A rare case of adult diphallus with anorectal malformation.

We present the case of a 24 year old man who presented with acute urinary retention and found to have diphallus with vertical duplication of penis. Superior phallus was well developed without any urethral meatus whereas inferior phallus was rudimentary but with patent urethra. History of erection was present in superior phallus only whereas patient was voiding urine from inferior phallus. It was associated with anorectal malformation and bilateral pelvic ectopic kidneys. Patient was managed by suprapubic catheter placement and planned for penile and urethral reconstructive surgery. Diphallus very rarely present in adulthood and vertical duplication is very unusual.

A 24–year-old male with history of anorectal malformation and cutback anoplasty presented with acute urinary retention. On examination, two phalluses were noticed lying between bifid scrotum. Anal opening was anteriorly placed [Figure 1]. Superior phallus was well developed with normal glans but without any urethral meatus. The inferior phallus was rudimentary with a narrow urethral meatus. There was history of voiding from the inferior phallus but erection in superior phallus only. Both testicles were normally located. Patient was managed by suprapubic catheter placement.

Figure 1

(a) Clinical photograph of patient showing two phallus, superior phallus at normal location and inferior phallus at the posterior end of bifid scrotum (b) Location of anus anterior to the anal dimple

On evaluation, ultrasound showed bilateral pelvic ectopic kidneys with hydroureteronephrosis. Urinary bladder and prostate were well developed. MRI abdomen and pelvis showed bifid corpora with one corpora opening in inferior phallus [Figure 2].

Figure 2

(a) Coronal image of magnetic resonance imaging (MRI) pelvis showing right pelvic kidney (red arrow) and two phalluses, thick arrow denotes superior phallus corpora and thin arrow denotes inferior phallus (b) Sagittal image of MRI showing divaricating corpora cavernosa from superior phallus

The condition of diphallus is rare, which occurs in about 1 in 5,000,000 live births.[1]

Vertical duplication of phallus is rarely seen. This anomaly may be due to a defect of fusion of the genital tubercle. It may have resulted from the failure of fusion of mesodermal bands or failure of mesoderm to surround two urethral anlage.[2]