Penoscrotal Transposition in Hypospadias vs. XX-Male Syndrome
Left picture: The diagnosis is a severe hypospadias with a partial penoscrotal transposition in which the scrotum is displaced in a dorsal direction in relation to the penis. Compare with analogous findings in a total penoscrotal transposition in the figure at the bottom of the same illustrations in which a scrotal hypospadias is also present. Right picture: The situation in this 16-month-old child is more complicated. According to the chromosomal analysis an XX-male syndrome is present, which is a special type of abnormal gonadal development. On unfolding the external genitals in the figure at the bottom of the same illustrations a penis-like structure is recogizable and in direction of the anus an opening which is partially stuck together. These findings feign a urethral opening as in a perineal hypospadias; in fact, it is a urogenital sinus, meaning that the external genitals are not exclusively male in this case. On the contrary, the external genitals are intersexual. The dorsal cleft is an indication against a penoscrotal transposition, although the halves of the scrotum nearly touch each other. Compare it with the figure at the bottom of contralateral patient.
Left picture: Abnormal external genitals in a toddler; the penis is partially hidden by two scrotal halves which are displaced in a dorsal direction, and which are empty. Right picture: The two empty scrotal halves lie nearly completely above a penis hardly recognizable as such.