Pediatric Surgery, Hospital CdC Petrucciani, Lecce, Italy.
J Pediatr Urol. 2013 Feb;9(1):108.e1-2. doi: 10.1016/j.jpurol.2012.09.001. Epub 2012 Nov 7.
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.
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.
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.
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.
对于阴茎发育不全的病例，两性畸形的新概念质疑了女性性别重置的策略。因此，我们展示了按照德卡斯特罗技术构建阴茎的视频，作为治疗这种破坏性疾病的替代方法。
选择了一名 12 岁的男孩，他患有先天性阴茎发育不全，尿道后端出现在直肠远端。采用 ASTRA 方法，从腹壁切取皮瓣，管状化形成阴茎外观。颊黏膜移植物被管状化以形成新的尿道。
即刻结果非常出色。仅出现了尿道背侧缝线部分裂开，术后 9 个月，患者开始通过阴囊尿道造口排尿。阴茎成形术提供了良好的男性外观和良好的美容效果。
该技术是一种可行的替代方法。分两期进行，先在后期构建新尿道，可能是一种避免观察到的尿道并发症的有趣选择。然而，需要进行长期随访以确认初始结果。
