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Diphallia, or penile duplication, is a rare congenital urological malformation. It may be associated with other congenital malformations. The objective of present paper is to report the case of a two-year boy with ventral duplication of the penis associated with proximal hypospadias. The ventral penis was amputated, and Duckett urethroplasty was done. There were no reported postoperative complications in the follow-up.

Diphallia (penile duplication) is a rare congenital malformation with an incidence of about 1 per 5–6 million newborns. The severity of diphallia varies from a small accessory penile-like tissue to complete true penile duplication with other deformities, usually involving the urogenital, gastrointestinal, and musculoskeletal systems. Pseudodiphallia, as a rare kind of diphallia, is characterized by a small accessory penile-like tissue without a normal penile anatomy structure. A 5.5-year-old male child was brought to the pediatric surgery outpatient department by the parents with complaint of difficulty in retracting the prepucial foreskin and the presence of some growth near the glans. There were no other complaints in specific. Clinical examination revealed foreskin retractable with difficulty and small conical lump smaller than the original glans approximately size ~1 cm diameter at the base attached horizontally at the left side of the original glans at the coronal sulcus and visible incomplete clefting in between the 2 glans visible from the aerial view. After approval from anesthetist, the patient was operated under general anesthesia by excision of pseudodiphallia. Urethral catheterization and circumcision of the penis after taking informed parental consent. Postoperatively, the period was uneventful. The patient responded well to the symptomatic treatment and was orally allowed on the same day evening. Urinary catheter was removed on 5th postoperative day. The patient was discharged on oral symptomatic medication and was advice for follow-up. [ABSTRACT FROM AUTHOR]

Hana Abebe Gebreselassie, Binyam Gebremedihin Godu, Hiwote Girma Assefa, Maru Gama Erge St. Paul’s Hospital Millennium Medical College, Department of Surgery, Pediatrics Surgery Unit, Addis Ababa, EthiopiaCorrespondence: Hana Abebe Gebreselassie, St. Paul’s Hospital Millennium Medical College, Department of Surgery, Pediatrics Surgery Unit, Addis Ababa, Ethiopia, Tel +251 913 766 868, Email hanaabebe23@gmail.comBackground: Exstrophy variants are well described urologic anomalies. They are characterized by atypical anatomical and physical findings than those found in patients with classic bladder exstrophy and epispadias malformation. The combination of these anomalies with duplicated phallus is a rare occurrence. Here we present a neonate with a rare form of exstrophy variant associated with penile duplication.Case Summary: One day old male neonate who was born at term was admitted to our neonatal intensive care unit. He had lower abdominal wall defect and open bladder plate with no visible ureteric orifices. There were two completely separate phalluses with penopubic epispadias and urethral orifices draining urine. Both testes were descended. Abdominopelvic ultrasound showed normal upper urinary tract. He was prepared and operated with intra operative finding of complete bladder duplication in the sagittal plane and each bladder has its own ureter. The open bladder plate which had no connection with both ureters and urethras was excised. The pubic symphysis was approximated without osteotomy and abdominal wall was closed. He was immobilized with mummy wrap. He had uneventful post-operative course and was discharged on the 7th post-operative day. He was evaluated on the 3rd month post operatively and he was thriving well with no complications.Conclusion: The occurrence of a triplicated bladder along with diphallia is an exceptionally rare urologic anomaly. As a number of variations are possible in this spectrum, the management of neonates with this anomaly should be individualized.Keywords: bladder duplication, exstrophy variant, diphallia, duplicate exstrophy

Abstract Background Penile duplication or diphallia is a rare congenital anomaly with unclear pathophysiological cause. Most cases of diphallia are reported postnatally; however, today with the use of a high-resolution ultrasound device, in-uterine diagnosis of many congenital anomalies is possible. Case presentation Herein we report a multiparous mother at 25 weeks of gestation who referred due to an abnormal cystic structure protruding from a large abdominal wall defect located below the umbilicus that was noted during a routine exam. Target scan revealed two penile-like protrusions with an empty scrotal sac and double bladder in an otherwise normal fetus, which was confirmed postnatally. Neonatal microarray study and karyotype were normal. Conclusion Diphallia could be detected prenatally as an isolated anomaly, associated with caudal duplication syndrome, or as an exstrophy-epispadias complex. As this is a rare congenital anomaly, all sonographers should be familiar with prenatal ultrasound features and associated anomalies, an important issue in prenatal counseling with parents, delivery planning, psychological support of the family, and postnatal management.

Diphallia or penile duplication is a rare anomaly, with an estimated prevalence of 1 in every 5.5 million live births. It may present alone or associated with other penile or abdominal malformations, such as renal and anorectal anomalies. At the genetic level, defects in the homeobox genes may be involved. We report a case of a 4-year-old boy, born at term, with adequate for gestational age anthropometrics, after a medically supervised pregnancy with normal prenatal ultrasounds. He exhibited two completely developed and structurally normal penile glands with urinary emission from the ventral penis, a right gluteus hypertrophy with a left side deviation of the internal groove with a well-positioned anus. Follow-up exams confirmed the presence of two complete penises (complete diphalia), a normal sized single bladder connected with two urethras (only one of which was working), and no valves or vesicoureteral reflux. The 99mTc-DMSA scintigraphy showed two kidneys, with a left uptake of 94.41%. The karyotype was normal and no cytogenetic test was conducted yet at the parents’ request. During these 4 years no urinary infection was reported and normal kidney function was confirmed in the last analytical panel. He also exhibits a global developmental delay, mostly in the language area, and is currently not enrolled in kindergarten. The surgical approach consisted on the excision of the accessory penis (with no functional urethra) and was conducted without complications. We describe a rare case of a complex polymalformative syndrome, where early and appropriate diagnosis and treatment are a major challenge and depend on the commitment of a multidisciplinary team. One has to ensure normal urinary and reproductive functions, while balancing the psychological impact, as the child gets older and more aware of physical differences.

Background: Duplication of the penis or Diphallia is a rare abnormality of the urogenital tract present once in every 5–6 million live births with varied presentations and associated systemic anomalies. Case presentation: We present the anesthetic management of a neonate presenting with duplication of penis, urethra, and anorectal malformation. Conclusions: With this rare case, we aim to shed light on the various perioperative anesthetic concerns of such neonates presenting with surgical emergencies and their successful management. [ABSTRACT FROM AUTHOR]

Abstract 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.

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. [ABSTRACT FROM AUTHOR]

Diphallia or duplication of penis is extremely rare condition with a reported incidence of 1 in 5-6 million live births. Approximately around 100 cases of diphallia have been described in literature, each case have a unique presentation from associated anomalies. Clinically these patients can be classified into complete (true diphallia) or partial duplication. In true diphallia, each penis has 2 corpora cavernosa and 1 corpus spongiosum. If the duplicate penis is smaller or rudimentary with complete structure, it is described as true partial diphallia. The term bifid phallus is used if there is only one corpus cavernosum in each penis. Due to low incidence and varied presentation, not much is known about the underlying pathophysiology, management options, and outcomes. Here, we report a case of partial diphallia with associated penoscrotal transposition of 2 hemi-scrotums.

Background: Penile duplication or diphallia is a rare congenital anomaly with unclear pathophysiological cause. Most cases of diphallia are reported postnatally; however, today with the use of a high-resolution ultrasound device, in-uterine diagnosis of many congenital anomalies is possible.Case Presentation: Herein we report a multiparous mother at 25 weeks of gestation who referred due to an abnormal cystic structure protruding from a large abdominal wall defect located below the umbilicus that was noted during a routine exam. Target scan revealed two penile-like protrusions with an empty scrotal sac and double bladder in an otherwise normal fetus, which was confirmed postnatally. Neonatal microarray study and karyotype were normal.Conclusion: Diphallia could be detected prenatally as an isolated anomaly, associated with caudal duplication syndrome, or as an exstrophy-epispadias complex. As this is a rare congenital anomaly, all sonographers should be familiar with prenatal ultrasound features and associated anomalies, an important issue in prenatal counseling with parents, delivery planning, psychological support of the family, and postnatal management. [ABSTRACT FROM AUTHOR]

Penile duplication is a very rare urological entity. It may be associated with other congenital conditions such as urogenital, GI tract and musculoskeletal anomalies. Properly classifying the condition may dictate the final treatment options. Our current case is the complete true duplication in which we performed side-to-side urethra-urethral anastomosis. We spared the posterior urethra as it may end up with postoperative urinary incontinence.

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. [ABSTRACT FROM AUTHOR]

Diphallia is an extremely rare congenital anomaly. Bifid phallus is a type of diphallia and is rarely recorded in published studies. According to the degree of separation of the penises at the base of the shaft or just at the glans, bifid phallus is further classified into complete or partial forms. Bifid phallus is often associated with hypospadias or part of the exstrophy–epispadias complex. We are really lucky to have successfully treated a 2-year-old patient with penoscrotal hypospadias combined with partial bifid phallus in the shaft. After the surgery, the patient had no issues with penile function.

Diphallia is an exceedingly rare anomaly characterized by partial or complete duplication of the phallus. Approximately 100 cases have been reported worldwide since its initial documentation, and incidence is estimated at 1 in 5 to 6 million live births. Therapeutic management is dependent on the extent of the anomaly, ranging from phallic excision to complex reconstructive procedures in cases of broader systemic involvement. We present the case of congenital true diphallia with associated penoscrotal transposition, bifid scrotum, partial urethral duplication, ventral chordee, large scrotal lipoma and sacral dimple. We further present a review of available literature pertaining to diphallia. [ABSTRACT FROM AUTHOR]

Diphallia is an extremely rare embryological anomaly, occurring once in 5–6 million births. Here we discuss a neonate who was referred for surgical consultation of diphallia, in which examination revealed a dominant right phallus and apparently shorter left phallus. MRI and retrograde urethrogram revealed a unique pathway of the right urethra and a stenosed, but otherwise normal left urethra. The decision was made to excise the right phallus and associated urethra due to the correct anatomy of the left phallus and corresponding urethra.

Background: Diphallia is a very rare anomaly and seen once in every 5.5 million live births. True diphallia with normal penile structures is extremely rare. Surgical management for patients with complete penile duplication without any penile or urethral pathology is challenging. Case Report: A 4-year-old boy presented with diphallia. Initial physical examination revealed first physical examination revealed complete penile duplication, urine flow from both penises, meconium flow from right urethra, and anal atresia. Further evaluations showed double colon and rectum, double bladder, and large recto-vesical fistula. Two cavernous bodies and one spongious body were detected in each penile body. Surgical treatment plan consisted of right total penectomy and end-to-side urethra-urethrostomy. No postoperative complications and no voiding dysfunction were detected during the 18 months follow-up. Conclusion: Penile duplication is a rare anomaly, which presents differently in each patient. Because of this, the treatment should be individualized and end-to-side urethra-urethrostomy may be an alternative to removing posterior urethra. This approach eliminates the risk of damaging prostate gland and sphincter.

Diphallia or penile duplication is a rare congenital abnormality thought to result from duplication of the cloacal membrane in the early developmental stages in the uterus. The present case concerned a 4-year old intact male German shepherd dog. The patient presented with a complaint of paraphimosis. Clinical, laboratory, radiological and ultrasonographic examinations were carried out. Semen samples collected prior to surgery were examined. Following amputation, the penis with paraphimosis was sent for histopathological investigation. Karyotype analysis of the patient was also performed. As well as the first report of this abnormality in Turkey, this case report represents the first report of this condition in a German shepherd dog.

Complete diphallia, a rare urogenital congenital anomaly in which a male is born with two fully formed phalluses, occurs in one out of every five to six million live births. The condition is characterized by two separate phalluses, each of which comprise a pair of corpora cavernosa and one corpus spongiosum with an orthotopic urethra. Approximately 100 cases have been reported worldwide, and it is thought that each case is unique. This article discusses diphallia, urethral duplication, and bladder duplication and concludes with a case study involving a three‐year‐old male born to consanguineous parents from a small, remote community in Ecuador who underwent surgery for correction of a complete coronal penile and bladder duplication. After consultation, the patient was scheduled for a right penectomy and cystoplasty. [ABSTRACT FROM AUTHOR]

Diphallia is a rare congenital anomaly with the incidence of 1 in 5–6 million live births. We are reporting a case of complete diphallia associated with accessory scrotum and undescended testis in a 2-year-old boy. We did amputation of the left phallus, urethral end-to-side anastomosis between the spatulated end of proximal left penile urethra and side of proximal part of right penile urethra, excision of accessory scrotum, and left-sided orchidopexy. Avoiding dissection in the posterior urethra leads to an acceptable outcome.

• Supernumerary penises is an extremely rare congenital anomaly. • It affects one in every 5–6 million live births. • Each case has a unique presentation and no cases are identical. • Around 100 cases of diphallia are reported till now. • No cases of Triphallia is reported before. Supernumerary penises is an extremely rare congenital anomaly which affects one in every 5–6 million live births. Affected patients may have only a rudimentary penis, supernumerary penile glances or complete duplication or triplication of penises. Some patients may have some other associated congenital anomalies. A 3-month-old child presented because of left side hydrocele. There were evidence of two supernumerary penises in the perineum, the first one was about 2 cm in length with a glans and was attached to the root of the penis, and the third one was about 1 cm and was below the scrotum. Hydrocelectomy was performed. The two supernumerary penises were extending to perineal region and were attached to original penis, both had corpora cavernosum and spongiosum with no urethra inside. Both supernumerary penises were excised and both corpora were sutured with a fine slowly absorbable suture material. The patient was discharged with no postoperative events and follow up was done for one years with no reported adverse events. Triphallia (three penises) is unreported condition in human until now. Patients with supernumerary penises have unique presentation and no cases are identical. The position of the penis may be ectopic or orthotopic. Treatment is difficult because it poses medical, ethical, and cosmetic aspects. A combined multidisciplinary team is required for the management and long term follow up is required. Excision or reconstruction of the duplicate penis is required depending on the corporal development and anatomy of the urethra. [ABSTRACT FROM AUTHOR]

Background: Diphallia is a very rare anomaly and seen once in every 5.5 million live births. True diphallia with normal penile structures is extremely rare. Surgical management for patients with complete penile duplication without any penile or urethral pathology is challenging. Case Report: A 4-year-old boy presented with diphallia. Initial physical examination revealed first physical examination revealed complete penile duplication, urine flow from both penises, meconium flow from right urethra, and anal atresia. Further evaluations showed double colon and rectum, double bladder, and large recto-vesical fistula. Two cavernous bodies and one spongious body were detected in each penile body. Surgical treatment plan consisted of right total penectomy and end-to-side urethra-urethrostomy. No postoperative complications and no voiding dysfunction were detected during the 18 months follow-up. Conclusion: Penile duplication is a rare anomaly, which presents differently in each patient. Because of this, the treatment should be individualized and end-to-side urethra-urethrostomy may be an alternative to removing posterior urethra. This approach eliminates the risk of damaging prostate gland and sphincter. [ABSTRACT FROM AUTHOR]

Summary Background Diphallia is a very uncommon malformation, and glans duplication (GD) is its rarest form. In this last group, patients normally present with esthetic/sexual complaints or obstructed voiding late in life after pubertal genital development. Associated malformations are uncommon and relatively mild in those cases. Methods After a case presented, we present herein an extensive review of GD, as the disease is rare, and there is very little about its treatment and there are diverse approaches to address the condition. Results After an extensive review of the available literature, we carefully analyzed each published case to describe specific aspects of their clinical presentation (age, main complaint, voiding/urethral problems, and individual anatomy) and treatment. Conclusion This review allowed us to propose a new classification for diphallia into four groups (true diphallia, hemiphallus, pseudodiphallia, and partial duplication), considering embryological, anatomical, clinical, and therapeutic implications (see Fig. 1). Glans duplications present as esthetic/sexual cases or show abnormal voiding patterns caused by urethral associated abnormalities. Reconstructive techniques may be simple (resection of a hypoplastic accessory glans + urethra) or relatively complex (glans and/or urethral reconstruction). [ABSTRACT FROM AUTHOR]

Diphallia or penile duplication is a rare congenital abnormality thought to result from duplication of the cloacal membrane in the early developmental stages in the uterus. The present case concerned a 4-year old intact male German shepherd dog. The patient presented with a complaint of paraphimosis. Clinical, laboratory, radiological and ultrasonographic examinations were carried out. Semen samples collected prior to surgery were examined. Following amputation, the penis with paraphimosis was sent for histopathological investigation. Karyotype analysis of the patient was also performed. As well as the first report of this abnormality in Turkey,this case report represents the first report of this condition in a German shepherd dog. [ABSTRACT FROM AUTHOR]

Diphallia is extremely rare urological anomaly with reported incidence of 1 in 5–6 million live births. It can present as complete or incomplete diphallia. In most of the cases it is associated with complex urological, gastrointestinal or anorectal malformations. We report here case of a newborn who was presented to us at 1st day of life with diphallia and anorectal malformation. He had true diphallia with two separate uretheral orifices. Both phalluses were uncircumcised, phallus 1 was 2.5 cm in length while phallus 2 was 1.5 cm. Both phalluses had normal shaped glans with uretheral opening located at the normal place He had a single scrotum with two midline raphe and well-formed rouge. He was passing urine from both orifices. His ultrasonography of urological system showed two ureters and a single hemi bladder. He was admitted and operated upon and a sigmoid divided colostomy was constructed. Per-operatively congenital pouch colon (type 4) was identified. His post-operative recovery was uneventful. The patient was discharged on second post-operative day and called for follow up. Diphallia is a rare congenital anomaly, which means two structurally and anatomically separate phalluses. Complete Duplication in Diphallia presents the kind of Diphallia in which both the phalluses have two corpus cavernosum and only one corpus spongiosum. As diphallia presents with a spectrum of diseases; therefore, it requires a multidisciplinary approach. A case of Diphallia may well present with complex urogenital, gastrointestinal or anorectal malformations. As in our case the patient had Diphallia with anorectal malformation. Hence he was operated upon and a sigmoid colostomy was constructed. Diphallia is a very rare congenital anomaly which can occur in association with anorectal malformations. Management of such cases should be individualized depending upon the spectrum of disease. • Diphallia is extremely rare its incidence is 1 in 5–6 million live births • The incidence of Diphallia with anorectal malformation is less than 1 % • It either presents as complete or incomplete diphallia. • In most of the cases it is associated with complex urological, gastrointestinal or anorectal malformations. • Resection of the replicated penis along with staged reconstruction is the mainstay of the treatment [ABSTRACT FROM AUTHOR]

Diphallia is a rare anomaly. It has a range of appearances from a small accessory penile to complete duplication. We present a 2 year-old boy with complete penile duplication. The left penile was the largest. NMR (Nuclear Magnetic Resonance) suggested one corporal body for each penile and VCUG (Voiding Cystourethrogram) showed a normal urethra in the right penile and stricture at glandular and mid penile urethra of the left penis. A Y confluence to bulbar urethra was observed confirming only one prostate and bladder. The cystoscopy through the right penile identified the urethral confluence in the bulbar area. We performed a meatotomy in the left penile to insert the cystoscope and confirmed the blind ending urethra. We decided to remove this penile. The penile was degloved entirely and clamped and took out the corpora at the base. Diphallia can have three presentations: only glans duplication, bifid diphallia and complete diphallia (two corpora cavernosa and a corpus spongiosum for each penile). In our case, each penile presented only one corpora cavernosa and the decision taken was based on urethral patency. The treatment should always be planned individually whereas associated anomalies with the goal of attaining satisfactory functional and cosmetic results. [ABSTRACT FROM AUTHOR]

Background: Penile duplication (diphallus) is an extremely rare disorder. It is almost always associated with other malformations like double bladder, exstrophy of the cloacae, imperforate anus, duplication of the rectosigmoid and vertebral deformities. Meanwhile anal canal duplication, the most distal and least common duplication of the digestive tube and is a very rare congenital malformation. Case Presentation: A 21 days old Egyptian neonate is reported with complete penile duplication and two scrotums with each one carrying two palpable testes. Both penises have normal shaft with normally located meatus. Clear urine voids from both meati spontaneously. The child had also a fold of redundant skin about 4x5 cm at the anal region in which two separate anal openings are present. In rectal examination we found two normal anuses passing stool spontaneously. Ascending (voiding) cystourethrography revealed two penises with two separate meatuses and one bladder from which the two urethras go out separately. Intravenous pyelogram (JVP) revealed two normal kidneys and ureters. Barium study revealed duplication o rectum and colon, otherwise normal GIT. Conclusion: In our review of the literature, we did not come across any other case of this variety of the penile duplication and congenital presence of two anuses. Unfortunately the patient expired before any surgical correction. [ABSTRACT FROM AUTHOR]

Diphallia is a rare congenital anomaly with the incidence of 1 in 5-6 million live births. We are reporting a case of complete diphallia associated with accessory scrotum and undescended testis in a 2-year-old boy. We did amputation of the left phallus, urethral end-to-side anastomosis between the spatulated end of proximal left penile urethra and side of proximal part of right penile urethra, excision of accessory scrotum, and left-sided orchidopexy. Avoiding dissection in the posterior urethra leads to an acceptable outcome. [ABSTRACT FROM AUTHOR]