II. Congenital Anomalies
After completing this section will know:
- the most frequently encountered congenital abnormalities
- the distinguishing features of various abnormalities
- the clinical importance of each abnormality
Congenital malformations of the penis are relatively uncommon. The
most frequently encountered abnormalities involve the formation of the
urethral groove and the prepuce.
When the urethra opens abnormally on the ventral (inferior) surface
of the penis, the condition is termed a hypospadias.
This term is used to describe the condition in which the abnormal urethral
opening is on the dorsal surface of the penis. It is rare and is almost
invariably associated with defects in the urethral valve, leading to
urinary incontinence. Patients with hypospadias do not typically have
These conditions are important because they are usually associated with
recurrent infections. The abnormal opening may be constricted causing
partial urinary obstruction, which leads to bacterial spread from the
blocked penile urethra into the bladder. Also infertility may result from
inability to properly inseminate. Both conditions are amenable to plastic
When the foreskin or prepuce cannot be retracted over the glans because
of an abnormally small orifice, the patient is said to have a phimosis.
The condition may also be acquired through inflammatory scarring of
the prepuce. It is the most common of the penile malformation.
Question: Why is phimosis important?
When a phimotic prepuce is forcibly retracted over the glans and cannot
be restored, paraphimosis results. This causes painful swelling of the
glans and is a medical emergency because of the compromised blood flow
with the potential for gangrenous necrosis of the glans. Also urethral
constriction causes acute retention of urine.