Phalloplasty in Infants with Congenital Absence of the Penis

PURPOSE To describe four patients affected with a congenital absence of the penis (aphallia, penile-agenesis) and no gender reassignment and treated with a one-stage male-genitoplasty in infancy MATERIAL AND METHODS Four patients, 7 months to 3 years old, had been reared as male. The urethra entered...

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Bibliographic Details
Published in:Journal of pediatric urology 2007, Vol.3, p.S29-S29
Main Author: Roberto DE CASTRO, Emilio MERLINI, Waifro RIGAMONTI , Antonio MACEDO , Simona NAPPO and Paolo CAIONE
Format: Article
Language:English
Subjects:
Pediatrics
Urology
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Summary:PURPOSE To describe four patients affected with a congenital absence of the penis (aphallia, penile-agenesis) and no gender reassignment and treated with a one-stage male-genitoplasty in infancy MATERIAL AND METHODS Four patients, 7 months to 3 years old, had been reared as male. The urethra entered the anterior rectum in all. Three were untouched and one had bilateral ureterostomies. Three presented with classical aphallia and one had a rudimentary micro-phallus with no urethra and a single corpus-cavernosum. In the youngest patient, an anorectal-malformation and recurrent orchiepididymites were associated. Anterior-sagittal-transanorectal-approach (3 cases) or Peña-approach (1 case) were utilized to divide the rectal-urethra. Subsequently using a lithotomy position, a new-urethra, using bladder/buccal mucosa grafts, and a new-phallus fashioned from a quadrangular abdominal skin-flap, were performed RESULTS Preliminary results after 5 and 3 years and 9 and 2 months, show that the phalloplasty was successful in all. One patient required a perineal urethrostomy because of a penile urethral stricture. One had a dehiscence of the dorsal penile suture, resulting in an epispadiac appearance. The other 2 are able to void through an urethral meatus at the tip of their new phallus CONCLUSIONS We report our preliminary surgical outcomes in a limited number of patients, showing good results with phalloplasty and some complications regarding the urethroplasty. Surgical technique of early phalloplasty may be improved in the future.However, we are convinced that retaining the male gender in 46XY individuals born with aphallia is the right approach and social, psychological and physical reasons justify early phallic reconstruction in infancy, waiting for possibly definitive treatment in adulthood
ISSN:1477-5131
1873-4898
DOI:10.1016/j.jpurol.2007.01.035