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28
TH
CONGRESS OF THE ESPU
S16: DSD
Moderators: Francisca Yankovic (Chile), Pierre Mouriquand (France)
ESPU Meeting on Friday 21, April 2017, 13:30–14:12
13:30–13:35
S16-1 (LO)
★
TECHNICAL EVOLUTION OF NEO-PHALLOPLASTY
IN PEDIATRIC AGE THROUGH 40 PROCEDURES
IN 15 YEARS
Roberto DE CASTRO
1
, Aurélie CHIAPPINELLI
1
, Emilio MERLINI
2
,
Marianna IAQUINTO
1
, Maria Grazia SCUDERI
3
, Anthony CALDAMONE
4
and Tue DINH
5
1) C.d.C. Petrucciani, Pediatric Surgery & Urology, Lecce, ITALY - 2) Regina Margherita Children’s Hospital, Pediatric
Urology, Torino, ITALY - 3) University of Catania, Pediatric Surgery, Catania, ITALY - 4) Brown University, Providence, RI,
USA, Pediatric Urology, Providence, USA - 5) University of Texas, Houston, Texas, USA, Plastic Surgery, Houston, USA
PURPOSE
In 2007 a technique for total-replacement phalloplasty in children affected by penile-agenesis was
introduced, reporting 4 cases. Afterwards 36 more procedures were carried out by the same sur-
geon. Herein the latest technical evolution of penile reconstruction in children is presented, allowing
better outcomes and less complications
MATERIAL AND METHODS
From 2001 to 2016, 40 patients have been treated in 14 Countries. Seventeen penile-agenesis,
10 traumatic/iatrogenic total amputations, 6 rudimentary/micropenis, 5 PAIS, and 2 cloacal-exstrophy
RESULTS
Several modifications have been introduced. Penile urethra is not simultaneously reconstructed.
Rectal ending urethra is divided from the rectum and sited at the perineal area. A rectangular skin-
expander is introduced subcutaneously in the lower abdominal wall 3-6 months before phalloplasty.
A composite rectangular skin-flap of the lower abdominal wall is designed to reproduce a cylindri-
cal penile body, spherical glans-penis and urethral meatus. Skin-flap lateral ends are elongated
with multiple “Z” plasty obtaining a longer dorsal penile aspect. A strip of rectal muscle fascia is
dissected, tabularized, incorporated and connected with the neo-urethral meatus. When present
corpora cavernosa remnants are lengthened and incorporated. In PAIS, the micro glans-penis is
saved and placed at the scrotal-raphe.
These modifications abolished distal urethroplasty complications and reduced formidably skin-flap
ischemia and wound dehiscence. Stability of the new penis is obtained, facilitating future penile
urethra reconstruction and prosthesis insertion. Patients/parents’ satisfaction improved with better
appearance, easier post-operative management and shorter hospital stay.
CONCLUSIONS
One of the very few techniques proposed for total penile reconstruction in pediatric age is revisited.
This is a challenging procedure, sometimes temporary, with possible complications and possible
disappointing final outcomes. Herein we report a unique 15-year-long experience of a single
surgical-team through a total of 40 procedures. Several technical refinements were progressively
introduced reaching improvements in the final outcomes and opening better prospective for these
unlucky children.