Micropenis (in children)
Summary/Definition
Micropenis is a case when the size of the penis is abnormally small, but the shape of the penis is normal and is not a consequence of a pathological condition. As a rule, the small penis is diagnosed by stretching the penis and measuring the length from the tip of the pubic bone to the edge of the head. At the same time, the length is more than 2 cm shorter than the length of the penis of a person of the same age. In newborns, a small penis is suspected if the measured length of the penis is less than 2 cm. In many cases, the testicles in the scrotum are small or cryptorchidism is observed, so it is necessary to carefully examine the external genitalia and differentiate them from the hidden penis. The hidden penis is an anomaly in which the penis is hidden by the tissues of the subcutaneous fat of the pubic region and looks very small or almost absent from the outside. Congenital cryptorchidism occurs when the penis enters the subcutaneous tissue due to the lack of fixation of the trunk of the penis to the skin, in some adolescents and adults cryptorchidism can also occur due to severe obesity.
The cause of micropenis is the absence of normal hormonal stimulation after 14 weeks of birth, when penis growth occurs, which can occur with a decrease in the level of gonadotropin in the fetal hypothalamus, hypogonadism or violations of the production of male hormones in the testicles. The reason for the hidden penis is considered insufficient fixation of the skin of the trunk of the penis, abnormal fibrous bands attached to the muscle fibers of the scrotum, fixing the penis to the pubic bone, as well as obesity in childhood and puberty.
Symptoms
In the case of a small penis due to disorders of the endocrine system, various concomitant symptoms may appear, such as bone growth retardation or anosmia. A hidden penis can cause difficulty urinating, balanoposthitis and urinary tract infections, pain during urination, resulting in involuntary leakage of urine. Both a small and a hidden penis can cause concern to patients and caregivers because their penis looks small on the outside.
Diagnostics
Micropenis is considered if the length of the stretched penis (the length of the penis measured in the erect position) is more than 2 cm shorter than the average length of the penis of peers and is characterized by delayed sexual development, anosmia, decreased learning ability, low levels of adrenocorticotropic hormone and thyroiditis. Since many cases are accompanied by insufficient hormone production, it is necessary to assess the state of the endocrine and central nervous system (hormonal examination, brain tomography, etc.). In addition, it is necessary to take into account the possible disorder associated with the component. A hidden penis can be diagnosed by confirming that the structural part or all of the cavernous bodies are hidden under the skin, as a result of which the penis appears small or hidden. During the diagnosis, it is necessary to measure the upper and lower parts of the penis to make sure that the length of the penis is normal.
Treatment and course of the disease
The goal of the treatment of the small penis is to provide a sufficient amount of male hormones for the growth of the penis, while preventing other growth disorders. Treatment begins at the age of one year and usually involves the administration of 25 mg of testosterone intramuscularly up to three times every 3-4 weeks or the appointment of male hormones, such as a cream with testosterone or a cream with dihydrotestosterone. There are still no standard terms and indications for the treatment of a hidden penis. In cases where balanoposthitis often occurs due to poor hygiene around the glans penis due to phimosis, or when urination is difficult due to the narrow foreskin and cannot control the direction of urine, or due to cosmetic problems, treatment can be carried out after 3-5 days. In some cases, patients are waiting for puberty and undergo penile elongation surgery. Before deciding on surgical intervention, it is necessary to get rid of severe obesity. The basic principle of the operation is to maximize the use of the remaining skin to cover the penis, increase the size of the penis so that the skin does not tighten, and attach the skin and subcutaneous tissue to the root of the penis.
Complications
Complications from hormonal treatment of micropenis include growth retardation and epiphyseal growth zones. Complications after surgical treatment of the hidden penis – there may be swelling of the penis for 60-90 days, but usually it goes away on its own. In some cases, the penis will again be hidden under the skin.
