173 / 330
173
19–22 APRIL, 2017, BARCELONA, SPAIN
13:35–13:40
S16-2 (VP)
★
SCROTAL FLAP PHALLOPLASTY (SFP) AS TEMPORARY
NEOPHALLUS IN PRE-PUBERTAL CHILDREN WITH PENILE
AGENESIS:SUCCESSFUL SURGERY IN THREE CASES
Bruno CEZARINO
1
, Francisco DENES
1
, Juan PRIETO
2
and Jeffrey LESLIE
3
1) University of sao paulo, Urology, Sao Paulo, BRAZIL - 2) University of Texas Health Science Center, Urology,
San Antonio, USA - 3) University of Texas Health Science Center, Urology, San Antonio, USA
INTRODUCTION AND OBJECTIVE
Penile agenesis, or aphallia, refers to the complete absence of a penis in a normal genotypic male
due to failed development of the genital tubercle. Sex reassignment to female gender is no longer
recommended in these patients due to conflicting results and high incidence of gender identity
disorder. To favor proper psychosexual development of a child with aphallia, a phallus must be
created in early childhood. We present a successful technique using a scrotal flap to build a tem-
porary neophallus in aphallia patients who usually have a well-developed, scar-free scrotum with
descended testes.
METHODS
Scrotal Flap Phalloplasty (SFP) involves the creation of a neophallus using a cylinder type shape
mid-scrotal flap along with rotation of Glenn-Anderson scrotal flaps for scrotoplasty. This video
demonstrates the SFP technique in patients with aphallia.
RESULTS
Three patients with aphallia underwent SFP at 15 months, 18 months, and 6 years old, respectively.
The end result was evident in the immediate post-operative period with a satisfactory cylindrical
structure resembling an uncircumcised phallus. The satisfactory cosmetic result has persisted up to
three years of follow up in two of them. Parents and patients are very satisfied with the neophallus
appearance. To date, there has been no evidence of contraction or loss of the flap. The parents of
the older patient requested volume/diameter enhancement of the phallus for which AlloDerm
®
graft
bulking procedure was performed satisfactorily.
CONCLUSIONS
SFP is a minimally invasive, simple and reproducible technique to create a temporary phallus in
boys with aphallia while awaiting a definitive phalloplasty after the onset of puberty. This technique
preserves the lower abdomen, forearms, or lower extremities for any definitive phalloplasty. A tem-
porary phallus should be pursued during childhood to reinforce the child’s male-gender identity
thereby favoring his self-esteem and psychosexual development.