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Abstract
To construct a reference range for fetal penile length.
The length of the penis was measured during ultrasound assessment of 95 structurally normal male fetuses of gestational ages 16-38 weeks. Two fetuses with bladder outflow obstruction were also examined.
Fetal penile length increases significantly with gestational age, from a mean value of 6.0 mm at 16 weeks to 26.4 mm at 38 weeks. One fetus with urethral agenesis had a penile length on the 0.3rd centile.
Measurement of the fetal penis is easy and not time-consuming. In cases of bladder outflow obstruction, assessment of penile length assists in the differentiation between urethral agenesis and posterior urethral valves.
... According to Fok et al., the penile length in the Chinese neonatal population was shorter than in Caucasians and other Asian counterparts [3]. In addition, studies have evaluated fetal penile measurements according to the gestational age [8][9][10][11][12][13]. However, reference values have not yet been established for each ethnic group. ...
... Although the measurement standards and normal ranges for the neonatal penile length were defined, there is no consensus for the intrauterine assessment of the penile size [12]. [8][9][10]. However, using these reference ranges may not differentiate between a micropenis (a true malformation) and buried penis (a penis that is buried in the scrotal tissue). ...
... In literature, stretched penile length of neonates from Chinese and Taiwanese populations were smaller than Caucasian counterparts [3,14]. When we compared our ultrasonographic penile length measurements with previous reports of English [8], American [10], and Israeli [9] populations, we observed that our reference ranges were similar to their reports. When we compared our measurements with Danon et al. [12] our results were consistent with their measurements of both penile length and penile width. ...
The intrauterine diagnosis of micropenis is an important clue in the discernment of some syndromes and hormonal deficiencies. In this study, we tried to establish reference ranges for the fetal penile length and penile width. This prospective cross-sectional study included 179 healthy singleton male fetus pregnancies that were between 17 and 37 weeks of gestation. Of these pregnancies, the fetal penile length and width were measured using trans-abdominal ultrasound. The correlation coefficients of gestational age with penile measurements were calculated. We observed that as the gestational age increased both the penile length and width increased (p < .0001, correlation coefficients R(2) = 0.854 and R(2) = 0.883; respectively). Reference values of the penile length in the Turkish Population were similar to previously evaluated populations including English, American and Israeli populations. The penile width measurement is a convenient way to diagnose micropenis, but penile width measurement alone might miss some penile abnormalities including chordee and hypospadias.
... From the eighth week onward, male and female developmental pathways diverge. In males, maternal chorionic gonadotropins from the placenta stimulate growth and development of the testicular Leydig cells, which eventually produce their own testosterone for further development (3). The development of the external genitalia in males is dependent on the conversion of testosterone to the active component dihydrotestosterone (DHT). ...
... The development of the external genitalia in males is dependent on the conversion of testosterone to the active component dihydrotestosterone (DHT). Testosterone is converted to DHT locally by 5 α-reductase and then directly acts on androgen receptors to initiate cell signaling pathways (3,4). ...
Penile elongation surgery is less commonly performed in the public sector, but involves a collaborative approach between urology and plastic surgery. Congenital and acquired micropenis are the classic surgical indications for penile elongation surgery. The goal of intervention in these patients is to restore a functional penis size in order to allow normal standing micturition, enable satisfying sexual intercourse and improve patient quality of life. Many men seeking elongation actually have normal length penises, but perceive themselves to be small, a psychologic condition termed ‘penile dysmorphophobia’. This paper will review the anatomy and embryology of congenital micropenis and discuss both conservative and surgical management options for men seeking penile elongation therapy.
... Penile differentiation is achieved by the thirteenth week of gestation, after which a marked increase in penis size occurs, with the penis growing almost 20 mm between the fourteenth and thirty-eighth week of gestation. 6,7 During this period, development of the penis is completed by foetal androgens, which are produced under the influence of stimulation by the foetal pituitary gonadotropins. Thus, a hormonal abnormality of the hypothalamic-pituitarytesticular axis occurring after the twelfth week of g estation can result in an u nderdeveloped penis. ...
The term 'inconspicuous penis' refers to a group of anatomical abnormalities in which the penis looks smaller than is expected. Micropenis can be defined as 'true micropenis'-which results from a defect in the hypothalamic-pituitary-gonadal axis-and 'micropenis secondary to congenital anatomical anomalies of the surrounding and overlying structures'-also known as 'concealed penis'. The different forms of concealed penis include webbed penis, congenital megaprepuce and partially hidden penis caused by prepubic adiposity. This disorder can also have iatrogenic causes resulting from adhesions that are secondary to circumcision-this type of concealed penis is known as 'trapped penis'. However, in both groups, micropenis is defined as a stretched penile length that is at least 2.5 SD below the mean for the patient's age, but without any other penile defects. Patients with true micropenis can be managed with testosterone, which has demonstrated good penile elongation results in the long term. Surgery also has a pivotal role in reconstruction for elongating the penis and for correction of anatomical abnormalities in concealed penis.
... Several authors [8,9] published normograms for penile length during normal gestation. Penile size correlates to gestational age and there is no difference in penile length if measured before or after bladder emptying. ...
... Achiron et al. 15 em 1998, criaram um gráfico que demonstra o crescimento do escroto fetal com a idade gestacional. O crescimento peniano também foi aferido em alguns trabalhos 26,27 e demostrou aumento de aproximadamente 20 mm entre 14 e 38 semanas. ...
Muito além da tarefa de saciar a curiosidade dos pais, a determinação do sexo fetal tem importante valor nas gestações com risco de anomalias congênitas. O gênero apresenta íntima relação com doenças hereditárias, tanto com as ligadas ao cromossomo X, como a distrofia muscular de Duchanne e hemofilia, como também em doenças autossômicas recessivas com diferentes formas de acometimento conforme o gênero, tais como a hiperplasia con-gênita de adrenal. Desta forma, a determinação do sexo fetal em estágios precoces da gravidez torna-se de grande relevância. Nesta revisão, abordamos alguns aspectos atuais na determinação precoce do sexo fetal. Palavras chave: Determinação do Sexo; Ultrassonografia; Doenças genéticas inatas. Abstract Beyond the task to quench the curiosity of parents, fetal sex determination has important value in pregnancies at risk for congenital anomalies. The genus has a close relationship with inherited diseases, both with X-linked, such as muscular dystrophy and hemophilia Duchanne, but also in autosomal recessive diseases with different forms of involvement by gender, such as congenital adrenal hyperpla-sia. Thus, fetal sex determination at early stages of pregnancy becomes highly relevant. In this review, we discuss some current issues in the early determination of fetal sex.
... With reference to penis development during the fetal period, the only studies available in the literature, apart from that of our group [5,6,[17][18][19][20][21]23] were performed by ultrasound or other imaging methods in utero, and were related only to penile length [24][25][26][27]. ...
Background
The penile erectile tissue has a complex microscopic anatomy with important functions in the mechanism of penile erection. The knowledge of such structures is necessary for understanding the normal physiology of the adult penis. Therefore, it is important to know the changes of these penile structures during fetal development. This study aims to analyze the development of the main components of the erectile tissue, such as collagen, smooth muscle fibers and elastic system fibers, in human fetuses.
Methodology/Principal Findings
We studied the penises of 56 human fetuses aged 13 to 36 weeks post-conception (WPC). We used histochemical and immunohistochemical staining, as well as morphometric techniques to analyze the collagen, smooth muscle fibers and elastic system fibers in the corpus cavernosum and in the corpus spongiosum. These elements were identified and quantified as percentage by using the Image J software (NIH, Bethesda, USA). From 13 to 36 WPC, in the corpus cavernosum, the amount of collagen, smooth muscle fibers and elastic system fibers varied from 19.88% to 36.60%, from 4.39% to 29.76% and from 1.91% to 8.92%, respectively. In the corpus spongiosum, the amount of collagen, smooth muscle fibers and elastic system fibers varied from 34.65% to 45.89%, from 0.60% to 11.90% and from 3.22% to 11.93%, respectively.
Conclusions
We found strong correlation between the elements analyzed with fetal age, both in corpus cavernosum and corpus spongiosum. The growth rate of these elements was more intense during the second trimester (13 to 24 WPC) of gestation, both in corpus cavernosum and in corpus spongiosum. There is greater proportional amount of collagen in the corpus spongiosum than in corpus cavernosum during all fetal period. In the corpus spongiosum, there is about four times more collagen than smooth muscle fibers and elastic system fibers, during all fetal period studied.
... Fetal androgen levels are high between the 8 th and 24 th weeks of gestation, with peak levels often observed between the 14 th and 16 th weeks. Consequently, there is a marked increase in penile length during the second and third trimesters, with an increase of approximately 20 mm from weeks 16 to 38 (4,5). It can thus be deduced that a true micropenis is caused by a hormonal abnormality that occurs after the 12 th week of gestation (6). ...
Micropenis is a medical diagnosis based on correct measurement of length. If stretched penile length is below the value corresponding to - 2.5 standard deviation of the mean in a patient with normal internal and external male genitalia, a diagnosis of micropenis is considered. Micropenis can be caused by a variety of factors including structural or hormonal defects of the hypothalamic-pituitary-gonadal axis. It can also be a component of a number of congenital syndromes. For the etiological evaluation, endocrinologic tests are important. This article reviews the etiology, diagnosis, treatment and management of micropenis.
Conflict of interest:None declared.
... To our knowledge , defining fetal penile length by measuring the corpus cavernosum is the first proposed and published. Johnson et al. constructed a reference range for fetal penile length from 16 to 38 weeks' gestation measuring the glans to the scrotal length (Johnson and Maxwell, 2000). Pinette et al. retrospectively reviewed the sonographic pictures of 494 anatomically normal male fetuses measuring the fetal penis from the base of the shaft to the tip of the glans. ...
To construct cross-sectional reference range of the penile length during pregnancy, measuring it from the proximal edge of the corpus cavernosum to the tip of the glans penis.
Fetal penile length was measured by high resolution transvaginal ultrasound at 14 to 16 weeks and by transabdominal ultrasound at 17 to 35 weeks' gestation.
Fetal penile length increased significantly with gestational age (GA), from 7 mm at 14 weeks' to 50 mm at 35 weeks' gestation. Penile length measurements were strongly related to the biometric fetal measurements.
A reference range of the fetal penile length was constructed, measured from the proximal edge of the corpus cavernosum to the tip of the glans penis at 14 to 35 gestational weeks. This reference range can assist in early identification of true penile maldevelopment, which obligate further diagnostic workup, as opposed to the benign disorder of buried or concealed fetal penis.
... During the second and third trimester, growth of the penis is accomplished through fetal androgens, which are produced under stimulation by fetal pituitary gonadotropin. There is a marked increased in penile size over that time period, with the penis growing almost 20 mm from weeks 16 to 38 [3,4]. Therefore, true micropenis must result from a hormonal abnormality that occurs after 12 weeks of gestation. ...
Micropenis is part of a larger group of conditions broadly known as inconspicuous penis; however, it is fundamentally different from the other diagnoses in this group, such as webbed penis and buried penis, in that the underlying problem is the size of the penis itself, not with the surrounding and overlying skin. This condition is usually the result of a defect in the hypothalamic-pituitary-gonadal axis, although iatrogenic causes are identified infrequently. Management revolves around testosterone (direct administration or encouraging the patient's body to make its own), and long-term results with respect to increase in penile length are promising. Reconstructive surgery is based on the use of a vascular pedicle free flap and is reserved for patients who fail to respond to hormonal treatment. Although substantial long-term data are lacking, adult patients with micropenis appear to report dissatisfaction with penile appearance, but the majority appear to have adequate sexual function.
Objectives
The subject of current work was to determine the relationship of fetal ultrasonographic biomarkers, including anogenital distance (AGD), adrenal gland volume, and penile length and width in mothers with male fetuses at 22–36 weeks of gestation for the assessment of the effect of fetal adrenal gland producing androgens on the male anogenital structures that are exposed to androgen effects as anogenital region and penis.
Methods
This study is a prospective cross-sectional study conducted in our hospital’s outpatient perinatal care unit. One hundred and seventy pregnant women with a male fetus aged 22–36 weeks of gestation were included in the study. The fetal adrenal gland length, width, and depth for the calculation of adrenal volume, AGD, and penile length and width were measured for each participant. The Pearson coefficients were calculated to assess the correlation among these parameters.
Results
The adrenal gland volume had a meaningful, positive moderate relationship with both the AGD (r=0.60) and penile length and width (r=0.57 and r=0.59, respectively; p<0.001). The AGD had a positive, strong correlation with the penile length and width (r=0.74 and r=0.76, respectively; p<0.001).
Conclusions
The fetal adrenal gland as one of the androgen sources of the fetus is an influencer of the development of the anogenital and penile region. The findings of the current study support that the adrenal gland considerably affects the masculinization of male fetuses, since there were remarkable correlations among the AGD, adrenal gland volume, and penile length and width.
Background
Evaluation of the external genitalia is an important part of prenatal ultrasound. However, there is no standardized methodology that includes biometric measurements and normative data to be able to carry out this evaluation.
Objective
To develop a standardized methodology for fetal genital biometry and obtain reference values for use in mid-trimester ultrasound.
Study design: A prospective cross-sectional study was used. 273 male and 253 female fetuses of normal, singleton pregnancies at 18 to 22 weeks were included. Measurements of fetal penis length, penile width and transverse scrotal diameter in male fetuses and bilabial diameter in female fetuses were performed by transabdominal ultrasound. Reference values were calculated for each gestational week.
Results
Realization of the open-legs axial plane is described as a working methodology. Normative data for penile length, penile width, transverse scrotal diameter and bilabial diameter are defined, including mean, minimum and maximum values, range, and 5th, 10th, 90th and 95th percentiles.
Conclusions
We have provided a standardized methodology using the open-legs axial plane, which would integrate the main measurements. In addition with the normative data constructed from their use, we hope to be able to improve the external genitalia assessment and diagnosis of genital anomalies in mid-trimester ultrasound.
Background:
Autism is more prevalent in males than in females. Hypotheses related to the extreme male brain theory of autism suggest that heightened androgen exposure during early development contributes to autistic traits. Whilst prior research focused mostly on the prenatal period, the current study tests the influences of androgen exposure during both the prenatal and the early postnatal periods on autistic traits during childhood.
Methods:
Anthropometric measures that are putative biomarkers of early androgen exposure were employed. Anogenital distance (AGD) was measured at birth and 3 months of age in boys and girls. Penile length at birth and 3 months of age was also measured in boys. When the children were 9-13 years old, a parent-reported questionnaire (the 10-item children's version of the Autism Spectrum Quotient; AQ-10 Child) was used to assess autistic traits in 97 boys and 110 girls.
Results:
There were no significant associations between any of the AGD or penile length measures and scores on the AQ-10 Child in boys, girls or the entire sample.
Conclusions:
The current study provides the first test of whether early measurements of AGD and/or penile length predict subsequent autistic traits. The current findings do not support a relationship between prenatal or early postnatal androgen exposure and autistic traits. The current study augments prior research showing no consistent relationship between early androgen exposure and autistic traits.
Postnatal penile length is a reliable, standardized, and widely used marker for the diagnosis of genitourinary pathology, as well as genetic and hormonal disorders. In contrast, prenatal diagnosis has not been developed equally and there is a lack of relevant literature. Our objective is to review the studies on fetal penile length, and apply findings to clinical practice. Although the most used technique is the outer penile length, there is no consensus regarding the appropriate technique for prenatal measurement. Several reports have provided reference data with high correlation. However, important issues like poor correlation with post-natal measures or presence of confounding variables are still present. Diagnosis of both a micropenis and macropenis can indicate related pathologies, and this information may benefit parental counseling and facilitate fetal management. Therefore, it is necessary to carry out prospective studies that provide reliable normative data.
Prenatal diagnosis of sex discordance is a relatively new phenomenon. Prior to cell‐free DNA testing, the diagnosis of a disorder of sexual differentiation was serendipitous, either through identification of ambiguous genitalia at the mid‐trimester morphology ultrasound or discovery of genotype‐phenotype discordance in cases where preimplantation genetic diagnosis or invasive prenatal testing had occurred. The widespread integration of cfDNA testing into modern antenatal screening has made sex chromosome assessment possible from 10 weeks of gestation, and discordant fetal sex is now more commonly diagnosed prenatally, with a prevalence of approximately 1 in 1500‐2000 pregnancies. Early detection of phenotype‐genotype sex discordance is important as it may indicate an underlying genetic, chromosomal or biochemical condition and it also allows for time‐critical postnatal treatment. The aim of this paper is to review cfDNA and ultrasound diagnosis of fetal sex, identify possible causes of phenotype‐genotype discordance and provide a systematic approach for clinicians when counselling and managing couples in this circumstance. This article is protected by copyright. All rights reserved.
One of the most commonly encountered problems in the practice of sexual medicine has been the serious concern men frequently have about penis size starting from puberty to adulthood. Men are extremely anxious about their penile length [1]. The penis is credited with the dual function of coitus and micturition. In biology, the ability to transfer sperms denotes maleness of an organism. To a man, no matter what his socioeconomic status is, the size of the penis always matters [2].KeywordsPenile LengthPenis SizeSexual MedicinePersistent Müllerian Duct SyndromeTrue MicroporesThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
An inconspicuous penis refers to a group of conditions that the penis appears to be small but the shaft can be normal or abnormal in size. It could be a source of constant concern for both parents and children. The term “inconspicuous penis” was first used in the literature by Bergeson et al. [1] in 1993. This could be secondary to short penile shaft often termed as micropenis. But more commonly, this inconspicuous appearance is secondary to other causes ranging from congenital conditions such as penoscrotal webbing or megaprepuce, developmental conditions like prepubic adiposity that overhangs the penis, and iatrogenic causes like trapped penis after adhesions secondary to circumcision [2]. However up to now there is still confusion by defining of inconspicuous penis in the literature review and in the clinical practice [3–15].
Fetal masturbation has been described previously once in utero but only as a description of an action. Masturbation is well described in infancy and early childhood when they discover that this practice can give them pleasure. Our letter proves that it could begin in utero as a ‘gratification behaviour’. We have shown this pattern clearly by using a volumetric rendering mode study. © 2016 John Wiley & Sons, Ltd. What's Already Known About This Topic? Masturbation is well described in infancy an early childhood but in fetal life it is only described as an action. What Does This Study Add? Our letter proves that it could begin in utero as a gratification behaviour. It is the first time that this pattern is shown so early by using a volumetric mode study.
Some observations were made that fetal penile erection can occur even during the intrauterine life. The current study was undertaken in order to determine how frequently and to what extent this may occur. In the course of the prenatal ultrasound examination the author identified the genitalia of 250 male fetuses during the 3rd trimester. Penile erection was noted in 9 (3.6%) fetuses. The observed erections lasted 8-10 minutes. While in the state of erection, both the length and diameter of the penis increased. Its length exceeded the diameter of the scrotum. Fetal penile erection appears to be the evidence of an appropriate genital development and its adequate hormonal and neurogenic supply. Therefore the occurrence of erection presumably may be a positive sign of fetal well being.
Prenatal diagnosis of disorder of sex development (DSD) aims at defining whether malformation is isolated or not and at determining the etiology depending on clinical background, hormonal and genetic tests. Diagnostic approach must be multidisciplinary. Congenital Adrenal Hyperplasia (CAH) is one of the leading causes of DSD in females. Management of pregnancies at risk is well standardized in France, which is based on fetal sex determination in maternal serum and prenatal treatment with dexamethasone.
In this study, obtaining reference ranges for fetal penis length, penis diameter and femur lengt were aimed. The study was conducted on fifty male fetuses ranging between 14 and 37 weeks of gestational age which was determined using CRL measurement, belonging to Meram Faculty of Medicine, University of Necmettin Erbakan. Data related to penis length, penis diameter and femur length among male fetuses were determined. In 2nd and 3rd trimesters, mean values were calculated 6.62 ±3.06 mm and 16.58±4.82 mm for penis length, 3.39±1.38 mm and 7.99±2.07 mm for penis diameter, and 40.72± 9.48 mm and 73.52±11.58 mm for femur length, respectively. The data were increased by gestational age at rates of %70 (r2=0.69), %81 (r2=0.81), and %90 (r2=0.89), respectively. The relationship between gestational age and all those parameters were statistically meaningful (p<0.01). The reference ranges were determined using the Least Squares regression analysis as follows: Penis length (mm)= 0.763 × Gestational Age (week) - 8.230 Penis diameter (mm)= 0.373 × Gestational Age (week) - 3.947 Femur length (mm)= 2.681 × Gestational Age (week) - 12.079 A normogram belonging to fetal penis was formed which may help to clinicians during ultrasonographic diagnose of genetical anomalies, endocrinological problems and fetal gender determination.
Purpose:
We analyzed the development of the area of the penis and erectile structures (corpora cavernosa and corpus spongiosum) and the thickness of the tunica albuginea during the fetal period (13 to 36 weeks after conception) in humans to establish normative patterns of growth.
Materials and methods:
We studied 56 male human fetuses at 13 to 36 weeks after conception. We used histochemical and morphometric techniques to analyze the parameters of total penile area, area of corpora cavernosa, area of corpus spongiosum, and thickness of tunica albuginea in the dorsal and ventral regions using ImageJ software (National Institutes of Health, Bethesda, Maryland).
Results:
Between 13 and 36 weeks after conception the area of the penis varies from 0.95 to 24.25 mm2. The area of the corpora cavernosa varies from 0.28 to 9.12 mm2, and the area of the corpus spongiosum varies from 0.14 to 3.99 mm2. The thickness of the tunica albuginea varies from 0.029 to 0.296 mm in the dorsal region and from 0.014 to 0.113 mm in the ventral region of the corpora cavernosa.
Conclusions:
We found a strong correlation between the total penile area, corpora cavernosa and corpus spongiosum with fetal age (weeks following conception). The growth rate was more intense during the second trimester (13 to 24 weeks of gestation) compared to the third trimester (25 to 36 weeks). Tunica albuginea thickness also was strongly correlated with fetal age and this structure was thicker in the dorsal vs ventral region.
Current reference range values for fetal penile growth are based on length measurements. However, methodologies for measuring penile length differ among studies and from the standard technique used in children. We propose that the measurement of penile width may aid in its evaluation. The aim of the study was to create normograms for penile length and width.
A prospective cross-sectional design was used. One hundred male fetuses at 22 to 36 gestational weeks were included. On ultrasound examination, penile length was measured from tip to base, where the penis joins the scrotum. Penile width was measured at the widest point across the penis. Reference values for the 5th and 95th percentiles were calculated for each gestational week.
There was a good correlation between gestational age and penile length (R(2) = 0.606) and width (R(2) = 0.683). The percentile of fetal weight estimation independently affected penile length and width. The interobserver correlation coefficient was 0.939 for length and 0.909 for width.
Reference range values of fetal penile length and width are presented for 22 to 36 weeks of gestation. These values correlate to gestational age and estimated fetal weight percentile. These reference range measurements may help the evaluation of suspected micropenis.
Anomalies of the penis and scrotum are common and may be congenital, acquired, or iatrogenic. The understanding of the normal
anatomy of the penis and scrotum is important in order to assist in evaluating congenital and acquired anomalies of the male
genitalia. The purpose of this chapter is to describe the normal anatomy and anomalies of the penis and scrotum.
KeywordsPenis-Scrotum-Anomaly-Anatomy-Pediatrics
To establish a nomogram of the corpus spongiosum dimensions in male fetuses and to evaluate its correlation with penile length. These references can be useful when fetal genital anomalies are suspected, particularly to distinguish micropenis from concealed penis cases.
A cross-sectional prospective study was conducted on 486 fetuses of normal singleton pregnancies between 18 and 40 weeks. Corpus spongiosum length, penile length, penile diameter and scrotal diameter were measured by one operator. All measurements were analyzed according to gestational age.
The four measurements were studied as a function of gestational age. Median values, 3(rd) and 97(th) percentiles were determined using regression curves. A correlation between penile length and corpus spongiosum length (r(2) = 0.845) was observed.
We established measurements of the length of fetal corpus spongiosum and a correlation between the former and the penile length. These references can be useful when fetal genital anomalies are suspected.
In view of the implementation of magnetic resonance imaging (MRI) as an adjunct to ultrasonography in prenatal diagnosis, this study sought to demonstrate normal penile growth on prenatal MRI.
This was a retrospective study of MRI of 194 male fetuses (18-34 weeks' gestation) with normal anatomy or minor abnormalities. On sagittal T2-weighted MRI sequences, we measured penile length from the glans tip to the scrotal edge (outer length) and from the glans tip to the symphyseal border (total length). Descriptive statistics, as well as correlation and regression analysis, were used to evaluate penile length in relation to gestation. T-tests were calculated to compare mean outer/total length on MRI with published ultrasound data.
Mean length values, including 95% CIs and percentiles, were defined. Penile length as a function of gestational age was expressed by the following regression equations: outer mean length = - 5.514 + 0.622 × gestational age in weeks; total mean length = - 8.865 + 1.312× gestational age in weeks. The correlation coefficients, r = 0.532 and r = 0.751, respectively, were statistically significant (P < 0.001). Comparison of outer penile length on MRI with published ultrasound penile length data showed no significant differences, while total penile length on MRI was significantly greater than ultrasound penile length (P < 0.001).
Our MRI results provide a reference range of fetal penile length, which, in addition to ultrasonography, may be helpful in the identification of genital anomalies. Outer penile length on MRI is equivalent to penile length measured on ultrasound, whereas total length is significantly greater.
Although sonographic fetal sex determination is feasible in most pregnancies, in some cases, it may pose difficulties. An attempt to determine the fetal sex should not be made before 12-weeks' gestation because this early, it is relatively inaccurate. After 13 weeks, it is accurate in 99% to 100% of cases without malformed external genitalia. Sonographic fetal sex determination in the late second trimester is based on direct visualization of the external genitalia, whereas in the late first and early second trimester, it is based mainly on the direction of the genital tubercle (the "sagittal sign"): downward direction of the genital tubercle indicates a female fetus and upward direction a male fetus. Other sonographic landmarks, such as the fetal scrotum, the midline raphe of the penis, the labial lines, the uterus, the descended testis, and the direction and origin of the fetal micturition jet in males may contribute to the correct determination of fetal sex. Inaccurate fetal sex determination may occur when the external genitalia are malformed. Three-dimensional ultrasound, although of generally limited diagnostic value for fetal sex determination, may aid in better definition of congenital malformations of the external genitalia.
Our aim in this retrospective sonographic study was to describe the normal growth and development of fetal external genitalia.
We reviewed the sonograms of anatomically normally fetuses, obtained over a 5-year period, and measured transverse scrotal diameter or penile length in male fetuses and bilabial diameter in female fetuses. Transverse scrotal diameter was measured from the midpoint of the lateral scrotal wall to the midpoint of the opposite lateral wall; penile length, from the base of the shaft to the tip; and bilabial diameter, from the midpoint of the lateral labial margin to the midpoint of the opposite lateral labial margin.
We examined sonograms from 1,182 fetuses and measured transverse scrotal diameter in 304 and penile length in 494 male fetuses and bilabial diameter in 384 female fetuses. The fetuses ranged from 14 to 41 weeks' menstrual age. Transverse scrotal diameter, penile length, and bilabial measurements were highly correlated with menstrual age (r = 0.941, r = 0.860, and r = 0.898, respectively). We found that growth of fetal external genitalia is similar to that for other parameters of fetal growth, such as biparietal diameter and femur length.
The results of this study may be helpful in understanding the natural course of the growth and development of fetal external genitalia. In addition, the data we gathered may be useful in combination with other biometric data for estimating fetal age and may help in detecting abnormalities in the fetal external genitalia.
The aim of this study was to evaluate the sonographic development of normal fetal male genitalia.
A longitudinal study was performed on 60 male fetuses. The development of penis, prepuce and presence of testes in scrotum were observed with a high resolution transabdominal ultrasonography between weeks 11 and 40.
The overall success of identifying correctly the fetal male gender increased with gestational age from 46% to 80%, and 96% at 12, 13 and 14 week, respectively. The number of the scans performed in relation to the gestational age from week 11 to week 14 improves the ability to assign the male gender and to report the penile length (P<0.05); the earliest observations of descend testis were at 24 weeks. The bilateral observation of testicular descend was at 31 weeks in 98% of fetuses.
Development of male genitalia is easy evaluated through the pregnancy. This could be useful to early identify male genitalia abnormalities.
The presence of hypopituitarism and invisible pituitary stalk on a magnetic resonance image (MRI) is commonly attributed to birth trauma. Two patients with severe hypopituitarism and invisible pituitary stalk are presented. One was born by breech delivery, the other by Cesarean section. The presence of a micropenis since early infancy in these two patients suggested that their hypopituitarism might have begun during early fetal life thus effecting penile growth during the second and third triministers of gestation. These findings raise the possibility that the association of hypopituitarism and invisible pituitary stalk may have multiple etiologies including hormonal abnormalities during early fetal life.
A method to estimate reference intervals which depend on gestational age is described. The approach is based on standard statistical techniques, so implementation should be straightforward with most statistical packages. The reference limits are defined by simple formulae which may be plotted as smooth curves. The method is illustrated with analyses of three real datasets arising from different aspects of fetal monitoring. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Sonographic fetal gender determination is undertaken as part of many prenatal ultrasound examinations. We describe three abnormalities of the fetal phallus, two that were related to family history and one that was associated with other genitourinary tract abnormalities of the fetus. Examination of the fetal genitalia is an important part of the sonographic examination, particularly when there is a genitourinary fetal anomaly or a family history of abnormal genitalia, because the external genitals are a part of the genitourinary tract that can occasionally be malformed. Caution is advisable in the sonographic gender determination in these cases.
We describe a material of 577 infants born of epileptic women treated with anticonvulsants in monotherapy during early pregnancy and collected from France, Italy, and Sweden. The incidence of major malformations is increased compared with the general population but no definite difference in risk can be demonstrated between the various anticonvulsants, but valproic acid was associated with a doubling of the average risk. The increased risk for facial clefts and for cardiac malformations, described from most studies on epilepsy during pregnancy, cannot be seen in this material. Unusually many cases of penis abnormalities (micropenis, hypospadias) were noted. An effect on fetal growth can be demonstrated and is apparently more pronounced for carbamazepine than for the other drugs. It results in a reduced birth weight in spite of normal gestational length, reduced body length and head circumference. The possible biological significance of this finding is discussed.
A level II ultrasound examination revealed a scrotum and penis in a fetus with a 46,X,+mar chromosome complement. The marker was subsequently considered to be a del(Y)(q11). A phenotypically normal male infant was born. Detailed ultrasound examination of similar cases for visualisation of the genitalia is recommended.
We describe clinically and cytogenetically a fetus with multiple congenital anomalies and partial dup(11q) born to a phenotypically normal mother with a 3:1 translocation. Fetal anomalies included complete cleft of lip and palate, small penis, myelomenigocele, and abnormal palmar creases. We think chromosome analysis should be performed when neural tube defects are observed in otherwise dysmorphic neonates, stillbirths, and abortuses.