Scrotoperineal Hypospadias vs. Adrenogenital Syndrome in the Girl
Left picture: In this patient a severe type of hypospadias is present. This type is named scrotoperineal hypospadias according to the site of the urethral orifice. Although at the moment of examination no testicles are visible, they may be palpated in front of the external inguinal ring and moved into the scrotum. Notice the typical folding of the scrotal skin in comparison with the labioscrotal folds of the picture of the contralateral patient. Right picture: The diagnosis is an adrenogenital syndrome in a female toddler. Some urine has been evacuated by the common section of the urogenital sinus; it is explained by a seeming incontinence due to evacuation of residual urine from a former micturation in the upper part of the vagina. The masculinized clitoris lies close to the anterior circumference of the opening of the urogenital sinus. The labioscrotal folds have a strong pigmentation and do not exhibit the structure of a scrotum. It is a stage III to IV according to Prader of a female pseuodhermaphroditism.
Left picture: Unfolding of conspicuous external genitals in a toddler. A foreskin is visible, which is intact on the dorsal side and extended, and between the divided labioscrotal halves a probe is introduced in an opening. Right picture: A foreskin-like structure is extended with a glans underneath it. Between two divided labioscrotal folds a V-shaped opening is recognizable, and in direction of the anus the skin is moist in the midline.