title: Phalloplasty and urethroplasty in a boy with penile agenesis.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Pediatric Surgery, Hospital CdC Petrucciani, Lecce, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: De Castro
authors.forename: Atila
authors.initials: A
authors.lastname: Rondon
authors.forename: Ubirajara
authors.initials: U
authors.lastname: Barroso
authors.forename: Valdemar
authors.initials: V
authors.lastname: Ortiz
authors.forename: Antonio
authors.initials: A
authors.lastname: Macedo
mesh_terms: D002648:Child; D005832:Genital Diseases, Male / Q000601:surgery*; D006801:Humans; D008297:Male; D010413:Penis / Q000002:abnormalities / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012007:Rectum / Q000002:abnormalities / Q000601:surgery; D014521:Urethra / Q000002:abnormalities* / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*