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CC BY-NC 4.0 · Arch Plast Surg 2019; 46(04): 381-385
DOI: 10.5999/aps.2018.00689
Case Report

Accessory penis: A rare method of peno-urethral separation of sexual function and voiding following successful complex hypospadias reconstruction with a free ileum flap

Rossella Elia 
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
,
Georgios Pafitanis 
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
Group for Academic Plastic Surgery, The Royal London Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK
,
Pedro Ciudad
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
,
Hung-Chi Chen
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
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Hypospadias is a congenital malformation of the male genitalia. The reconstructive objectives are to obtain voiding with laminar flow and satisfactory sexual function. Several urethroplasty techniques have been described, but for perineal or revisional cases no single technique has shown robust success. In this study, we describe the expanded use of intestinal flaps for urethral reconstruction and report a peculiar request from a patient to undergo peno-urethral separation after successful hypospadias repair with a free ileum flap. A 51-year-old male patient with perineal hypospadias underwent several urethral reconstructive procedures with poor outcomes. A free ileum flap was attempted as a substitute for the urethra. Following successful reconstruction, separation of the neo-urethra (ileum) from the penile body was performed to address the patient’s sexual expectations. A free ileum flap proved to be a reliable urethral substitute in perineal hypospadias reconstruction, with a successful outcome. The peno-urethral separation with the creation of an “accessory penis,” however peculiar, optimized the results in terms of both sexual and urinary function. Anatomical restoration of the urethra and patient-reported expectations are the key to successful hypospadias reconstructive procedures. Sexual function outcomes and the patient’s perception of success should not be underestimated, even when urinary function has been restored.

Keywords

Hypospadias - Ileum - Urethra - Penis


Publication History

Received: 11 June 2018

Accepted: 23 April 2019

Article published online:
28 March 2022

© 2019. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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