Anatomical study of hypospadias penis using magnetic resonance imaging in children

Published:November 05, 2021DOI:https://doi.org/10.1016/j.jpurol.2021.10.024

      Summary

      Introduction

      To assess the various anatomical patterns of the hypospadias penis, anatomical and histological study of the penile tissues, planes, and vascular patterns, and imagings such as ultrasound of penis, elastography, and Magnetic resonance imaging (MRI) of penis have been described in the literature. All these have been done to attempt the identification of anatomical variations that may influence surgical outcomes. There are very limited MRI studies of hypospadias penis to look for the pristine anatomy.

      Objective

      The objective was to identify anatomical variations in hypospadias penis such as the penile tissues and planes and the vascularity using MRI.

      Material and methods

      The total number of patients enrolled was 24 from January 2019 to July 2020. This included all the cases of hypospadias at any location aged ≥5 years. MRI penis was done using 3T (3 Tesla) MRI scanner (GE Healthcare signa 3T Scanner machine) with 3 mm body coil slice thickness and the surface coil of 3 inches. Non-contrast images were taken using fast spin-echo sequences in sagittal, coronal, and transverse planes. The findings analyzed were: presence and distribution of penile tissue and fascial structures, urethral plate thickness, and penile vasculature.

      Results

      The mean age was 7.62 ± 2.14 years. The types of hypospadias included were Coronal 1/24 (4.2%), Subcoronal 14/24 (58.3%), Distal penile 3/24 (12.5%), Midpenile 5/24 (20.8%) and Penoscrotal 1/24 (4.2%) (Summary Table 1). The mean urethral plate thickness was 1.33 ± 0.38 mm. The penile soft tissues were well visualized along with their fascial planes. The majority of patients (91.7%, 22/24) had Superficial Dartos vessels with both branches. Bulbourethral vessel was present in 18 (75.0%) cases but could not be visualized in the rest. Ventral and Lateral Dartos vessels were seen in 20 (83.3%) cases. Perforators distal to meatus were visualized in 21 (87.5%) cases and not visualized in 3 (1 each in Penoscrotal, Midpenile, and Coronal hypospadias). Collaterals at corona sulcus were visualized in 23 (95.8%) cases, at paraurethral spongiosum in 15 (62.5%) cases, and at dorsum in 22 (91.7%) cases.

      Conclusion

      Summary Table 1Details of the patients in the study-age, type of hypospadias and urethral thickness.
      Basic Details Mean ± SD || Median (IQR) || Min-Max || Frequency (%)
      Age (Years) 7.62 ± 2.14 || 7.00 (6.00–8.25) || 5.00–13.00
      Type of hypospadias
      Subcoronal 14 (58.3%)
      Midpenile 5 (20.8%)
      Distal Penile 3 (12.5%)
      Coronal 1 (4.2%)
      Penoscrotal 1 (4.2%)
      Urethral Plate Thickness (mm) 1.33 ± 0.38 || 1.25 (1.00–1.50) || 0.70–2.00

      Keywords

      Abbreviations:

      Field of View (FOV) (3 Tesla (3T))
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