A novel technique to construct a neo-scrotum out of preputial skin for agenesis and underdeveloped scrotum

Abstract

Congenital scrotal agenesis (CSA) is an extremely rare condition with fewer than 10 cases reported in the literature. These patients are often further complicated by undescended testicles as well as systemic developmental disorders. Herein, we report our experience and an innovative surgical technique for creation of a neo-scrotum in three children. We evaluated the records of three children in our database who were labeled as having an absent (1 patient) or severely underdeveloped scrotum (2 patients). Patients were aged 6, 14, and 16 months. All patients were uncircumcised, and the decision was made to create a neo-scrotum using the foreskin. The prepuce was harvested on a pedicle of dartos and transposed over the perineal cleft to create a neo-scrotal pouch. The flap was allowed to heal for 12-14 weeks, at which time the orchidopexy was performed. The follow-up to the surgery was 5 years, 3 years, and 6 months, respectively. There were no instances of flap necrosis, dehiscence, or wound infection. The three children had a capacious, aesthetically pleasing scrotal sac, which in all cases accommodated both testicles. In our experience, a well-vascularized preputial skin flap rotated to the perineum based on its ventral dartos pedicle provides an excellent source of tissue for creation of a neo-scrotum. We believe that the esthetic outcome of our technique rivals that of other reported techniques.