Pediatric Surgery, Al Azher University, Cairo, Egypt
Deficient prepuce is not recognised before as a specific disease entity, and little attention was paid for this anomaly in the literature, herein this anomaly will be described with some details, as it may be associated with major penile deformities.
KeywordsDeficient prepuceMicroposthiaHypoposthiaPeeper penis
Deficient prepuce is not recognised before as a specific disease entity, and little attention was paid for this anomaly in the literature , herein this anomaly will be described with some details, as it may be associated with major penile deformities.
Microposthia, Hypoposthia, and Peeper penis, which is a term refers to the penis whose foreskin is short enough to expose some of the glans when flaccid.
In a sample of 3000 young men examined W. Schoeberlein found a lack of, or spontaneous atrophy of the foreskin among approx. 4 % .
5.1 Significance of Microposthia
Failure of development of urethral groove; results in hypospadias and subsequently associated with ventrally deficient prepuce (hooded Prepuce) in many cases. In female the urethral groove persist so preputial hood is a normal finding with clitoris, and it is extremely rare to have a complete prepuce ensheathing entirely the clitoris, but till now, there is no conventional explanation why there is some boys had a completely formed prepuce with hypospadias as in Intact Prepuce Megameatus (IPM) anomaly and other cases -that we will describe herein- with a deficient prepuce but with a normally formed urethra?, but many of these cases had an associated defective penile development along the defectively developed prepuce.
So cases of microposthia may present as an arrest of the normal preputial development secondary to failure of complete urethral folding (hypospadias) or due to an unknown (not yet detected) process where a feminine pathway of preputial development predominate.
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It is a condition of having a very small foreskin not covering the whole penis; microposthia diagnosed if the glans penis could be seen partially in a flaccid penis (Fig. 5.1). It is not a rare condition, and it could be considered as a normal variation, where the prepuce looks shorter to give the chance for the glans or the urinary meatus to be visible in a neonate without foreskin retraction . In all cases of microposthia frenulum is absent and penile raphe end at the coronal sulcus. Usually the foreskin is defective at the ventral aspect of the penis, but rarely it is completely normal in the ventral surface but shows deficiency only in the dorsum of the glans, which may hide an episodic or duplicated urethra (Figs. 5.2 and 5.3).