Phalloplasty and Urethroplasty in Children With Penile Agenesis: Preliminary Report

Abstract

Opposite gender should not be assigned in patients affected by penile agenesis, who are better raised according to their karyotype and hormonal production. Definitive phalloplasty in adults may achieve good results. Nevertheless, this procedure is generally performed in postpubertal boys and it is not easily available everywhere. Therefore, we believe that social and psychological concerns justified this type of phalloplasty as a palliative preliminary procedure in 3 of our patients. In those countries where definitive forearm phalloplasty is not available our method may also be justified in older children (as in 1 of our patients) as an attempt at a definitive procedure.

Aphallia: experience with 3 cases

“…Studies to evaluate the long-term results have shown viability of neophallus bone resulting in a satisfactory cosmetic and functional outcome [25]. The longterm complications of early phalloplasty using abdominal wall skin flap include dorsal urethral dehiscence resulting in an epispadiac urethra and necrosis of the distal urethra [21]. One of our cases (case 2) had a stenotic urethral opening and died because of urosepsis.…”

“…In 2007, an article by De Castro et al [21] influenced change the management of aphallia. They proposed that the opposite sex should not be assigned in patients affected by aphallia.…”

“…These patients usually are not able to expel urine at the meatus in a forceful stream. This problem may eventually compel the surgeon to resort to a scrotal urethrostomy later on [21]. The osteocutaneous forearm free flap is the most popular technique for definitive phalloplasty after puberty [25].…”

Urethral Reconstruction in Patients Suffering from Aphallia: A Reconstructive Challenge

“…He stated that the long-term sexual function of his patients would be reported later on; at the time of publication of his study, none of his patients were sexually active. De Castro et al [4] in their landmark study mentioned that they performed phalloplasty and urethroplasty in all their patients using the abdominal skin flap. …”

“…It can coexist with other congenital defects [1,2] . There is a paucity of papers written in English which describe reconstruction of the urethra in patients suffering from aphallia [3][4][5] . The few articles which do exist are single case reports and contain only a brief description of the surgery undertaken [6][7][8][9][10] .…”