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CASE REPORT
Year : 2019  |  Volume : 35  |  Issue : 4  |  Page : 299-300
 

Surgical correction of ectopic scrotum and penile torsion in a 5-year-old boy


Department of Urology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan

Date of Submission22-May-2019
Date of Acceptance12-Aug-2019
Date of Web Publication1-Oct-2019

Correspondence Address:
Eiji Hisamatsu
Department of Urology, Aichi Children's Health and Medical Center, Obu, Aichi
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.IJU_160_19

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   Abstract 

Ectopic scrotum is a rare condition, which is described as an anomalous position of one hemiscrotum along the inguinal canal. This anomaly is associated with other genitourinary anomalies. We report a 5-year-old boy with ectopic scrotum and penile torsion, who was successfully treated by simultaneous surgery.



How to cite this article:
Hisamatsu E, Shibata R, Yoshino K. Surgical correction of ectopic scrotum and penile torsion in a 5-year-old boy. Indian J Urol 2019;35:299-300

How to cite this URL:
Hisamatsu E, Shibata R, Yoshino K. Surgical correction of ectopic scrotum and penile torsion in a 5-year-old boy. Indian J Urol [serial online] 2019 [cited 2019 Oct 22];35:299-300. Available from: http://www.indianjurol.com/text.asp?2019/35/4/299/268300



   Introduction Top


Ectopic scrotum is a rare condition, which is described as an anomalous position of one hemiscrotum along the inguinal canal. This anomaly is associated with other genitourinary anomalies.[1] We report our experience of surgical correction of ectopic scrotum with penile torsion.


   Case Report Top


A 3-year-old boy was referred to our center with genital abnormalities. He had surgical repairs of omphalocele, bilateral inguinal hernia, and right lower extremity abnormality. He received intramuscular injections of testosterone enanthate for the management of micropenis. On physical examination, the right hemiscrotum was located in the right infrainguinal region and contained the right testis. The left hemiscrotum was located in the normal position with the left retractile testis. He had 90° clockwise penile torsion [Figure 1]a. Renal and bladder ultrasonography showed right small kidney. On dimercaptosuccinic acid renal scan, the split function of the right kidney was 24%.
Figure 1: Intraoperative findings of surgical correction of ectopic scrotum and penile torsion. (a) Rotation flap was designed for scrotoplasty. (b) The rotation flaps and right testis were mobilized after correction of the penile torsion. (c) The flaps were switched, and the right testis was fixed in the right rotated hemiscrotum. (d) Byars flap was crisscrossed for skin covering of the penis

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At the age of 5 years, we performed surgical correction of ectopic scrotum and penile torsion [Figure 1]. Degloving was done following transscrotal orchiopexy for the left retractile testis. After that, 45° clockwise penile torsion persisted. Subsequently, a dartos flap was dissected from the dorsal skin. The flap was transposed ventrally from the left side of the penis and fixed to the tunica albuginea of the right corpus cavernosum. After penile torsion was improved, we performed rotation flap scrotoplasty with right orchiopexy. The ectopic scrotal skin was pedicled inferiorly with a superior pedicle to the intervening skin. The flaps were mobilized and switched, and the right testis was fixed in the right rotated hemiscrotum. Byars flap was crisscrossed for skin covering of the penis.

On follow-up evaluation at 16 months after the surgery, 15° clockwise penile torsion persisted. The rotated scrotum had an acceptable cosmetic appearance, and both testes were viable in the scrotum [Figure 2].
Figure 2: Genital appearance 16 months after the surgery. The rotated scrotum had an acceptable cosmetic appearance, and both testes were viable in the scrotum

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   Discussion Top


Ectopic scrotum is extremely rare, with 27 cases reported in the literature up to 2017.[2] Two theories have been proposed to account for this condition: abnormalities in the development of the gubernaculum with its secondary attachment to the skin covering the genital tubercle and failure of fusion of the outer genital folds due to heel compression during intrauterine life.[3]

The location of ectopic scrotum can be suprainguinal, infrainguinal, or perineal, and suprainguinal type is the most common.[1] Ectopic scrotum is associated with inguinal hernias, penile torsion, hypospadias, patent urachus, imperforate anus, bladder exstrophy, cleft lip or palate, and leg deformities.[1],[2] In one review, 70% of boys with a suprainguinal ectopic scrotum had ipsilateral upper urinary tract anomalies, including renal agenesis, renal dysplasia, and ectopic ureter.[4] Our patient with infrainguinal ectopic scrotum had renal hypoplasia, omphalocele, penile torsion, inguinal hernia, and leg deformity.

The management of ectopic scrotum includes one-stage repair (simultaneous scrotoplasty and orchiopexy), two-stage repair (orchiopexy with subsequent scrotoplasty or scrotoplasty with subsequent orchiopexy), and excision of ectopic scrotal tissue.[2] We performed one-stage repair for infrainguinal ectopic scrotum with penoplasty for penile torsion without any postoperative complication.

In conclusion, simultaneous one-stage repair of ectopic scrotum and penoplasty of penile torsion could be performed safely. The rotated scrotum had a good cosmetic appearance, and the testes were viable in the scrotum.

Declaration of patient consent

The authors certify that they have obtained the appropriate patient consent form. In the form, the patient and his legal guardian have given the consent for his images and other clinical information to be reported in the journal. The patient and his legal guardian understand that his name and initial will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

 
   References Top

1.
Palmer LS, Palmer JS. Management of anormalities of the external genitalia in boys. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh Urology. 11th ed.. Philadelphia: Elsevier; 2016. p. 3382.  Back to cited text no. 1
    
2.
Chiang G, Cendron M. Disorders of the penis and scrotum. In: Gearhart JP, Rink RC, Mouriquand P, editors. Pediatric Urology. 2nd ed. Philadelphia: Saunders Elsevier; 2010. p. 553.  Back to cited text no. 2
    
3.
Hoar RM, Calvano CJ, Reddy PP, Bauer SB, Mandell J. Unilateral suprainguinal ectopic scrotum: The role of the gubernaculum in the formation of an ectopic scrotum. Teratology 1998;57:64-9.  Back to cited text no. 3
    
4.
Elder JS, Jeffs RD. Suprainguinal ectopic scrotum and associated anomalies. J Urol 1982;127:336-8.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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