title: Deviation of the penoscrotal median raphe: Is it a normal finding or within the spectrum of hypospadias?
abstract: OBJECTIVE
  Hypospadias is the most common congenital abnormality of the penis, and is most commonly diagnosed during the postnatal physical examination. However, milder forms of the condition can be difficult to detect, leading to delayed referral to specialist teams. We aim to determine whether there is an association between hypospadias and the position of the penoscrotal raphe.
  
  
  METHODS
  A case - control study was performed where clinical photographs from children undergoing hypospadias correction were compared with a control group of children without the condition. The position of the penoscrotal raphe was documented as midline, left or right. Pearson's chi squared test was used to determine significance.
  
  
  RESULTS
  Images for 80 children undergoing hypospadias correction were compared with 80 normal children in the maternity ward. 88.8% of the children with hypospadias had a penoscrotal raphe deviated from the midline compared with only 13.8% in the control group (P < 0.0003).
  
  
  CONCLUSIONS
  Our study demonstrates a significant association between hypospadias and deviation of the penoscrotal raphe from the midline. Consideration should be given to whether to include this finding within the spectrum of abnormalities seen in hypospadias. Examination of the penoscrotal raphe is simple to perform and could aid in the early diagnosis in children with milder forms of the condition.
authors.affiliation: Department of Plastic Surgery, Royal Preston Hospital, Plastic Surgery Department, Lancashire, UK.
authors.forename: Arvind
authors.initials: A
authors.lastname: Mohan
authors.affiliation: Department of Plastic Surgery, Royal Preston Hospital, Plastic Surgery Department, Lancashire, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Ashton
authors.affiliation: Department of Plastic Surgery, Royal Preston Hospital, Plastic Surgery Department, Lancashire, UK.
authors.forename: Milind
authors.initials: M
authors.lastname: Dalal
keywords: Deviation; hypospadias; penoscrotal raphe