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Determination of Normative Values of Stretched Penile Length

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Determination of Normative Values of Stretched Penile Length DETERMINATION OF NORMATIVE VALUES OF STRETCHED PENILE LENGTH AND TESTICULAR VOLUME OF APPARENTLY HEALTHY TERM IGBO NEONATES IN ENUGU. A DISSERTATION SUBMITTED TO NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE FELLOWSHIP IN THE FACULTY OF PAEDIATRICS. BY CHIKANI UGO NNENNA. MBBS (NIG), 2004. DEPT OF PAEDIATRICS UNTH, ENUGU. EXAMINATION DATE: MAY 2013 1 DECLARATION I hereby affirm that this work is original unless otherwise acknowledged. The work has neither been presented to any other College for a Fellowship nor has it been submitted elsewhere for publication. _______________________________________ CHIKANI UGO NNENNA DATE_____________________________ 2 ATTESTATION The candidate did the study reported in this dissertation under our supervision. We also supervised the writing of the dissertation. DR IKEFUNA AN (FMCPaed) CONSULTANT PAEDIATRICIAN/LECTURER UNTH, ENUGU. SIGNATURE: _______________________________________ DATE: _____________________________________________ DR ADIMORA GN (FMCPaed) CONSULTANT PAEDIATRICIAN/LECTURER UNTH, ENUGU. SIGNATURE:_______________________________________ DATE:_____________________________________________ DR IBEKWE MU (FWACP) CONSULTANT PAEDIATRICIAN/LECTURER FEDERAL TEACHING HOSPITAL ABAKILIKI SIGNATUE:__________________________________________ DATE:_______________________________________________ 3 DEDICATION This work is dedicated to all the babies and their mothers who participated in the study and to my mother Angelina, of blessed memory, whose love for the medical profession was unparalleled. 4 ACKNOWLEDGEMENTS I wish to express my profound gratitude to Almighty God and the Blessed Virgin Mary for their inspiration and guidance towards me. I am most indebted to my supervisors; Drs Ikefuna A N, Adimorah G N and Ibekwe M for their mentorship, steadfast counsel and critical appraisal of this work. I am most grateful to my research assistants, Drs Eze and Ugwoke for their immense help and co-operation. I must not forget to thank Dr Chinawa C J who actually introduced me to the world of research and helped me in understanding the intrigues in research. I wish to acknowledge Dr T Oguonu and Dr M. Ughasoro who painstakingly read the manuscript and made constructive comments in spite of short notice. To all my teachers and colleagues in the Department of Paediatrics, UNTH, Ituku-Ozalla, Enugu, for their advice and help in the course of the work, I wish to say thank you. I wish to thank my father, Fabian for his endless bounty of love and my siblings, for being there always. I appreciate the efforts of my statistician Gabriel, who did the statistical aspect of my work. Finally, My love and gratitude to the perennial keepers of my heart my husband Mark and my children, I thank you all for your understanding and support. 5 TABLE OF CONTENTS Title_________________________________________________________________________i Declaration___________________________________________________________________ii Attestation___________________________________________________________________iii Dedication__________________________________________________________________ iv Acknowledgements____________________________________________________________v Table of contents______________________________________________________________vi List of Abbreviations__________________________________________________________viii List of Tables________________________________________________________________ix List of Figures________________________________________________________________x List of Appendices____________________________________________________________xi Summary___________________________________________________________________ xii Introduction___________________________________________________________________1 Literature Review______________________________________________________________3 Objectives___________________________________________________________________13 Methodology_________________________________________________________________14 Results______________________________________________________________________22 6 Discussion___________________________________________________________________40 Conclusion__________________________________________________________________44 Recommendation_____________________________________________________________45 Limitation of study___________________________________________________________ 46 Lines of Future Research_______________________________________________________ 47 Reference_________________________________________________________________ _48 Appendices__________________________________________________________________59 7 LIST OF ABBREVIATIONS BW Birth weight BL Body Length ESUTH Enugu State University Teaching Hospital GA Gestational Age MCSH Mother of Christ Specialist Hospital SD Standard deviation SPL Stretched Penile Length TV Testicular Volume UNTH University of Nigeria Teaching Hospital 8 LIST OF TABLES Table No Page Table I: Stratification of study subjects according to gestational age 16 Table II: Distribution of Birth Weight (kg) of subjects 23 Table III: Distribution of body length (cm) 24 Table IV: Distribution of Stretched penile length (cm) of subjects 25 Table V: Smoothed percentiles for stretched penile length (cm) 26 Table VI: Distribution of testicular volume (ml) of subjects 27 Table VII: Percentiles for testicular volume (ml) by gestational age (weeks) 28 Table VIII: Pearson’s correlation between stretched penile length and testicular volume with growth parameters of birth weight and length. 29 TableIX: Linear Regression for Stretched penile length versus Testicular volume 31 Table X: Linear Regression for Stretched penile length versus Body length 32 Table XI: Linear Regression for Stretched penile length versus Gestational age 33 Table XII: Multiple regression of Stretched penile length versus Gestational age and Testicular volume. 34 9 LIST OF FIGURES Page Figure 1: Distribution of subjects according to gestational age (weeks). 22 Figure 2: Linear regression showing the correlation between SPL and TV 35 Figure 3: Linear Regression showing the correlation between SPL and BL 36 Figure 4: Linear Regression showing correlation between SPL and BW 37 Figure 5: Linear Regression showing correlation between SPL and GA 38 Figure 6: Linear Regression showing correlation between SPL and GA 39 10 LIST OF APPENDICES Appendix Page Appendix A: Ethical Clearance (UNTH) 5 9 Appendix B: Ethical Clearance (ESUTH) 60 Appendix C: Written Permission (MCSH) 61 Appendix D: Consent Form 62 Appendix E: Study Proforma 64 11 SUMMARY Establishing the normal penile length of newborn males for every population is of paramount importance as various studies have shown disparity in penile length among different racial and ethnic groups. The reference value currently in use was derived from the Caucasoid race and may not be applicable to Afro population. In addition, the extent of in –utero development of penile length depends partly on the level of testosterone secreted by the testes, which has been found to have a direct positive correlation with testicular volume. There is also a linear relationship between stretched penile length and gestational age, especially from mid trimester until birth. Indigenous data on the normal penile length and testicular volume of healthy Igbo neonates will help in early diagnosis and prompt treatment of anomalies of penile length and testicular volume such as micropenis and testicular agenesis. This descriptive, cross-sectional and hospital based study was undertaken to determine the normative values of stretched penile length and testicular volume of apparently healthy term Igbo neonates in Enugu. Eight hundred and eleven apparently healthy term male neonates within the first three days of life were studied. The stretched penile length was measured using Schonfeld method while the testicular volume was determined with the Prader orchidometer. The mean and standard deviation of both stretched penile length and testicular volume were calculated. In addition, the stretched penile length and testicular volume for each gestational age (37 to 42 weeks) were determined. The relationships between penile length and testicular volume with growth parameters were determined using the Pearson’s correlation coefficient while the linear relationship between the variables were established using the linear regression analyses. The mean stretched penile length was 3.46cm ± 0.44cm and the mean testicular volume was 12 1.74mls±0.62. There was a significant positive correlation between the stretched penile length and testicular volume(r =0.592, p =0.0001) as well as body length(r= 0.357, p = 0.0001) and birth weight(r = 0.224, p=0.0001) There was a significant linear relationship between stretched penile length and testicular volume(R =0.356,p=0.0001) as well as body length (R2=0.117,p=0.0001) using linear regression analysis. Formula was derived for predicting stretched penile length using testicular volume. The first set of standards for stretched penile length and testicular volume according to gestational age in healthy term Igbo neonates has been established and the mean stretched penile length was found to differ from those reported among other races. These determined values can be used as reference values for Igbo and Nigerian babies at large. 13 INTRODUCTION Penile length in newborn males varies among different populations. This is an evidence-based statement emanating from various studies done
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