COMPLEX PENILE JOINING IN A CASE OF WIDE PENILE DUPLICATION

Abstract

A 15-month-old boy with multiple congenital malformations was referred for surgical correction. Physical examination revealed 2 complete separated penises 10 cm apart. Both penises had severe penoscrotal hypospadias with marked chordee. Separated hemiscrotums with 1 testicle each and a huge ventral hernia were also noted (fig. 1, A). Both urethras were easily catheterized, and retrograde cystograms showed 2 separate bladders and wide pubic diastasis. Grade III vesicoureteral reflux was noted on the left side (fig. 1, B). Sonography confirmed 2 corpora cavernosa for each penis. Karyotype was normal. Our goal was to join both penises in a normal midline position. The neurovascular bundles were lifted and the urethral plates were removed. The urethras were extensively mobilized including the proximal bulb. Suspensory ligaments were divided to lengthen the penises. Further dissection disclosed paired corpora cavernosa on both sides. Chordees were repaired by tunica albuginea plication. Symphyseal diastasis was approximated with bilateral innominate osteotomies. A poorly developed left glans with neurovascular bundle was dissected from the corpora and removed. The right glans cap was undermined to enable coverage of the distal left corpora as well. All 4 corpora cavernosa converged in the midline. Both urethras were approximated side by side to be joined distally during the second stage. Hemiscrotums were joined to form a singular scrotal sac. Penile body skin was reconstructed using vascularized sliding skin flaps. The ventral hernia was repaired during the second stage. Followup 1 year later demonstrated good penile size with symmetrical contours (fig. 2). Parents confirmed continence and good erectile function.