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A different surgical technique for reconstruction of penile duplication
Mariam Malallaha, Peter Metcalfeb
University of Alberta, Canada

Introduction:
Diphallus is a rare congenital anomaly which accounts for 1 per 5 to 6 million live births1,2. Until now, about 100 cases have been reported in literatures3. The current classification classifies diphallia into true diphallia and bifid phallus. Each of these is further subdivided into partial or complete duplication. We report a different surgical approach for penile duplication reconstruction.
Case Report:
Our case was a baby boy diagnosed at birth with a duplicated penis. VCUG confirmed no urethral duplication. At the age of 7 months he underwent EUA and penile exploration demonstrating two separate corpora cavernosa were each had developed its own glans but one lacked its corpora spongiosa. The patient was subjected to a new technique, reconstructing the penis with preservation of the native urethra and most of the normal glans, partial penile amputation of his accessory penis then grafting it to the normal looking phallus ensuring a proper anchoring to the pubic tubercles to maximize fixation for erection and intercourse. Rotational byars flap was done in a functional area. A technically successful reconstruction was achieved. Post-Operative follow up showed a quite normal looking penis with a straight stream voiding. Our surgical approach is different in contrast to previously reported management techniques involving surgical excision of the abnormal penis with or without urethral reconstruction.3,4
Conclusion:
Due to the rarity of this malformation, surgical reconstruction should be individualized as it poses a great challenge taking into account the medical, surgical and ethical considerations without imperiling penile function or cosmesis.
References:
1. Adair EL, Lewis EL. Ectopic scrotum and diphallia. J Urol 1960; 84:115e7.
2. Kaufman Ariel, Guia Ronald, Davila Hugo, Kaufman Alfredo. Diphallus with third urethra. Urology 1990;35:257-60.
3. Gyftopoulos K, Wolffenbuttel KP, Nijman RJ. Clinical and embryologic aspects of penile duplication and associated anomalies. Urology 2002;60:675.
4. Rock SD, Gearhart JP. Complete lower urinary tract duplication with true diphallia presenting as a rare covered exstrophy variant. J Urol 1907;157:1997.


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