title: Neophalloplasty to congenital aphallia using two transverse skin-flaps: an alternative approach.
abstract: OBJECTIVE
  Penile agenesis is a rare congenital abnormality with an incidence of 1 in 30 million births. We want to demonstrate in this video a new technique of neophalloplasty based on two transverse skin flaps from lower abdominal wall.
  
  
  METHODS
  The patient was placed into a prone position; the urethral meatus was found inside the rectum, 2 cm from the anal border. An Anterior Sagittal Transrectal Approach (ASTRA) approach was performed; the urethra was isolated and repositioned as a perineal urethrostomy. We created the neophallus based on two flaps, each measuring 7 × 3 cm. After incision, flaps were rotated 90° and sutured to each other creating the neophallus. We also created a Mitrofanoff channel to secure bladder emptying in cases of urethrostomy stricture.
  
  
  RESULTS
  The patient had an uneventful immediate postoperative evolution, but later showed some degree of penile retraction. He voids preferably through the urethrostomy and his mother uses the Mitrofanoff once a day. The current follow-up is 18 months.
  
  
  CONCLUSIONS
  We acknowledge limited clinical experience with this technique. However, the same principle has been used to create catheterizable urinary channels, with favorable results and longer follow-up. The use of transverse skin flaps might be an interesting alternative for neophalloplasty in aphallia.
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Macedo
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil. Electronic address: ma_celaleal@yahoo.com.br.
authors.forename: Marcela Leal
authors.initials: ML
authors.lastname: da Cruz
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Gustavo Marconi Caetano
authors.initials: GM
authors.lastname: Martins
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: João Luiz Gomes
authors.initials: JL
authors.lastname: Parizi
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Diego Estevam
authors.initials: DE
authors.lastname: Oliveira
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Valdemar
authors.initials: V
authors.lastname: Ortiz
mesh_terms: D005832:Genital Diseases, Male / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010413:Penis / Q000002:abnormalities* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D013521:Urologic Surgical Procedures, Male / Q000379:methods*
keywords: Aphallia; Neophalloplasty; Penis