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【Objective】 To investigate the efficacy of negative pressure suction and topical testosterone cream in the treatment of simple micropenis in school-aged obese children and the effects on blood lipids and serum sex hormones. 【Methods】 A total of 79 children aged 7 to 14 (10.50±1.62) years treated and followed up during Nov.2020 and Jul.2022 were involved. The patients were randomly enrolled in the negative pressure suction group (n=39) and the topical testosterone cream group (n=40). The negative pressure suction group was treated with negative pressure suction for 30 min/time, 1 time/day, for 30 d. The topical testosterone cream group was treated with topical testosterone cream applied to the scrotum of the penis 2 times/day for 30d. The transverse and longitudinal diameter of the glans, penile flaccidity, retraction length, serum sex hormones and blood lipids were measured before and after treatment. 【Results】 In both groups, penile flaccidity, retracted length and transverse and longitudinal diameter of the glans were significantly greater at 30 days of treatment and 2 months of follow-up than those before treatment (P0.025). In the topical testosterone cream group, at 30 days of treatment, there were significant differences in serum total cholesterol (CHOL), apolipoprotein B (Apo B), apolipoprotein A1 (Apo A1), high-density lipoprotein (HDL), low-density lipoprotein (LDL), sex hormone binding protein (SBG), estradiol (E2) and testosterone (TES) compared to those before treatment; at 2 months of follow-up, the differences in Apo A1, HDL, TES and DHS were still significant (P<0.025). 【Conclusion】 Both topical testosterone cream and negative pressure suction have significant efficacy in the treatment of micropenis in school-aged obese children, while topical testosterone cream has some side effects and retraction may occur after treatment. Negative pressure suction is safe and easy to operate, without side effects and retraction, and can be promoted for the treatment of micropenis in obese children.
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Micropenis is an objective diagnosis based on accurate measurement of the length of the penis. Micropenis can be caused by many factors, including the structure of the hypothalamic-pituitary-gonadal axis or hormone defects. Therefore, examination of the endocrine system is extremely important for the diagnosis of the etiology. Once the diagnosis is confirmed, a multidisciplinary team of endocrinologists, geneticists, pediatricians, pediatric surgeons, and urologists are required to jointly develop individualized treatment plans. This article reviews the etiology, diagnosis and treatment of micropenis, aiming to raise awareness and concern about micropenis.
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@#Introduction: Penile length is defined as a length from base of penile until the tip of the glans. If the length of penile less than 2.5 standard deviations (SD) on average of its age it characterized as a micropenis. The aim of this study is to describe the penile length and micropenis condition in elementary school student. Method: This is a descriptive study to find out the penile length in elementary school boys. Penile length was measured from symphysis pubic to tip of the glans using a rigid ruler by stretching the penile or stretching penile length (SPL) and identified the micropenis condition. Results: There were 203 boys with age ranging from 6 until 13 years old. Mean penile length on all age groups are slightly above mean - 2.5 SD. Micropenis was found in 52 boys (22.6%), half of them are in 9 to 11 years old groups. Most subjects are Sundanese. Conclusions: The mean penile length in all age groups were shorter than the reference that we used. Majority of the subjects in our study were Sundanese, this finding suggest that Sundanese children has a shorter penile length than a subject used in our reference study. Micropenis case findings in this study turned out to be quite large and surprising.
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@#Primary partial empty sella occurs when less than 50% of an enlarged or deformed sella turcica is filled with cerebrospinal fluid in the setting of unidentified etiologic pathological conditions. Prepubertal hypogonadotropic hypogonadism presenting as its main manifestation is rare since its peak incidence commonly occurs late at 30 to 40 years of age and has a sexual predilection for female. We described a case of 20-year-old male who presented with micropenis and absent secondary sex characteristics. Work up showed cranial MRI finding of partial empty sella, low testosterone, LH, FSH, Estradiol and Beta HCG levels. Sex hormone replacement may not improve fertility for this case but may help produce and maintain virilization and prevent future complications of hypogonadotropic hypogonadism.
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Genital Diseases, Male , Penis , HypogonadismABSTRACT
Objective To investigate the cliuical phenotype and the genotype of forty-one patients with steroid 5α-reductase type 2 deficiency.Methods The clinical data were collected including physical examination,medical history,laboratory test,as well as ultrasonic examination.Genomic DNA was extracted from peripheral blood leukocytes.Sanger sequencing and targeted gene captured next-generation sequencing were applied to detect the SRDSA2 gene mutation.Results All the patients are Han nationality and their ages ranged from 4 months to 11 years old.The karyotypes of 41 patients were 46,XY and all SRY genes were detected as positive.There were 26 (63％) patients manifested isolated micropenis,and the rest of fifteen patients were hypospadias associated with microphallus accounting for 37％.There were 39 patients who carried biallelic mutation.Two cases just identified one allele mutation.Sixteen gene mutation types were confirmed.Among them c.725A ＞ G (p.Tyr242Cys),c.694C ＞ G (p.His232Asp),and c.548-9T＞G are the novel gene types.The allele frequency of c.680G＞A (p.Arg227Gln) is 60％ (48/80).Conclusion The primary manifestations of patients with steroid 5α-reductase type 2 deficiency were micropenis or hypospadias accompanied with micropenis.c.680G＞A (p.Arg227Gln) is the predominantly mutation type of Chinese patient with steroid 5α-reductase type 2 deficiency.
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Objective To evaluate the curative effectiveness and safety of human chorionic gonadotropin(HCG) treatment on children with microphallic hypospadias.Methods A total of 48 consecutive children with microphalic hypospadias were enrolled in the study,and the children were randomized into the experiment group(HCG treatment) and the control group with the research randomizer.The patients in experiment group were treated with HCG prior to surgery,and the control group did not received any hormone therapy preoperatively.All children in the experiment group and the control group underwent hypospadias repair by using transverse preputial island flap (Duckett technique) urethroplasty.Penile length,diameter of glans penis,bone age,serum testosterone level,and secondary effects were recorded before and after therapy in the experiment group.Postoperative complications were assessed with respect to fistulas,urethral strictures,diverticula,meatal stenosis,and glanular dehiscence in both groups.Results (1)Mean penile length and diameter of the experiment group increased significantly by (1.08±0.47) cm (t=-5.196,P<0.05) and (0.31±0.06) cm and there was a significant difference between before and after treatment (t=-5.080,P<0.05).(2)Urethrocutaneous fistulas were observed in 8 patients in the control group compared to 2 patients in the experiment group with a statistically significant difference (χ2=4.547,P<0.05).There was a significant difference between the overall reoperation rates of control group (9 patients) and the experiment group (3 patients,χ2=4.000,P<0.05).The penile tissue of the patients in the experiment group was soft and able to be easily separated and released during the operation and the flap had more blood supply.Conclusions Pretreatment with HCG therapy prior to hypospadias repair is beneficial to children with microphallic hypospadias.Significant penile growth was seen in the children treated with HCG and there was no obvious side effect.Moreover,pretreatment with HCG is beneficial to decrease the complications and reoperation rates of hypospadias repair which proves to be effective and safe.
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Micropenis is one of clinical manifestations of 46,XY disorders of sex development.Due to the complex etiology,the limitation of diagnostic methods,it is difficult to define the causes in some complicated cases.The abnormality in any part of the hypothalamic pituitary gonadal axis,androgen synthesis and function will influence the development of penis.Based on the statistical data of penis in comparison,trying to find the reference data for clinical application,used in the diagnosis of micropenis.For the patient raise a boy,the treatment including medicine and operation to improve the size of penis.Exogenous androgen and human chorionic gonadotrophin (HCG) treatment are the main methods in present,it can effectively promote the micropenis to increase in size.But it is debatable when to start the treatment,dosage and the duration.The potential side effects are unknown.Operation treatment can improve the hypospadias induced abnormal appearance and reconstruction of urethra.Treatment of gonadotropin can be applied to the patients who want to acquire fertility.For patients reared as female,male gonads must be removed,and estrogen replacement administered after adolescent.
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Penile growth is under androgenic control. Human chorionic gonadotropin (hCG) has a stimulatory effect on testicular steroidogenesis and penile growth. The purpose of this study was to evaluate the effect of hCG treatment on the gonadal response and penile growth in male idiopathic hypogonadotrophic hypogonadism (IHH) presenting with micropenis. A total of 20 IHH patients who met the criteria for micropenis were included in this study. hCG (1,500-2,000 IU) was administrated intramuscularly, 3 times per week, for 8 weeks. Basic laboratory and hormonal indexes (including serum testosterone and LH levels), penis length (flaccid and stretched), and testicular volume were measured before and 24 weeks after hCG treatment. The patients' mean age was 18.9 years (range, 12 to 24 years). The mean serum testosterone level was significantly increased after hCG treatment (baseline, 2, 4, 12, and 24 weeks: 0.90+/-1.35 ng/ml, 1.77+/-1.31 ng/ml, 3.74+/-2.24 ng/ml, 5.49+/-1.70 ng/ml, and 5.58+/-1.75 ng/ml, respectively; p<0.05). Mean penile length also increased significantly 24 weeks after treatment (flaccid length: from 3.39+/-1.03 cm to 5.14+/-1.39 cm; stretched length: from 5.41+/-1.43 cm to 7.45+/-1.70 cm; p<0.001). Mean testicular volumes increased significantly as well (left: from 5.45 cc to 6.83 cc; right: from 5.53 cc to 7.03 cc). There were no remarkable adverse effects of the hCG treatment. The hCG treatment increased the serum testosterone level, penile length, and testicular volume in IHH patients. Our results suggest that hCG treatment has a beneficial effect on gonadal function and penile growth in patients with IHH presenting with micropenis.
Subject(s)
Humans , Male , Chorionic Gonadotropin , Genital Diseases, Male , Gonads , Hypogonadism , Penis , TestosteroneABSTRACT
Penile growth is under androgenic control. Human chorionic gonadotropin (hCG) has a stimulatory effect on testicular steroidogenesis and penile growth. The purpose of this study was to evaluate the effect of hCG treatment on the gonadal response and penile growth in male idiopathic hypogonadotrophic hypogonadism (IHH) presenting with micropenis. A total of 20 IHH patients who met the criteria for micropenis were included in this study. hCG (1,500-2,000 IU) was administrated intramuscularly, 3 times per week, for 8 weeks. Basic laboratory and hormonal indexes (including serum testosterone and LH levels), penis length (flaccid and stretched), and testicular volume were measured before and 24 weeks after hCG treatment. The patients' mean age was 18.9 years (range, 12 to 24 years). The mean serum testosterone level was significantly increased after hCG treatment (baseline, 2, 4, 12, and 24 weeks: 0.90+/-1.35 ng/ml, 1.77+/-1.31 ng/ml, 3.74+/-2.24 ng/ml, 5.49+/-1.70 ng/ml, and 5.58+/-1.75 ng/ml, respectively; p<0.05). Mean penile length also increased significantly 24 weeks after treatment (flaccid length: from 3.39+/-1.03 cm to 5.14+/-1.39 cm; stretched length: from 5.41+/-1.43 cm to 7.45+/-1.70 cm; p<0.001). Mean testicular volumes increased significantly as well (left: from 5.45 cc to 6.83 cc; right: from 5.53 cc to 7.03 cc). There were no remarkable adverse effects of the hCG treatment. The hCG treatment increased the serum testosterone level, penile length, and testicular volume in IHH patients. Our results suggest that hCG treatment has a beneficial effect on gonadal function and penile growth in patients with IHH presenting with micropenis.
Subject(s)
Humans , Male , Chorionic Gonadotropin , Genital Diseases, Male , Gonads , Hypogonadism , Penis , TestosteroneABSTRACT
The management of children with intersex or micropenis is an ongoing challenge to clinicians. Topics including the recent surgical developments and controversies of management are reviewed. In feminizing genitoplasty, clitoroplasty is done as early as the first few months of life, however there are controversy in vaginal reconstruction for high vaginal confluence. In the patients with complete androgen insensitivity the testes are left intact until after puberty, so that hormone replacement therapy may be delayed. The sex assignment and surgical management of patients with intersex is very complex and should be made by the intersex team and family. Micropenis should be diagnosed by measuring stretched penile length and differentiated from buried penis which has basically normal penile size. In most boys with small penis, the size of penis reaches the normal range through a catch-up growth after puberty. Therefore close observation is a general rule in management of small penis. However low dose androgen treatment can be applied without complication in children with micropenis, especially who have severe psychological stress.
Subject(s)
Child , Humans , Male , Genital Diseases, Male , Hormone Replacement Therapy , Penis , Puberty , Reference Values , Stress, Psychological , TestisABSTRACT
Twenty seven patients with micropenis including 15 patients who had micropenis accompanied by hypospadias were managed at Seoul National University Hospital during the recent seven years. Eleven patients had cryptorchidism, 9 of them were bilateral. Etiology was determined by hormonal assay including HCG stimulation test ; 9 as hypogonadotropic hypogonadism, 3 as primary testicular dysfunction, I as partial androgen insensitivity syndrome and 5 as idiopathic. Etiology was undertimined in 9 patients. One patients was found to be Prader-Willi syndrome and another one patient Kallmann`s syndrome. Four other patients had other anomalies , imperforate anus. cleft palate, hypertelorism and ptosis of eyelid, respectively. Nineteen patients had endocrine therapy using HCG, testosterone cream or Depotestosterone injection and all except one case respodeded satisfactorily in penile size increase.