Phalloplasty and urethroplasty in children with penile agenesis: Preliminary report

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dc.contributor.authorDe Castro, Roberto
dc.contributor.authorMerlini, Emilio
dc.contributor.authorRigamonti, Waifro
dc.contributor.authorMacedo, Antonio
dc.contributor.institutionOsped Maggiore Bologna
dc.contributor.institutionUniv Padua
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2016-01-24T12:41:56Z
dc.date.available2016-01-24T12:41:56Z
dc.date.issued2007-03-01
dc.description.abstractPurpose: Female gender has been assigned to 46,XY newborns affected by aphallia, possibly resulting in subsequent gender dysphoria. Prenatal and postnatal effects of the androgens on the brain and sexual orientation cannot be modified later. Therefore, patients affected by aphallia should be raised as males. Because definitive forearm flap phalloplasty is generally not recommended before puberty, we performed a preliminary penile reconstruction during childhood in 4 patients.Materials and Methods: Four patients with aphallia who had no sex reassignment at birth were treated at age 9, 17 and 36 months, and 12 years in a single operation. the urethral channel was dissected through an anterior-sagittal-transanorectal approach, and then phalloplasty and urethroplasty were carried out using an abdominal skin flap and a bladder/buccal mucosa free graft.Results: Immediate postoperative outcome was excellent in all the patients. One patient had excellent functional and cosmetic results at 5 years, while 2 had a partial dorsal urethral dehiscence resulting in an epispadiac urethra at 2 years, and 1 had necrosis of the distal urethra and was voiding through a scrotal urethrostomy at 9 months postoperatively. Phalloplasty survived and provided an adequate male appearance in all patients.Conclusions: 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.en
dc.description.affiliationOsped Maggiore Bologna, Dept Pediat Surg, I-40133 Bologna, Italy
dc.description.affiliationUniv Padua, Osped Maggiore Car Novara, Padua, Italy
dc.description.affiliationUniv Padua, Dept Urol, Padua, Italy
dc.description.affiliationUniversidade Federal de São Paulo, Dept Urol, São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Dept Urol, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent1112-1116
dc.identifierhttp://dx.doi.org/10.1016/j.juro.2006.10.095
dc.identifier.citationJournal of Urology. New York: Elsevier B.V., v. 177, n. 3, p. 1112-1116, 2007.
dc.identifier.doi10.1016/j.juro.2006.10.095
dc.identifier.issn0022-5347
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/29555
dc.identifier.wosWOS:000244211600076
dc.language.isoeng
dc.publisherElsevier B.V.
dc.relation.ispartofJournal of Urology
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.rights.licensehttp://www.elsevier.com/about/open-access/open-access-policies/article-posting-policy
dc.subjectpenisen
dc.subjecturogenital abnormalitiesen
dc.subjecturologic surgical proceduresen
dc.subjectmaleen
dc.subjectreconstructive surgical proceduresen
dc.titlePhalloplasty and urethroplasty in children with penile agenesis: Preliminary reporten
dc.typeinfo:eu-repo/semantics/article
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