Summary
Introduction
Aphallia is a rare congenital disorder pertaining to genotypic males. Early surgical
creation of a neophallus is recommended to reinforce the child’s male gender-identity,
favoring proper psychosexual development. Modern microsurgical techniques used to
create a neophallus in adults are not recommended in children due to the invasiveness
and complexity of the procedures, along with high complication rates. Scrotal flap
phalloplasty is a simple and reproducible technique to create a temporary neophallus
in prepubertal boys with aphallia.
Objective
We present a multi-institutional experience, ten years after the initial description
of the scrotal flap phalloplasty (SFP) technique, in which a flap from the well-developed
scrotum is used to build a temporary neophallus, without obvious scars in patients
with aphallia.
Study design
The records of surgical neophalloplasty for aphallia patients from 4 centers between
2011 and 2021 were reviewed. All patients had at least one year follow-up to assess
for short and long-term complications. Age at initial operation, associated anomalies,
and other related surgical procedures were analyzed.
Results
The post-operative aesthetic result in all patients was satisfactory and has been
maintained in the long-term follow-up, with all patients presenting a cylindrical
structure resembling an uncircumcised penis, without evidence of significant contraction
or loss of length. (Summary Figure)
Discussion
Non-microsurgical neophalloplasty techniques in patients with penile agenesis are
temporary procedures that help to establish the body image and preserve the psychosexual
development of the patient with aphallia. These techniques do not involve tissue transplant
from a distant region, and are simpler to perform, with less scarring at the donor
sites. Due to significant donor scars and considerable morbidity and complexity associated
with the definitive phalloplasty techniques, we created a simple, reproducible and
straightforward procedure to serve as a temporary neophallus in young boys with aphallia.
As affected patients usually have a well-formed scrotum with normal and orthotopic
testicles, it is the ideal donor site for a temporary neo-phallus in childhood. Furthermore,
other donor sites are preserved for a definitive phalloplasty. There are limitations
to this study, as quality of life could not be assessed and psychological or gender-identity
investigations have not been carried out. None of these children have reached puberty,
and hence decision and outcomes of definitive neophallus reconstruction has not been
considered to date.
Conclusion
Graphical AbstractLong-term results (patients 1 and 2).
Keywords
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Article info
Publication history
Published online: October 06, 2022
Accepted:
October 3,
2022
Received in revised form:
September 5,
2022
Received:
June 29,
2021
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
