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Penile Length, Digit Length, and Anogenital Distance According to Birth Weight in Newborn Male Infants

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Penile Length, Digit Length, and Anogenital Distance According to Birth Weight in Newborn Male Infants Original Article - Pediatric Urology Korean J Urol 2015;56:248-253. http://dx.doi.org/10.4111/kju.2015.56.3.248 pISSN 2005-6737 • eISSN 2005-6745 Penile length, digit length, and anogenital distance according to birth weight in newborn male infants Jae Young Park, Gina Lim1, Ki Won Oh1, Dong Soo Ryu2, Seonghun Park3, Jong Chul Jeon, Sang Hyeon Cheon, Kyung Hyun Moon, Sejun Park, Sungchan Park Departments of Urology and 1Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, 2Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, 3School of Mechanical Engineering, Pusan National University, Busan, Korea Purpose: Anogential distance (AGD) and the 2:4 digit length ratio appear to provide a reliable guide to fetal androgen exposure. We intended to investigate the current status of penile size and the relationship between penile length and AGD or digit length ac- cording to birth weight in Korean newborn infants. Materials and Methods: Between May 2013 and February 2014, among a total of 78 newborn male infants, 55 infants were pro- spectively included in this study. Newborn male infants with a gestational age of 38 to 42 weeks and birth weight>2.5 kg were assigned to the NW group (n=24) and those with a gestational age<38 weeks and birth weight<2.5 kg were assigned to the LW group (n=31). Penile size and other variables were compared between the two groups. Results: Stretched penile length of the NW group was 3.3±0.2 cm, which did not differ significantly from that reported in 1987. All parameters including height, weight, penile length, testicular size, AGD, and digit length were significantly lower in the LW group than in the NW group. However, there were no significant differences in AGD ratio or 2:4 digit length ratio between the two groups. Conclusions: The penile length of newborn infants has not changed over the last quarter century in Korea. With normal penile ap- pearance, the AGD ratio and 2:4 digit length ratio are consistent irrespective of birth weight, whereas AGD, digit length, and penile length are significantly smaller in newborns with low birth weight. Keywords: Anthropometry; Newborn infants; Penis This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. INTRODUCTION dependent on testosterone, its conversion via steroid 5­alpha­ reductase to dihydrotestosterone, and a functional androgen Deficient androgen exposure during fetal masculini­ receptor [5]. Penile length increases slowly until 4 years of zation results in smaller sized testes, prostate, seminal ve­ age, after which follows a steady phase and then a rapid sicles, and penis in adulthood and is associated with an in­ increase with puberty. Androgen deficiency is also known to creased risk of hypospadias and lower testosterone levels [1­ be associated with a reduction in anogenital distance (AGD) 4]. It is well established that normal penile development is in adults [6], and it is postulated that the ratio of the second Received: 8 January, 2015 • Accepted: 6 February, 2015 Corresponding Author: Sungchan Park Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan 682-714, Korea TEL: +82-52-250-7190, FAX: +82-52-250-7198, E-mail: [email protected] ⓒ The Korean Urological Association, 2015 www.kjurology.org 248 Penile and digit length and anogenital distance to the fourth finger length (2:4 digit ratio) in adult men disorders [11]. Therefore, most newborn infants who were reflects fetal androgen exposure [7]. considered to be normal and healthy except for their birth Studies on penile length in newborns have been very ra­ weights were included in the current study. The infants rely conducted, especially in Korea. In 1987, a study on penile were divided into two groups. The normal weight group length and testicular size was conducted with 1,071 Korean included newborns with a gestational age of 38 to 42 children including 49 newborn infants [8]. In newborns, the weeks and birth weight≥2.5 kg (NW, n=24). The low birth mean and standard deviation (SD) of stretched penile length weight group included newborns with gestational age<38 (SPL) was 3.3±0.5 cm. Early diagnosis of abnormalities in weeks and birth weight<2.5 kg (LW, n=31). penile size is important both medically and psychologically [9]. The exact penile size is a most important factor in 2. SPL and variables diagnosing penile problems such as micropenis, which is The penile length was measured as the SPL. The leng­ defined as an SPL<2.5 SDs below the mean for age with th was measured twice for each infant and the mean of the normal function and structure [10]. two measurements was recorded. The SPL was measured Until now, no reports have addressed penile length ac­ with a ruler by compressing the fat tissue with one end of cording to birth weight and its relationship with birth the ruler through the pubic ramus; then the penis was fully weight and AGD or digit length in newborn infants. This stretched and the distance to the glans of the stretched penis study was preliminarily performed to update the normal was plotted [11]. None of the 55 infants had been circumcised. SPL values that can be used for Korean newborns. We also Foreskins of the uncircumcised infants were not involved intended to investigate the current status of penile length in the measurement. Testicular size was measured by using and the relationship of penile length with AGD or digit Prader orchidometry (mL). Genital distances were measured length according to birth weight in Korean newborn infants. with the male infant in a supine and frog­leg position [12]. AGD1 was the distance from the anterior aspect of the penis MATERIALS AND METHODS to the anal verge (Fig. 1A). AGD2 was the distance from the posterior aspect of the penis to the anal verge. AGD3 was 1. Patient characteristics the distance from the posterior aspect of the scrotum to the This cross­sectional study was performed in the neo­ anal verge as measured by use of a caliper [13]. Digit lengths natal unit of our institution between May and January were measured by using a ruler on the left hand. Digit 2014. Of a total of 78 newborn male infants, 55 infants lengths were measured twice for each infant and the mean were prospectively enrolled in this study. Exclusion criteria of the two measurements was recorded. The measurement were penile diseases, including hypospadias, concealed was taken from the basal crease to the tip on the ventral penis, cryptorchidism, and varicocele, and other growth surface of the hand at a point midway across a line perpen­ problems such as chronic renal failure and endocrinologic dicular to the base by using rulers (Fig. 1B). Fig. 1. Measurement of anogenital dis- tance (AGD) and 2:4 digit lengths. (A) AGD has been measured in three ways (AGD1, AGD2, AGD3), AGD3 appears to be the most reliable and repeatable measure- ment. (B) Digit lengths is measured form the basal crease to the tip on the ventral surface of the hand at the point midway A B across a line perpendicular to the base us- ing rulers. Korean J Urol 2015;56:248-253. www.kjurology.org 249 Park et al For all infants, age, SPL, height, body weight, testicular evaluated by Student t-test. Variables in the NW and LW size, digit lengths of the second and fourth fingers and groups were compared by Mann­Whitney U test. A p­value the ratio between them, and AGDs and their ratios we­ of <0.05 was accepted to be statistically significant. re measured. Penile size and other variables were also This study was approved by the Institutional Review compared between the two groups. Board of Ulsan University Hospital (IRB No. 2013028). Cli- nical data were prospectively collected and the medical re­ 3. Interobserver variability cords of all the participants were reviewed. SPL was measured in 55 infants by two observers (an urologist and a pediatric doctor) to estimate interobserver RESULTS difference. Differences in the measurements of penile le­ ngth were evaluated by using paired t­tests for the LW 1. SPL compared with the previous study (1987) group and Wilcoxon’s signed rank test for the NW group. The SPL of the NW group (n=24, >2.5 kg) was 3.3±0.2 cm. Compared with the previous study results reported in 4. Statistical analysis and ethics statement 1987, there was no significant change in the SPL (p=0.445). Data analysis was performed by using the software Among the anthropometric measurements of Korean chil­ package SPSS ver. 17.0 (SPSS Inc., Chicago, IL, USA). Con­ dren, there was a significant decrease in height (49.8±1.9 tinuous variables were expressed as the mean±SD. Diffe­ cm), whereas there were no significant changes in body rences in SPL, height, body weight, and testicular size weight (3.2±0.5 kg) or testicular size (1.1±0.4 mL) (Table 1). between the study in 1987 and the current study were Table 1. Changes in stretched penile length and anthropometric data compared with a previous study conducted in 1987 Variable Present data (n=24) 1987 Data (n=49) p-value Penile size (cm) 3.3±0.2 3.3±0.5 0.445 Testis size (mL ) 1.1±0.4 1.2±0.2 0.248 Height (cm) 49.8±1.9 52.5±2.5 <0.001 Weight (kg) 3.2±0.5 3.3±0.4 0.393 Values are presented as mean±standard deviation.
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