V3-07: Scrotal Flap Phalloplasty (SFP) as Temporary Neophallus in Pre-pubertal Children with Penile Agenesis

Video

Introductions and Objectives
Penile agenesis, or aphallia, refers to the complete absence of a penis in a normal genotypic male due to failed development of the genital tubercle. Sex reassignment to female gender is no longer recommended in these patients due to conflicting results and high incidence of gender identity disorder. To favor proper psychosexual development of a child with aphallia, a phallus must be created in early childhood. We present a technique using a scrotal flap to build a temporary neophallus in aphallia patients who usually have a well-developed, scar-free scrotum with descended testes.

Methods
Scrotal Flap Phalloplasty (SFP) involves the creation of a neophallus using a cylinder type shape mid-scrotal flap along with rotation of Glenn-Anderson scrotal flaps for scrotoplasty. This video demonstrates the SFP technique in patients with aphallia.

Results
Two patients with aphallia underwent SFP at ages 18 months and 6 years old, respectively. The end result was evident in the immediate post-operative period with a satisfactory cylindrical structure resembling an uncircumcised phallus. At follow up, both patients demonstrated satisfactory cosmetic result of the neophallus with no evidence of contraction or loss of the flap.

Conclusions
SFP is a minimally invasive, simple and reproducible technique to create a temporary phallus in boys with aphallia while awaiting a definitive phalloplasty after the onset of puberty. This technique preserves the lower abdomen, forearms, or lower extremities for any definitive phalloplasty. A temporary phallus should be pursued during childhood to reinforce the child’s male-gender identity, favoring his self-esteem and psychosexual development.

Funding: None