent,
and they edited with each disease to demonstrate its details, and some anima-
tions will be available online for the difficult and complex cases.
ix
x Preface
I am delighted that the quantity of text has been kept to a minimum. To
find out exactly which subjects have been covered you can go to the index to
see the wide variety of topics, but they vary from the common, e.g. phimosis
to the rarer penile duplications. This book is valuable for the experienced
paediatric urologist to use as an occasional reference, and probably very use-
ful for teaching as it will form the basis of discussions of both the common
and rare abnormalities.
Many congenital penile diseases like penoscrotal transposition, median
raphe and intact prepuce megameatus anomalies are re-classified with new
entities added to the previously described categories; like central penile scro-
talization and caudal scrotal regression in penoscrotal transposition, and cen-
trally located megameatus without hypospadias or epispadias in megameatus
chapter. Also in prepuce section a new anomaly of microposthia is described
with some details. At the meantime the common anomalies like hypospadias
and bladder exstrophy are not discussed herein as the reader can find a lot of
literature explaining it elsewhere, only variant of hypospadias and primary
epispadias are considered. Despite this book is dedicated for congenital
anomalies of the penis, we opted to add some acquired diseases, which may
had a congenital background, like balanitis and balanoposthitis; also from my
experience in dealing with a huge number of cases of circumcision and its
complications, I found the congenital penile anomalies like micropenis,
webbed penis and penile chordee had a great impaction in the incidence of
such complications, so we discussed this complications briefly in one
chapter.
I hope this textbook will add a deep insight into the congenital diseases of
the penis and will help early detection of such diseases during childhood,
which had a great impaction not only in sexuality and fertility but also in the
psychological makeup of the child.
Cairo, Egypt Mohamed Fahmy
Acknowledgement
I wish to acknowledge my colleagues who lent me their own photos of some
rare diseases of the penis; in this regard I express my gratitude to Dr. Naeem
Khan, from Pakistan, Dr. Mohamed Abdalbari, from Yamen, Dr. Wael
Ghanem, Cairo, and Dr. Cansu Ünden Özcan, from Turkey.
My great thanks to dearest friend Dr. Alae Elshennawy, consultant urolo-
gist for effort he exerted to review some of the manuscripts.
I’m very grateful to Andre Tournois and Evgenia Koutsouki, Springer’s
Clinical Medicine Editor, for their great effort and support throughout prepa-
ration of this book.
xi
Contents
Part I Introduction
1 Embryology of the Penis ................................ 3
1.1 Penile Development ................................ 4
1.2 Urethral Development .............................. 6
1.3 Preputial Development .............................. 7
References ............................................ 8
2 Anatomy and Normal Variations ......................... 9
2.1 Introduction ...................................... 9
2.2 Penile Innervation ................................. 9
2.3 Penile Vasculature ................................. 10
2.3.1 Arteries .................................... 10
2.3.2 Veins ...................................... 11
2.3.3 Corpora Spongosium ......................... 11
2.4 Urethra .......................................... 11
2.5 Tunica Albuginea .................................. 12
References ............................................ 13
3 Penis in History ....................................... 15
3.1 The Venerable Organ of Antiquity ..................... 15
3.2 Phallic Cult. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.3 The Curative Penis ................................. 21
3.4 Scientific Penetration of the Penis ..................... 22
3.5 Spectrum of Penile Malformations in Ancient Times ...... 24
3.6 Penis Yielding to Surgical Scalpel ..................... 26
3.6.1 Hypospadias in History ....................... 26
3.6.2 Micropenis and Penile Lengthening Procedures .... 27
3.7 Psychology of the Penis ............................. 27
3.8 Royal Members with Penile Anomalies ................. 28
3.8.1 Tutankhamun’s Erect Penis and the Exodus ....... 28
3.8.2 Epispadiac Emperor Heraclius .................. 29
3.8.3 Hypospadias of King Henry II .................. 29
3.8.4 Phimosis of Louis XVI and the French Revolution .. 29
3.8.5 Napoleon’s Micropenis and His Bruised Ego ...... 30
References ............................................ 30
xiii