Lower Abdominal Flap Phalloplasty in Older Children for Congenital and Acquired Diseases

Abstract

PURPOSE Phalloplasty with lower abdominal flap (PAF) was introduced in infants as a temporary procedure for penile agenesis (ESPU 2002, 2005 & 2007). We would like to present indications and outcomes of PAF in older children affected by congenital or acquired diseases. PATIENTS AND METHODS From November 2005 to July 2007, 6 patients, 4 to 14 years old (overage 9 years), received PAF for phallic-replacement. Two patients were affected by penile agenesis, 2 by DSD, and 2 by iatrogenic or traumatic penile amputation. Total urethral reconstruction has been simultaneously carried-out in 3 cases. Partial urethroplasty has been utilized in the remaining 3 making a penoscrotal urethrostomy. RESULTS After 3 to 22 months, phalloplasty was successful in all, but one had a dorsal penile suture dehiscence, resulting in an epispadiac appearance. The 3 total urethroplasties failed for untreatable meatal/distal-penile urethral stricture; perineal or scrotal urethrostomy were the salvage procedures. The 3 partial urethroplasties are working properly. CONCLUSIONS In high-specialized centers, microsurgical-transferred radial-forearm-flap phalloplasty, achieves good results in adults and has to be considered the technique of choice. Microsurgical phalloplasty is a team-procedure, not recommended before age of 15 years. In comparison, PAF is simpler, performed by a single surgeon, and has anyway shown satisfactory outcomes. For patients under 15 years of age or when a specialized team is not available, the questions are: is PAF justified? Do social and psychological reasons validate PAF that may be temporary or just cosmetic phalloplasty? Might auto-manipulation or special devices achieve an increase in length, with the expectation that new phallus might reach an acceptable size to insert of a penile prosthesis?