A new surgical technique for phalloplasty in patients with exstrophy of the bladder

Posterior pelvic osteotomy has not been a satisfactory operation to provide penile length in the repair of defects associated with bladder exstrophy. The authors are proposing a new technique based on the movement of the halves of the symphysis and pubic rami (en bloc with the attached corpora cavernosa) to the midline. This is accomplished by osteotomies of the superior and inferior rami and bone grafting of the resulting defects in the superior rami only. The hip joints are not disturbed, risk of complications appears to be reduced, and increased effective penile length is obtained. Cadaver dissections confirmed the practicality of this operation and a successful case is reported. The anatomy and physiology of penile function that is important to surgeons is reviewed.