# Two holes??? (Newly-retracting ds2.) I'm a bit freaked.



## pjlioness (Nov 29, 2001)

I have seen only two intact penises up close - my sons'. Ds2 (3 in August) has just recently been retracting a little bit while playing - just beyond his glans. The other night I happened to be watching, and something looked strange. I looked a little closer and saw what looked like a second hole in the tip of his glans. There is a small hole just above the center of the tip, but there is another much larger one that is upside-down (IIRC) "V" shaped. I looked carefully, and it doesn't seem to be an area where the foreskin has not retracted.

I asked ds1 to retract his penis so that I could compare them, as he doesn't retract much more than his brother. Ds1 most definitely does not have two holes - he has one in the center of the tip of his glans, where it is supposed to be.

Does anyone have any idea what this might be, if it's a problem, etc.?

I'm thinking of having our intact-friendly-does-not-do-circ. ped. take a look at it. I wouldn't think of having any surgery done until he's older, and even then, I'd do it only if it is a *real* problem, not just an odd looking penis, but I would like it checked out.


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## MCatLvrMom2A&X (Nov 18, 2004)

I dont think it would be a problem since he is peeing ok. Could be a slight birth abnormality. Is the V saped hole right on the tip of the glans or more underneth?


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## pjlioness (Nov 29, 2001)

It's just below the very tip, and the smaller hole is just above the very tip. He has no problem peeing, though I don't know which hole he pees from (not going to put myself in firing range to find out, either







).


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## MCatLvrMom2A&X (Nov 18, 2004)

Found this: Congenital urethral fistula:

Quote:

Although rare, a congenital urethral fistula refers to an abnormal passage that develops in pregnancy between the urethra and penile skin, somewhere beneath the normal urethral opening. During urination two streams of urine may be obvious - one coming from the urethral opening and the other from the site of the abnormal opening (fistula). A diagnosis is usually made by physical examination and observation of urination.


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## pjlioness (Nov 29, 2001)

Do you know of a site that has pictures of that/other abnormalities?

(I must say that I dislike using abnormality in connection with my babe. It sounds negative.







)


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## MCatLvrMom2A&X (Nov 18, 2004)

I hear u there I am doing a search now but cant think of how to phrase it to pull up what I really want. That article dosnt have pictures and that sentence was all i found.


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## pjlioness (Nov 29, 2001)

BTW, thank you. I had no idea where to start.


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## mamaverdi (Apr 5, 2005)

It could be a double or duplicated urethra. It could be a fistula. It could be any number of rare conditions.

Here is an article which I haven't read....
http://www.emedicine.com/ped/topic2354.htm

I couldn't get this to link, but here is a brief article:

The urinary system is both amazing and complex. Urine is formed in the kidneys by their filtering the blood. The kidneys are located in the back, just under the ribs. A tube called a ureter extends from each kidney down to the bladder. As the urine is formed, it flows down these tubes and is stored in the bladder. Urine leaves the bladder and exits the body through a tube called the urethra.

In girls the urethra is short and straight; in boys the urethra is long, and S-curved. The final portion travels the length of the penis, and typically opens at the hole in the tip.

The formation of the male urethra in utero is complex, and not completely understood. This development can go awry in a number of ways, including part or all of the urethra in the wrong location, valves blocking urine flow, or dilatation so that flow isn't blocked when it should be. Some boys even have two urethras.

Urethral duplications occur in many varieties and seem to come from many different abnormalities of development. No widely accepted classification has yet been adopted. Most duplications occur with one urethra on top of the other. Occasionally, however, duplex urethras occur side by side. This is usually the case if a child has two complete penises, but also occurs if the penis is fused but widened. Most of these children have two bladders, plus two normal urethras, and only need surgery if it is needed for cosmetic reasons.

The more common situation of one urethra on top of another occurs in dorsal and ventral varieties.

In dorsal duplications of the urethra, a normal urethra follows the usual channel and ends in a normal hole at the tip of the penis. The other opening appears on the upper surface of the penis, anywhere between the tip and the base. This extra urethra may end in a blind pouch before reaching the bladder. If it does extend the entire length and insert into the bladder, the child will usually dribble urine out of this urethra, since there is no sphincter mechanism to restrain urine flow. Surgery is sometimes needed for incontinence or repeated infections. Since the normally positioned urethra has a normal bladder neck and normal sphincter mechanism, surgery consists of simply excising the extra urethra.

The ventral variety is more variable and less well understood. In some instances, two complete urethras come off the bladder; in others, the urethra bifurcates somewhere along the path. The opening from the second urethra is often located on the underside of the penis (and is thus less visible than in the dorsal variety), but it can appear further down, even as far away as the anterior rim of the anus. The closer the opening is to the anus, the more likely that this abnormally placed urethra is the normal one, with the functioning sphincter mechanism. The normally located penile urethra is often narrow, inelastic, and functions poorly, if at all. As an adult, ejaculation would also occur out of the anal urethra, not necessarily diminishing sexual pleasure, but certainly affecting fertility.

Not all cases of duplex urethras need surgery, or any treatment at all. Perianal urethras should be repaired; the surgery is complicated and usually involves trying to move that urethra forward. If both openings are on the penis, as in your son, surgery is only indicated if there is a problem with incontinence, infections, or reflux (the backward flow of urine). Incontinence or isolated infections are usually present early on if they will be present at all. Reflux can be present early on, but then disappear on its own. It can, however, develop or re-develop at any time, even in adulthood, leading to infections and pressure-related kidney problems. If the two urethras lie right next to each other, the thin wall between them can give way. When the person urinates, this perforated wall can act as a flap-valve to obstruct urine flow, causing pressure back up. When undetected, this pressure can, over years, lead to renal failure, and even to kidney transplant.

For most of us, the medical conditions that afflict us as adults have their roots in childhood. Attention and appropriate medical care can prevent many of these conditions. For your son, close attention is even more important. His situation might cause him no problems (some cases of double urethra are only noticed incidentally, late in life). It could, however, progress to something serious if not followed carefully. Stay in close contact with your pediatrician and/or urologist, so that infections or reflux can be quickly treated.

Alan Greene MD FAAP

July 17, 1996


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## Lula's Mom (Oct 29, 2003)

I had a boyfriend in college (intact) who had two holes. If I recall he peed from both of them.







It didn't cause him any problems. I hope it's the same for your little guy.


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## MCatLvrMom2A&X (Nov 18, 2004)

Found this but still no pictures grrrr

Quote:

Another variation of the regular urethral meatus is the split meatus, where a thin band of tissue splits the urethral opening into two. In some very rare cases there may actually be two urethras running the length of the penis.


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## wendy1221 (Feb 9, 2004)

My dh and ds2 have long slits instead of a little hole. Are you sure this isn't the case? I think a wide variation must be normal, cuz I mean LONG slits whereas all the penises I'd seen before were little round hles. lol


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## MCatLvrMom2A&X (Nov 18, 2004)

Found this with a picture







http://www.the-penis.com/zskin.html Scroll down to Double urethra meatus. u can click on the picture to inlarge it some.


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## pjlioness (Nov 29, 2001)

Quote:


Originally Posted by *wendy1221*
My dh and ds2 have long slits instead of a little hole. Are you sure this isn't the case? I think a wide variation must be normal, cuz I mean LONG slits whereas all the penises I'd seen before were little round hles. lol

Nope, it's definitely not just one loooong slit.


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## polarbear (May 6, 2005)

Could it be that you are beginning to see the space between the foreskin and the frenum on the underside of the glans? If he is not retracting past that, then the ‘fissure’ might look like a secondary meatus. Once he can fully expose it, it might be an open indent rather than an enclosed area like the urethra. Maybe?


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## pjlioness (Nov 29, 2001)

Quote:


Originally Posted by *MRDCatLvr*
Found this with a picture







http://www.the-penis.com/zskin.html Scroll down to Double urethra meatus. u can click on the picture to inlarge it some.

Okay, that's more like two small holes, which is not what I'm seeing.


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## pjlioness (Nov 29, 2001)

Quote:


Originally Posted by *polarbear*
Could it be that you are beginning to see the space between the foreskin and the frenum on the underside of the glans? If he is not retracting past that, then the 'fissure' might look like a secondary meatus. Once he can fully expose it, it might be an open indent rather than an enclosed area like the urethra. Maybe?

Maybe, but I don't think so. It was something I considered, but it just doesn't look like I think that probably would. It's too deep and wide, and is on the tip of the glans. It looks like he's retracting beyond that place.


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## pjlioness (Nov 29, 2001)

Okay, so now ds has stopped retracting himself. I guess he thought maybe I was too interested in his penis...and perhaps my concern showed more than I thought. Poor babe.

I would still like to have our Dr. look at it, but I will wait until he's playing again, as I don't want anyone else (even me) retracting him. I suppose we may have to wait until he is older and can accept/understand the Dr. wanting/"needing" to see his penis. I know there is probably no *need* for him to see it unless there is a real problem, but I would like to know what I saw, I guess for my own peace of mind.

On that note, has anyone found any other sites with pictures? I'd like to have a preliminary idea of what this is.


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## mamaverdi (Apr 5, 2005)

Have you considered just calling your doc and asking? It sounds like you have a very intact friendly doc. Mostly likely, it is nothing worrisome....however, if it is a fistula, it could mean he has an obstruction in his urinary tract and thus a problem with his kidneys. These things do not necessarily show up as problems until renal failure.

Good luck whatever you decide.

mv


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## pjlioness (Nov 29, 2001)

I hadn't, but a phone call or an appt. (not looking unless ds is amenable) sounds like a good idea, given any possibility that it could end up being that serious.

Thanks for the suggestion/info.


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## mamaverdi (Apr 5, 2005)

Statistically the chances are very very low. Very low: 1 in 8000 for a common type of obstruction. It really depends on how you do risk assessment, ya know?

I may have a picture of when my son developed a fistula...but it came out of his scrotum....it looked like a little v with a little mouth at the tip of the v.

Let me ask my dh....

No, he says, we didn't have one.


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## mamaverdi (Apr 5, 2005)

Pam, have you gotten any more information on this?

mv


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## pjlioness (Nov 29, 2001)

Quote:


Originally Posted by *mamaverdi*
Pam, have you gotten any more information on this?

mv

No, not yet. We're all due for a checkup, though, so I am planning to make appointments for us all (family Dr.), and I'll bring it up there, though I suspect my babe will not be up to showing the Dr. anything. I can describe it though, draw a picture, etc.







(I must say that I find it very odd looking at pictures of penises trying to find one that looks somewhat like my son's.)


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## mamaverdi (Apr 5, 2005)

I bet if you can describe it over the phone or email to a competent urologist, they would have an inkling of what it was right away. Maybe you could even get a digital pic to send/show the doc?


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## pjlioness (Nov 29, 2001)

Quote:


Originally Posted by *mamaverdi*
I bet if you can describe it over the phone or email to a competent urologist, they would have an inkling of what it was right away. Maybe you could even get a digital pic to send/show the doc?

I'd be better off describing it. He's playing again, and I now see that it is a V, not an upside-down V.

As for a digital pic, we did try that, but I don't think we have a close zoom on any of our cameras, plus the babe gets shy when it gets too much attention.

I plan to call our Dr. this week.


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## mamaverdi (Apr 5, 2005)

Did you ever find out anything about this?


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## nd_deadhead (Sep 22, 2005)

Pam, my identical twin boys have two holes, very similar to what you're describing. They are almost 12 (so I haven't looked at their penises for years), and they have not had any difficulty at all. If your son can urinate fine, and does not get UTIs, it's probably nothing at all to worry about. But I would have the doctor take a peek next time you're in.


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## pjlioness (Nov 29, 2001)

Quote:


Originally Posted by *mamaverdi*
Did you ever find out anything about this?

Not yet. Summer got busy. Ds1 needs a physical for school, so we will be going soon.


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