Challenges, Clinical and Laboratory Profile of Children Referred for Micropenis at a Nigerian Tertiary Hospital
Main Article Content
Keywords
micropenis, children, stretched penile length, testosterone
Abstract
Background: Micropenis in a child may not only be related to cosmesis but raise the suspicion of a disorder of sex development or endocrine conditions requiring urgent attention. The study aims to describe the clinical and laboratory profile of children referred for micropenis over a six-year period at the Lagos University Teaching Hospital (LUTH) and highlight challenges encountered in management of these children.
Methodology: This was a retrospective study. Case records of patients who were referred with complaints or diagnoses of “micropenis” from March 2018 to March 2024 were analysed. The Health Research and Ethics Committee of LUTH approved the study.
Results: Eighty-three children were referred for micropenis. On review, the stretched penile length (SPL) in 16 children (mean [SD]age of 8.9± 3.42 years) was within reference ranges and they were excluded from further evaluations. The remaining 67 children with confirmed micropenis constituted 12.4% of 541 new paediatric endocrine cases. The median age (range) at presentation was 9(0.7-16) years. Boys within the peripubertal age group constituted the majority of the patients. Co-morbidities included obesity, Down Syndrome, sickle cell anaemia, and growth hormone deficiency. Challenges in management included unaffordability of laboratory tests as only 21 children (31.3%) performed the human chorionic gonadotrophin (hCG) stimulation, our local testing, more than half (68.6%) could not carry out any investigations and age-appropriate/ preparations of testosterone were unavailable for treatment.
Conclusion: Micropenis constituted a sizeable proportion of the paediatric endocrine consultations in our setting. Accurate measurements are important to exclude unaffected children and prevent unnecessary expensive investigations. The National Health Insurance Services (NHIS) should be strengthened to enable patients to access necessary investigations and treatment related to micropenis. Licensing of age-appropriate drugs for treatment by relevant authorities is advocated.
References
2. Hatipoğlu N, Kurtoğlu S. Micropenis: etiology, diagnosis and treatment approaches. J Clin Res Pediatr Endocrinol. 2013;5(4):217-23. DOI: 10.4274/Jcrpe.1135
3. Stancampiano MR, Suzuki K, O'Toole S, Russo G, Yamada G, Ahmed SF. Congenital Micropenis: Etiology and Management. J Endocr Soc. 2021; 15;6(2):bvab172.DOI: 10.1210/jendso/bvab172
4. Menon PS, Khatwa UA. The child with micropenis. Indian J Pediatr J.2000; 67(6):455-60. DOI: 10.1007/BF02859468
5. Elusiyan JBE, Ojetayo FG, Fajola AO. Penile dimension of newborns at Obio Cottage Hospital, Port Harcourt, Nigeria. Niger Postgrad Med J. 2016; 23(2): 67-70.DOI: 10.4103/1117-1936.186296
6. Jarrett OO, Ayoola OO, Jonsson B, Albertsson-Wikland K, Ritzen EM. Penile size in healthy Nigerian newborns: country-based reference values and international comparisons. Foundation Acta Paediatr. 2014; 103(4):442-446. DOI: 10.1111/apa.12517
7. Chikani U, Chinawa JM, Ikefuna AN, Ibekwe M. Stretched penile length of healthy term neonates: normative values among Igbo babies in Southeastern Nigeria. J Trop Paediatr. 2014; 61(1):69-73.DOI: 10.1093/tropej/fmu064
8. Ogundoyin OO, Lawal TA, Olulana DI. Measurement of penile size in healthy Nigerian newborns using conventional penile length measurement technique. Ann Pediatr Surg.2016; 12(4):155-157. Doi: 10.1097/01.XPS.0000491012.28417.28
9. Adekoya AO, Fetuga MB, Jarrett OO, Ogunlesi TA, Chanoine JP, Oba-Daini OO. Normative data on penile and anogenital measurements of term male infants in Sagamu, Nigeria. Acta Paediatr. 2019; 108(11):2041-2047.DOI:
10.1111/apa.14885
10. Kareem AJ, Elusiyan JBE, Kareem AO. Stretched penile length and total serum testosterone in term male neonates. Pan Afr Med J. 2020;15:37:61.DOI: 10.11604/pamj.2020.37.61.21123
11. Fagbuyi O. Prevalence of Micropenis and Cryptorchidism among Neonates delivered at the Lagos Island Maternity Hospital. 2023 (A Dissertation Submitted to The Paediatric Endocrinology Training Centre for West Africa in Partial Fulfilment of The Award of the Fellowship).
12. Asafo-Agyei SB, Ameyaw E, Chanoine JP, Nguah SB. Normative penile anthropometry in term newborns in Kumasi, Ghana: a cross-sectional prospective study. Int J Pediatr Endocrinol 2017;2017:2. doi: 10.1186/s13633-017-0042-1.
13. Yarhere IE, Jaja T, Wekere GC. Genital Abnormalities and Management Outcomes as Seen in the University of Port Harcourt Teaching Hospital, Nigeria. Nig J Med 2022; 31(3): 268-273.DOI: 10.4103/NJM.NJM_33_22
14. Adekanye AO, Adefemi SA, Onawola KA, James JA, Adeleke IT, Francis M et al. Abnormalities of the external genitalia and groins among primary school boys in Bida, Nigeria. Afr Health Sci.2017; 17(4):1120-1125. DOI: 10.4314/ahs.v17i4.20
15. Schonfeld WA, Beebe GW. Normal growth and variation in the male genitalia from birth to maturity. J Urol. 1942; 48(6)759–777. doi.org/10.1016/S0022-5347(17)70767-7.
16. Kolon TF, Miller OF. Comparison of single versus multiple dose regimens for the human chorionic Gonadotropin stimulatory test. J Urol.2001; 166 (4)1451–1454.
17. Honour J, Savage M. Testicular endocrine function. In: Ranke MB, ed. Diagnostics of Endocrine Function in Children and Adolescents.3rd Revised and Extended edn. Basel: Karger: 2003; p.339-355
18. Han JH, Lee JP, Lee JS, Song SH, Kim KS. Fate of the micropenis and constitutional small penis: do they grow to normalcy in puberty? J Pediatr Uro. 2019; 15(5):526.e1-526.e 6.doi.org/10.1016/j.jpurol.2019.07.009
19. Wilcox SL, Redmond S, Davis TL. Genital Image, Sexual Anxiety, and Erectile Dysfunction Among Young Male Military Personnel. J Sex Med. 2015; 12(6):1389–1397. doi.org/10.1111/jsm.12880
20. Mancini M, Pecori Giraldi F, Andreassi A, Mantellassi G, Salvioni M, Berra CC et al. Obesity is Strongly associated with Low Testosterone and Reduced Penis Growth During Development. J Clin Endocrinol Metab. 2021; 21;106(11):3151-3159. doi: 10.1210/clinem/dgab535.
21. Ryu DS, Cho WY, Chung JM, Kang DI, Lee SD, Park S. Comparison of penile length at 6-24 months between children with unilateral cryptorchidism and a healthy normal cohort. Investig Clin Urol. 2018; 59(1):55-60. doi: 10.4111/icu.2018.59.1.55.
22. Cinaz P, Yesilkaya E, OnganlarYH, Boyraz M, Bideci A, Camurdan O et al. Penile anthropometry of normal prepubertal boys in Turkey. Acta Paediatr. 2012; 101:33-36. DOI:10.1111/j.1651-2227.2011.02386.x
23. Camurdan AD, Oz MO, Ilhan MN, Camurdan OM, Sahin F,Beyazova U. Current stretched penis length: cross-sectional study of 1040 healthy Turkish children aged 0 to 5 years. Urology.2007; 70:572–5.DOI: 10.1016/j.urology.2007.04.051
24. Ozbey H, Temiz A, Salman T. A simple method for measuring penis length in newborns and infants. BJU Int. 1999; 84(9):1093–4. DOI: 10.1046/j.1464-410x.1999.00366.x
25. Fawaz LM, Mira M, Ibrahim SY, Maarouf YS, Badawi NE (2021) Stretched Penile Length and Anogenital Distance in Egyptian Boys Aged One Month to Five Years. J Pediatr Urol.2021;17(1): 110.e1-110.e7. doi: 10.1016/j.jpurol.2020.11.007.
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