Diphallus and associated anomalies with balanced autosomal chromosomal translocation

Diphallia: literature review and proposed surgical classification system

Background

Diphallia occurs once in 5–6 million births, with no two patients presenting with the same anatomical variation. Here we discuss a review of diphallia case reports, as well as present a new surgical classification system based on the soft tissue composition of the two phalluses, the anatomy of the urethra present within the most normal phallus and the bladder configuration.

Methods

Eighty‐seven diphallia case reports were collected and analysed, excluding those presented in animals and articles that were non‐English, with the results compiled to provide an in‐depth reference of the specific anatomy found in diphallia patients and the associated abnormalities.

Results

Our proposed classification system was then applied to each patient and the most common configuration base on our classification system presented, along with commonly seen associated anomalies.

Conclusion

The reviewed cases represent a subset of the most unique diphallia patients; thus, several cases may be left unreported. Future reports can then be categorized, aiding as a reference, and potentially building on the classification, should the patient not fit into a specific group, leading to an expansion of the classification system.

Complete diphallia associated with unusual multiple congenital anomalies: case report and review of literatures

Background

Diphallus (duplication of phallus) is rarely encountered in surgical practice with only 100 cases reported in literature. Some cases may be isolated but mostly associated with other anomalies, without clear data about its etiology.

Case presentation

We reported a 1-day-old newborn baby who was presented with complete duplication of the phallus, one of them being hypospadic associated with a high type imperforate anus, omphalocele, congenital pouch colon, sacral meningocele, and other congenital anomalies not reported before in such combinations.

Multiple stages surgical corrective procedures were performed over a period of 4 years with 4–6 months interval between each stage, starting with the management of omphalocele and colostomy, ended by excision of the abnormal phallus with abdominoplasty and closure of colostomy.

The outcome was evaluated, and literatures were reviewed in relation to types, presentations, and options for surgical correction with optimal outcomes.

Conclusion

A combination of diphallia and other abnormalities in our patient are not reported previously in such manner and were very difficult to be corrected.

Only expert pediatric surgeons should treat such conditions as every case is unique in nature. In all conditions, the abnormal phallus should be excised, and the final aim is to achieve a continent child with cosmetically acceptable genitalia.

Pseudodiphallia: a rare kind of diphallia: A case report and literature review

RATIONALE

Pseudodiphallia, as a rare kind of diphallia, which is characterized by a small accessory penile-like tissue without a normal penile anatomy structure. Only a few cases have been reported. Here, we report a case of pseudodiphallia with phimosis and bilateral extrarenal pelvis.

PATIENT CONCERNS

A 23-year-old male visited our hospital with a complaint of external genitalia malformation. Physical examination revealed a normal-sized penis with phimosis, and an extra half glans horizontally attached to the right side of the normal glans penis is visible after completely retracting the foreskin. The CT urography showed a bilateral extrarenal pelvis, and no other abnormalities were found in the kidneys, ureter, bladder, and vertebral bodies.

DIAGNOSIS

Based on the physical examination and the CT urography results, the 23-year-old male was diagnosed with Pseudodiphallia.

INTERVENTION

Excessive penile tissue was resected, and a foreskin circumcision operation was performed under general anesthesia.

OUTCOMES

The patient recovered smoothly without complications (no infection, hematoma, or wound dehiscence) after surgery. At 6 months follow-up, the patient was content with the external genitalia's appearance, and the urination and erectile function were normal.

LESSONS

Pseudodiphallia is a rare kind of diphallia, and this is the first report on pseudodiphallia with a bilateral extrarenal pelvis. CT urography can be used to assess the associated internal anomalies before surgery.

A Rare Case of Human Diphallia Associated with Hypospadias

Diphallia or penile duplication is a rare congenital variant with an estimated frequency of 1 per 5 to 6 million live births. The extent of duplication varies widely and typically occurs with other malformations including urogenital, gastrointestinal, and musculoskeletal anomalies. Here we present a case of human diphallia that was detected during routine dissection of an 84-year-old cadaver. Upon thorough examination, this case was characterized as a complete bifid penis which was accompanied by hypospadias with no other anatomical abnormalities detected. To gain insights into the etiology of this case, we analyzed DNA procured from the body for putative genetic variants using Next Generation Sequencing (NGS) technology. Our results support clinical observations consistent with human diphallia being a polygenic syndrome and identify new genetic variants that might underlie its etiology.

Surgical management of complete penile duplication accompanied by multiple anomalies

Diphallus (penile duplication) is very rare and seen once every 5.5 million births. It can be isolated, but is usually accompanied by other congenital anomalies. Previous studies have reported many concurrent anomalies, such as bladder extrophy, cloacal extrophy, duplicated bladder, scrotal abnormalities, hypospadias, separated symphysis pubis, intestinal anomalies and imperforate anus; no penile duplication case accompanied by omphalocele has been reported. We present the surgical management of a patient with multiple anomalies, including complete penile duplication, hypo-gastric omphalocele and extrophic rectal duplication.

Diphallus with anorectal malformation-case report

Diphallus is a very rare condition. We report a case of a newborn with absent anal opening and duplication of external genitalia. Examination of the external genitalia showed two well formed penises with fully descended testis within each of the separate hemiscrotums along with soft tissue mass resembling accessory buttock behind the hemiscrotum. Staged reconstruction of duplicated genitalia and anorectal malformation was done. We achieved excellent cosmetic and functional external genitalia.

Multiple-stage correction of caudal duplication syndrome: a case report

Caudal duplication syndrome is a very rare congenital deformity. A 13-year-old boy was born with duplicated colon-rectum and anus, diphallus, hydronephrosis of left kidney with megaureter, double bladders and urethras, and vertebral abnormalities. Multiple-stage correction was performed to remove the duplicated colon and the mucosa of the duplicated rectum. A new colon was reconstructed. The left kidney and megaureter were excised. The septum in the bladders was removed to convert the double bladders into a single bladder. The double phalluses were fused into a single penis. After these staged procedures, the boy is now living a normal life.

Triplication of colon with diphallus and complete duplication of bladder and urethra

Gastrointestinal duplications are a common type of congenital anomaly usually restricted to one part of the gut. Triplication of colon is a rare variation of duplication of the hindgut. Hindgut duplications are commonly associated with anomalies of other derivatives of the cloaca, namely, the lower genitourinary system. Here, we describe a child with triplication of colon with associated duplication of bladder and urethra and diphallus. The child described here is the only reported survivor with triplication.

Hydrocephaly, penoscrotal transposition, and digital anomalies associated with de novo pseudodicentric rearranged chromosome 13 characterized by classical cytogenetic methods and mBAND analysis

We report on a patient with hydrocephaly, penoscrotal transposition, oligodactyly, and minor anomalies. Comprehensive cytogenetic studies involving both classical cytogenetic methods and mBAND analysis were used to show a stable dicentric rearranged chromosome 13 that result in a 46,XY,psu dic(13;13)(13pter --> 13q32::13q11 --> 13pter) de novo karyotype. This aberration probably arose as a consequence of unequal sister chromatid breakage repair events. This report is the first to describe all of the most severe features associated with partial monosomy in one patient. Moreover, the delineation of monosomy 13q32 --> qter in this patient facilitates identification of the developmental genes responsible for the clinical features within this region of chromosome 13.

Benign symmetric lipomatosis with myelomeningocele in an adolescent: An uncommon association-case report

The authors report an unusual localization of symmetric adipose tumors associated with spinal dysraphism. Initially, the patient underwent a closure of the lumbosacral myelomeningocele. At that time, the tumors were not evident and remained undiscovered up until puberty. However, during puberty, the symmetric lipomatous masses grew at the perineal region. Except the patient's age, all findings and the clinical picture supported the diagnosis of a benign symmetric lipomatosis (BSL). To the authors' knowledge, the following case has not been described previously.

Incomplete diphallus: correction in one stage

We report a patient with an anorectal malformation and an abnormal penis with an isolated prepuce, double glans, and two corpora cavernosa. A right main urethra opened into the bladder neck; the right meatus was hypospadiac. The proximal end of the left accessory urethra opened into the right prostatic urethra and the left meatus was orthotopic. Severe chordee and normal urinary flow through both meatuses were present. At the age of 4 years, the diphallus was corrected. Both corpora cavernosa were dissected and the urethra was reconstructed, lengthening the right urethra with a 2.5-cm fragment of left urethra as a free graft excised from the emergence point and joined to the main urethra pasteriorly. The right urethra, whose meatus was hypospadiac and lateral, was dissected until a medial course was obtained. The glans was reconstructed using the lateral aspect of each glans; both medial aspects were extirpated. To correct the urethral trajectory, the urethra was fixed to the tip of the glans. A penis with two corpora cavernosa, a single glans, and a complete urethra with a meatus at the tip of the glans was obtained. The prepuce was reconstructed from the dorsal redundant aspect. The postoperative course was satisfactory.