Penile Fusion Technique for Correction of Diphallia
Allison Sih, MD1, Gregory Dean, MD, FAAP, FACS2.
1Temple University Hospital, Philadelphia, PA, USA, 2St Christopher's Hospital for Children, Philadelphia, PA, USA.
BACKGROUND: Diphallia is a rare congenital anomaly with approximately a hundred cases reported in the literature. We present a case of an adolescent with penile and urethral duplication who desires surgical reconstruction.
METHODS: The patient is a 16-year-old male who presents with penile and urethral duplication. He has a history of bladder exstrophy closure and imperforate anus repair in Ecuador. He was able to void from both meatuses. Physical exam showed a single shaft with two separate glans and meatuses. MRI evaluation showed four corporal bodies with a fused corpora spongiosum. Cystourethroscopy showed two parallel, but separate urethras which entered the bladder. The surgical strategy centered on maximally preserving glans tissue and creation of a single meatus. A circumferential incision was made and the shaft was degloved. The glans were separated using electrocautery and the urethras were incised sharply. A side-to-side anastomosis of each urethra using 5-0 Monocryl facilitated voiding from a single meatus. A small portion of the ventral and dorsal glans skin was excised to create a two layer closer, forming a single glans. The penile skin was reapproximated to give a circumcised appearance. RESULTS: Total operative time was approximately 180 minutes. Estimated blood loss was 10 ccs. The patient did well post-operatively. The catheters were removed after two weeks. At three month follow-up, the patient is doing well and is happy with his cosmetic result.
CONCLUSIONS: Diphallia is a rare congenital anomaly. We present a case of an adolescent with diphallia who had two separate glans and meatuses with a single penile shaft. Surgical reconstruction consisted of maximal glans preservation and formation of a single meatus. The patient is pleased with his cosmetic result.
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