A modification of the De Castro neophalloplasty: The continuous search for improvements.

INTRODUCTION

We want to present a 9 months old boy with congenital aphallia treated with the latest refinements and modifications in the technique, avoiding a full quadrangular lower abdominal flap but with some new design in the flap.

METHODS

Basically, the lower abdominal flap resembles two joined bottles with 3 triangular deflections in each side to produce a zetaplasty in the dorsal aspect of the neophallus and avoid ventral retractions. The new format flap design allows an easier and more aesthetical conformation of the glans, neomeatus at the tip of the neo glans and the zetaplasty to create the cylindrical phallus and promote a less tension dorsal suture.

DISCUSSION: We strongly believe that at this time, feminizing genitoplasty should be avoided and all efforts to construct a neophalloplasty at infancy should be done. We have already treated patients implanting a penile prosthesis after a De Castro and we have been able to confirm phallus growing with age. This new modification seems to improve aesthetic and functional results and has been used with success by the creator of the methods over the last few years.