Robotic pedicled appendix graft for urethral reconstruction in penile agenesis: A novel surgical approach

Penile agenesis is an extremely rare congenital anomaly that poses major challenges for urological reconstruction. The appendix, due to its consistent vascular supply and mobility, represents a promising option for complex urethral reconstructions. This case report describes a 10-year-old boy with penile agenesis who initially underwent perineal urethrostomy and colostomy, followed by neophalloplasty using a scrotal flap and Vantris injections to enhance neophallus volume. Later, urethral reconstruction was performed using a pedicled appendiceal graft harvested robotically and implanted into the neophallus with microsurgical precision, preserving vascularity. The procedure was successful, and the patient is awaiting the next stage for urethral anastomosis. This study presents a minimally invasive technique employing the appendix as a neourethra, combining functional and aesthetic outcomes in the challenging context of penile agenesis.