Pediatric Genital Abnormalities
At Mount Sinai, we also treat a variety of pediatric genital abnormalities.
Hypospadias are the most common genital abnormality we see. Children with this condition have a urethral opening that is not at the tip of the penis but is further down on the ventral surface (between the head of the penis and the scrotum). These children also tend to have chordee, a curvature of the penis down towards the scrotum. We recommend surgical repair because hypospadias affects fertility, sexual intercourse, appearance (cosmesis), and the ability to void standing up. We do not know the cause of hypospadias. We are often able to treat hypospadias on an outpatient basis, under general anesthesia. We often use the penis foreskin in the repair. Even if there is no foreskin, medical advances enable us to repair certain types of hypospadias even without the foreskin.
Epispadias is present at birth. The urethra, the tube that carries urine out of the body from the bladder, does not develop into a full tube. This makes it difficult to urinate. Children with this condition tend also to have bladder exstrophy. We can correct this condition by creating a new urethra and rotation of the corporeal bodies to give the penis its more normal orientation.
Chordee is a curvature of the penis. Some children are born with a chordee without associated hypospadias or epispadias. We can usually correct this condition on an outpatient basis, by surgical resection and placing placating sutures in the penis.
Ambiguous genitalia can arise due to abnormal chromosomes, gonadal problems or enzymatic disorders. During development, both the male and female external genitalia arise from the same common structures. Children with XY genes can appear to have female genitalia and children with XX genes can appear to have male genitalia. We can often treat these conditions surgically. At Mount Sinai, we use a multidisciplinary team of a pediatric urologist, pediatric endocrinologist, geneticist, and neonatal intensive care physician to determine what possible abnormalities are present in the genes, hormones, and anatomy.
Undescended testicles is one of the most common conditions we see, affecting about 3 percent of all boys. Testis form in the retroperitoneum (the back part of the abdomen), then descend to the iguinal canal and into the scrotum. We diagnose undescended testis with a physical exam. If we cannot feel the testis, it is considered “non-palpable.” In general, there are three reasons for nonpalpable testis:
- the testis is in the inguinal canal and for some reason cannot be palpated
- the testis is inside the abdomen
- the testis does not exist on that side altogether
For most boys, the testis descends into the scrotum during the first year of life. If they do not descend the first year, we recommend surgical correction to avoid damaging the testis, which function and grow best in the scrotal position. If we cannot palpate the testis, we perform laparoscopy to determine the reason that we cannot feel the testis. We can move many intra-abdominal testes into the scrotum by laparoscopy alone. If cryptorchidism is corrected, fertility potential should approach that of the general population. We check regularly for possible testis tumors.
Inguinal hernias appear quite frequently in young children. These hernias differ from adult hernias in that the peritoneum (the sack that encompasses the intestines) fails to seal, leaving a boundary between the abdomen and scrotum. You can tell that a child has a hernia by a bulge in the groin or in the scrotum that often changes size. We treat inguinal hernias by closing the patency with an outpatient surgical procedure. The recurrence rate is minimal.
Hydrocele is a collection of fluid along the membrane covering the front and sides of the testicle. We can treat these easily by closing the patency with an outpatient procedure. The recurrence rate is minimal.
Hydronephrosis happens when a kidney swells due to back-up of urine.
Circumcision is the surgical removal of the penis’s foreskin (a small flap of skin that covers its tip), generally performed shortly after birth. This is a very safe procedure when performed in a sterile environment by a specially trained professional or physician, such as a urologist. Bleeding is minimal and infections are rare.
Most boys are circumcised before one month of age, by an obstetrician at the hospital or, in some instances, a professionally trained mohel, in a Jewish ceremony. At this point, we only need to use a local anesthetic. After a month of age, most children are circumcised by a pediatric urologist in an operating room under general anesthesia.
Research suggests that circumcision reduces the risk of HIV, HPV, and other sexually transmitted infections as well as penile and prostate cancers and urinary tract infections. According to the American Association of Pediatrics, the health benefits of newborn circumcision outweigh the risks, though the final decision is up to the parents.
Certain children are not appropriate candidates for circumcision, including premature babies, babies with a bleeding disorder, and babies with conditions whose correction might require foreskin tissue as part of the repair.