Phalloplasty and urethroplasty in a boy with penile agenesis

New concepts in ambiguous genitalia have questioned the strategy of female gender reassignment in cases of penile agenesis. Hence, we present a video of the construction of a phallus according to the De Castro technique as an alternative approach for this devastating condition.

A 12-year-old boy with congenital penile agenesis and posterior urethra emerging in the distal rectum was selected. An ASTRA approach was used and a phallus was constructed with a skin flap from the abdominal wall, tubularized to produce a phallic appearance. A buccal mucosa graft was tubularized to create the new urethra.

Immediate outcome was excellent. Partial dehiscence of the dorsal urethral sutures occurred and the patient started voiding through a scrotal urethrostomy at 9 months postoperatively. Phalloplasty provided an adequate male appearance with a good cosmetic aspect.

The technique is a feasible alternative. A procedure in 2 stages by first creating the neourethra at a later date might be an interesting option to try to avoid the urethral complications observed. Long-term follow-up is however necessary to confirm the initial results.