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Surgical treatment of disorders of sexual development
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Rafael V. Pieretti, Patricia K. Donahoe
Most girls with 46,XX DSD have labioscrotal swellings that are anterior in relation to the vagina than normal labia majora. Significant skin rugation may be present as well. To move this labioscrotal skin posteriorly, “Y”-shaped incisions are outlined with an extension posterior to the swellings. The scrotal flaps are cautiously defatted and moved posteriorly, beside the introitus, as bilateral Y–V advancements (Figure 80.9). The medial aspects of these skin flaps are then sutured to the lateral edges of the prepucial skin flaps mobilized during clitoroplasty (now labia minora) (Figure 80.10). The result is an anatomically correct positioning of the labia minora and majora posteriorly, beside the introitus, rather than anteriolaterally.
The urinary and reproductive systems and the external genitalia
Published in Frank J. Dye, Human Life Before Birth, 2019
In the development of a male, the genital tubercle gives rise to the penis. As the penis forms (which involves growth of the genital tubercle and fusion of the urogenital folds), a portion of the urogenital sinus is incorporated into the penis as the penile urethra. Fusion of the labioscrotal swellings gives rise to the scrotum, into which the testes descend during the late fetal period (see Figure 18.8).
Anatomy of the vulva
Published in Miranda A. Farage, Howard I. Maibach, The Vulva, 2017
Aikaterini Deliveliotou, George Creatsas
Early in the fifth week of embryonic life, the cloaca is divided by the urorectal septum, which gives rise to the perineum. Folds of tissue form on either side of the cloaca: the anterior folds are urogenital and the posterior folds are anal. The anterior folds meet at the midline to form the genital tubercle. The genital tubercle enlarges. In the male embryo, under the influence of androgens, the genital tubercle becomes the penis; in the female embryo, growth slows and it becomes the clitoris. On either side of the tubercle, the urogenital folds form the labia minora. In the indifferent stage, the labioscrotal swellings develop on either side of the urogenital folds. In the male embryo, under the influence of androgens, they differentiate into the scrotum; in the female, lacking androgenic stimulation, they remain largely unfused to become the labia majora. The definitive urogenital sinus gives rise to the vaginal vestibule, into which the urethra, vagina, and greater vestibular glands open.
Accessory Scrotum
Published in Fetal and Pediatric Pathology, 2020
Fatma Fitouri, Nesrine Chebil, Sabrine Ben Ammar, Sondes Sahli, Mourad Hamzaoui
Accessory scrotum describes the anomalous position of scrotal tissue and can be either a mid-perineum type or a lateral type [2]. Some authors have suggested that the failure of movement of the labioscrotal swelling to the midline could be responsible for the occurrence of accessory scrotum. Other authors think that abnormal division of the labioscrotal swelling could be the cause [3]. Absence of other organ malformations suggests that the causative factor may not have adverse effects on other organ systems undergoing differentiation at the same time [4]. The treatment is simple surgical excision. The accessory scrotum is different from the ectopic scrotum. The ectopic scrotum contains a testis, requiring repositioning or excising the scrotum with preservation of the testis [5]. The accessory scrotum which does not contain a testis is treated by simple excision after verification that there is no testis present [2].