Pentaphalia: a case report

Abstract

Introduction

Supernumerary penis is an exceedingly rare congenital malformation, with an incidence of approximately 1 in 5–6 million births. It is usually associated with other congenital anomalies.

Case presentation

A male infant was noted to have abnormal genital at birth, in the for of five penises. Physical examination revealed five distinct penile-like structures of varying sizes. Three of them exhibited a normal glans penis, while the other two were underdeveloped. All structures were covered by preputial skin. Only one of them had a normally located and functional urethra, while the others had blind ending pits at their ends. There was additionally a soft tissue mass in the perineum next to the scrotum, and right testis was undescended and palpable in the inguinal are. Ultrasound and computerized tomography scan (CT) studies showed a cystic abdominal mass, which eventually was confirmed to be a colonic duplication, right renal agenesis, and a lumbosacral spina bifida occulta. The patient was taken to the operating room at the age of 8 months for a perineal reconstruction. All the non-functioning penises were excised, and a urethral catheter was left in the urethra of the functioning penis. Additionally, he underwent resection of the colonic duplication and a right orchiopexy. He was discharged on the third postoperative day. The urethral catheter was removed seven days after the operation. At nine months of follow up he has not had urinary infections or signs of a urethral stricture. All wounds have healed well.

Conclusion

Patients with supernumerary penises should be thoroughly evaluated for additional congenital anomalies. Ideally, a complete evaluation of the urinary system should be done prior to attempting a definitive reconstruction.