Hypospadias 2 (DD Ambiguous External Genitals)

geni_32a_n.jpg to geni_32d_n.jpg: 5-month-old infant with asymmetrical external genitals. geni_32a_n.jpg: The left scrotum is larger and exhibits typical, distinct, and fine folds in contrast to the smaller right scrotum. geni_32b_n.jpg: The unfolded external genitals show in the midline of the ventral penis surface a cutaneous ridge and in its continuation a catheterized opening. geni_32c_n.jpg: In the left scrotum, a testis is palpable the same size as the testicular prothesis shown in the picture. geni_32d_n.jpg: Operative findings after laparotomy in the same patient; the structures which are pulled downward by stay-sutures are as follows from the left to the right side of the patient: Peritoneal reflecting fold, uterus, and right fallopian tube. At the base of the fallopian tube an elongated structure is visible, and a twisted tube is running over the bladder. The diagnosis is not scrotal hypospadias but asymmetrical mixed gonadal dysgenesis which is an abnormal development of the gonads due to a chromosomal mosaic. A clinical indication of intersexual external genitals is the strikingly asymmetrical scrotum with a palpable testis only on one (left) side. The interscrotal opening corresponds to a vagina; on the right side there is a streak ovary (= cord-like gonad) with a fallopian tube and uterus, and on the left side a vas deferens is recognizable.