Penoscrotal transposition

Penoscrotal transposition (PST) is a rare congenital genital anomaly in which the normal anatomical relationship between the penis and scrotum is reversed, with the scrotum positioned superior to (above) or surrounding the penis. This condition results from abnormal development of the external genitalia during embryogenesis, specifically a failure of normal infraumbilical midline fusion and labioscrotal migration. The severity can range from incomplete (partial) penoscrotal transposition, where the scrotum partially encroaches on the penile shaft, to complete transposition, where the scrotum is entirely cranial to the penis. Penoscrotal transposition primarily affects the genitourinary system and is frequently associated with other congenital anomalies, including hypospadias, chordee, cryptorchidism, and inguinal hernias. It may also occur as part of broader syndromic conditions or chromosomal abnormalities. The condition is typically identified at birth during physical examination of the newborn. In addition to the genital findings, associated anomalies may involve the urinary tract, cardiovascular system, gastrointestinal tract, and central nervous system, depending on whether the condition is isolated or part of a syndrome. Renal anomalies and anorectal malformations have been reported in some cases. Treatment is surgical and aims to restore normal anatomical positioning of the penis and scrotum, improve cosmetic appearance, and preserve urinary and future reproductive function. Surgical correction typically involves scrotoplasty with repositioning of the scrotal tissue inferior to the penile shaft, and may be combined with repair of associated anomalies such as hypospadias. The timing and complexity of surgery depend on the severity of the transposition and the presence of associated malformations. Outcomes are generally favorable when managed by experienced pediatric urologists or surgeons, though multiple staged procedures may be required in complex cases.

Common questions about Penoscrotal transposition