Journal of Pediatric Surgery (2006) 41, E13–E14

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Successful surgical correction of true , scrotal duplication, and associated

Hatangadi Sanjay Bhat*, Sudhir Sukumar, Tiyadath Balagopal Nair, Cherukareth Saifuddin Mohammed Saheed

Department of , Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala 682 026, India

Index words: Abstract A 1-year-old child with complete duplication of presented with continuous dribbling of Congenital abnormalities; urine. Examination revealed hypospadias of 1 penis and a duplicated with 2 normal testes. Penis; Cystourethrogram revealed a single bladder with a normal in the dorsally placed phallus and Urogenital surgical ectopic insertion into the bladder of the ventral urethra. Abnormality was corrected by excision of the procedures ventrally located penis bearing the ectopic urethra. The preputial skin of this ventral penis was used to repair the hypospadias of the dorsal penis. The case is being reported in view of its rarity and the successful surgical correction. D 2006 Elsevier Inc. All rights reserved.

Diphallia or penile duplication is a very rare congenital anomaly. We report total surgical correction of true diphallia, which was associated with complete urethral duplication, double scrotum, and hypospadias.

1. Case history

A 1-year-old male child presented with double penis and continuous dribbling of urine. Examination of the external genitalia showed 2 and a normal-appearing testis within each of the separated hemiscrotums (Fig. 1). The dorsal penis had a penoscrotal hypospadias with significant . The ventral penis had a normally located meatus with evidence of continuous urinary incontinence. Both could be easily catheterized, and cystour- ethrogram (Fig. 2) revealed complete duplication of urethras opening into a single bladder. The urethra of the dorsal penis

* Corresponding author. Tel.: +91 484 4001320; fax: +91 484 4002020. Fig. 1 Complete duplication of penis associated with separated E-mail address: [email protected] (H.S. Bhat). hemiscrotums.

0022-3468/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2006.06.024 E14 H.S. Bhat et al.

Fig. 2 Cystourethrogram showing ectopic ventral and orthotopic Fig. 4 Appearance after scrotal reconstruction. dorsal urethra opening into a single bladder. genitalia (Fig. 3), the child voided satisfactorily after opened through the normal bladder neck, whereas the ectopic removal of the splint. urethra of the ventral penis opened into the lateral bladder wall. Later, at the age of five years, the asymmetric scrotum There was no pelvic diastasis or other systemic anoma- was reconstructed using a scrotal rotation flap as for a lies. Karyotyping was normal. prepenile scrotum. After this, the child has normal-appear- The first-stage surgery was aimed at correcting the ing genitalia (Fig. 4) and is continent with a straight and diphallia while preserving the dorsal penis with the forceful urinary stream. orthotopic urethra. Dorsal penis was degloved and chordee corrected by excision of dysgenetic spongiosum distal to the urethral meatus. Both its corporal bodies were preserved, 2. Discussion and satisfactory orthoplasty was confirmed by intracorporal injection of normal saline (Gittes’ technique). Ventral penis Less than 100 cases of penile duplication have been was then degloved and its urethra and both corpora were reported worldwide, and it is believed that no two are excised at the level of the perineal membrane. The preputial identical [1]. It is thought to result from varying degrees of skin from this ventral penis was then mobilized to form a incomplete fusion of the genital tubercles [2,3]. tubularized island flap (Duckett tube) and tunneled under The spectrum may vary from a bifid penis to true the skin between the 2 phalluses to form a neourethra for the diphallia [2]. True diphallia is extremely rare and is dorsal penis. Although there was some asymmetry of the characterized by 2 separated penises each having 2 corporal bodies and 1 corpus spongiosum. It may be associated with urethral, bladder, and scrotal duplication [4]. Other systemic anomalies include ventral hernias, bladder extrophy, sepa- ration of pubic symphysis, and vertebral and anal anomalies [3,4]. Surgical correction is individualized with the aims of achieving proper urinary continence, urinary stream, and with adequate cosmesis [5].

References

[1] Gyftopoulos K, Wolffenbuttel KP, Nijman RJ. Clinical and embryo- logic aspects of penile duplication and associated anomalies. Urology 2002;60:675. [2] Hensle TW. Genital anomalies. In: Gillenwater JY, Grayhack JT, Howards SS, et al, editors. Adult and . Missouri7 Mosby; 1996. p. 2530-1. [3] Hollowell Jr JG, Witherington R, Ballagas AJ, et al. Embryologic consideration of diphallus and associated anomalies. J Urol 1977; 117:728. [4] Djordjevic ML, Perovic SV. Complex penile joining in a case of wide penile duplication. J Urol 2005;173:587-8. [5] Dean JA, Horton CE. Diphallia and duplication. Plast Reconstr Surg Fig. 3 Appearance after penile surgery. 1991;87:358-61. 本文献由“学霸图书馆-文献云下载”收集自网络，仅供学习交流使用。

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