Our Summary

The study discusses a condition called penoscrotal transposition (PST), where the penis is positioned improperly in relation to the scrotum. It’s a rare abnormality that can occur alongside other issues like hypospadias (a condition where the urethra, the duct where urine comes out, opens on the underside of the penis) and chordee (a condition causing a downward curve of the penis).

The researchers reviewed their experiences of surgically treating PST using a modified version of a technique called the Glenn-Anderson technique. This was performed on 29 young patients, aged between 8 months and 15 years, from 2004 to 2022. The majority had complete PST, while the rest had a partial form of the condition.

The patients were divided into three groups. In the first group, the PST repair was part of a one-stage male genital reconstruction. In the second group, the PST repair was the final stage of a multi-stage hypospadias repair. In the third group, the children underwent PST repair without having hypospadias.

The Glenn-Anderson technique was adjusted for each case. It involved using a flap of skin from the scrotum, fully disconnecting the testes from the inner part of the scrotum when needed, and repositioning the scrotum to a normal location.

The follow-up period for the patients ranged from 6 months to 18 years. In the first group, most had a type of surgery for hypospadias repair called Onlay Prepucial Island Pedicle Flap (OIF), and the rest had Long Tubularized Incised Plate Repair (TIP). In the second group, the surgeries were a mix of OIF, Long TIP, and staged hypospadias repair. Post-surgery complications occurred in the first two groups, but not in the third group.

The researchers concluded that the modified Glenn-Anderson technique is a reliable and long-lasting surgical solution for PST in children. However, these children need to be monitored carefully until they reach adolescence to ensure no further operations are needed.

FAQs

  1. What is penoscrotal transposition (PST) and how is it corrected surgically?
  2. What is the Glenn-Anderson technique and how is it used in the repair of PST?
  3. What were the results of the study and were there any post-operative complications observed in patients who underwent PST repair?

Doctor’s Tip

A helpful tip a doctor might tell a patient about detethering surgery for penoscrotal transposition is to follow post-operative care instructions closely to ensure proper healing and minimize the risk of complications. This may include keeping the surgical area clean and dry, avoiding strenuous activities or heavy lifting, and attending follow-up appointments as scheduled. Additionally, it is important to communicate any concerns or changes in symptoms to your healthcare provider promptly.

Suitable For

Patients with penoscrotal transposition, especially those with complete transposition, are typically recommended detethering surgery to correct the malposition of the penis in relation to the scrotum. This surgery may also be recommended for patients with associated anomalies such as hypospadias and chordee. The surgery is usually performed in pediatric patients, with careful monitoring required until adolescence to ensure long-term success of the procedure.

Timeline

Before detethering surgery:

  • Patient presents with penoscrotal transposition (PST) anomaly, characterized by malposition of the penis in relation to the scrotum
  • Patient may have associated anomalies such as hypospadias, chordee, or other genital abnormalities
  • Surgical repair is planned, with consideration of whether PST repair is an integral part of one-stage male genitoplasty, an isolated last stage of staged hypospadias repair, or without the presence of hypospadias
  • Pre-operative assessments and preparations are conducted

After detethering surgery:

  • Patient undergoes modified Glenn-Anderson technique for PST repair, involving bilateral rotational advancement scrotal flap, complete de-tethering of the testis from the internal part of the scrotum, and relocation of the scrotal compartment in a normal position
  • Post-operative follow-up and monitoring range from 6 months to 18 years
  • Complications, such as Clavien Dindo grade III, may occur in some patients post-operatively
  • Patients require careful monitoring until adolescence to ensure no re-operation is needed

What to Ask Your Doctor

  1. What is the success rate of detethering surgery for penoscrotal transposition in pediatric patients?
  2. What are the potential risks and complications associated with this surgery?
  3. What is the expected recovery time following detethering surgery?
  4. Will my child need any additional surgeries or follow-up procedures after the initial surgery?
  5. How long will my child need to be monitored post-operatively to ensure the success of the surgery?
  6. Are there any long-term effects or considerations we should be aware of following detethering surgery?
  7. What is the experience of the surgical team with performing this specific type of surgery?
  8. Are there any alternative treatment options or approaches for penoscrotal transposition that we should consider?
  9. What can we expect in terms of post-operative pain management and care for our child?
  10. How can we best prepare our child for detethering surgery and the recovery process?

Reference

Authors: Perez D, Kocherov S, Jaber G, Raisin G, Chertin B. Journal: Arch Ital Urol Androl. 2024 Oct 2;96(3):12899. doi: 10.4081/aiua.2024.12899. PMID: 39356009