Neophallus and Urethroplasty Revisions: Step-by-step Surgical Techniques and Key Reconstructive Maneuvers

Abstract

The aim of this video is to demonstrate step-by-step surgical techniques for neophallus and urethroplasty revisions, emphasizing key reconstructive maneuvers and improving patient outcomes. Neophallus and urethroplasty revisions can be challenging procedures associated with complications. We present a 25-year-old male with a history of ambiguous genitalia and micropenis due to 17-hydroxylase deficiency. The patient presented with bothersome penile skin redundancy at the base of the neophallus and a history of intermittent urinary incontinence, necessitating “milking the base of the neophallus” to completely evacuate his urethra. The patient also reported foul-smelling discharge with urine. Imaging evaluation, including retrograde urethrogram and voiding cystogram, revealed a smooth cystic dilatation of the posterior urethra with a normal bladder contour and capacity. Further evaluation with cystoscopy identified a Mullerian duct remnant in the urethra. We recommend surgical excision of the remnant and neophallus skin revision using intraoperative SPY Indocyanine green to carefully delineate the blood supply to the neophallus and mitigate potential risks and complications. This paper demonstrates step-by-step surgical techniques for neophallus and urethroplasty revisions, highlighting key surgical maneuvers such as using intraoperative SPY Indocyanine green to delineate blood supply, excision of the Mullerian duct cystic lesion, and urethroplasty. These techniques aim to improve patient outcomes by addressing penile skin redundancy and urinary incontinence while minimizing potential complications. As neophallus reconstruction becomes increasingly common, familiarity with surgical anatomy, complications management, and outcomes is essential. This video provides a valuable resource for surgical education and may aid in the improvement of patient outcomes.