Bengaluru : Rare and complex multiple surgeries were successfully performed on a 12-year-old Nigerian boy who lost his external genitalia in a road accident six years ago. He was a victim of multiple body injuries and had undergone amputation of his entire penis and right testes, owing to the major accident. Since then he has been unable to pass urine normally and has been living with a catheter. He was even going to school with the plastic bag hanging down all the time. A multi-disciplinary team of doctors, comprising of Pediatrician, Endocrinologist, Plastic Surgeon, Surgical Gastroenterologist and Pediatric Intensive Care Unit Team, led by Dr Mohan Keshavamurthy, Director – Urology, Uro-Oncology, Uro-gynecology, Andrology, Transplant & Robotic Surgery at Fortis Hospitals, Bangalore & Chairman – Renal Sciences Specialty Council at Fortis Hospitals, India successfully reconstructed his genital organs. The patient was discharged post 10 days of the surgery. 

When presented at Fortis Bannerghatta, the boy was on a urethral catheter, had a weak bladder with less urine holding capacity which resulted in incontinence between routine catheterizations. He also had a history of two hemorrhages from damaged femoral blood vessels (blood vessels supplying blood to lower body).  While the doctors at his hometown managed the hemorrhages non-operatively, they could not conduct surgical reconstruction of the external genitalia, due to unavailability of the medical facilities/medical infrastructure, post which he was referred to Fortis Bannerghatta Road. Once the necessary medical assessments were conducted, the team of doctors decided to perform the surgery in 3 stages – Stage1 (Cystoscopy and Robot-Assisted Laparoscopic Ileal Augmentation of Bladder), Stage 2 (Complete Penile reconstruction) and Stage 3 (Urethral reconstruction). Stage 3 could be carried out only post 6 months of completion of stage 1 and 2. 

 Elaborating on the rare procedure, Dr. Mohan Keshavamurthy, Director – Urology, Uro-Oncology, Uro-Gynaecology, Andrology, Transplant & Robotic Surgery at Fortis Hospitals, Bangalore & Chairman – Renal Sciences Specialty Council at Fortis Hospitals, India said, “This was a very complex and rare surgery. We had to do a Cystoscopy (a procedure to look inside the bladder using a thin camera) followed by a Robot-Assisted Laparoscopic Ileal Augmentation of Bladder wherein the bladder is enlarged using a section of small intestine under general anesthesia to protect the upper urinary tract and re-establish continence. The patient was then moved to the Paediatric Intensive Care Unit for observation. Post successful completion of the first stage, hormonal replacement procedure was done. 

The second stage – penile reconstruction was carried out using superficial circumflex iliac island skin flap wherein a thin skin flap was harvested from the groin and penile prosthesis with a cylinder inside the flap to assist in sexual intercourse once the child becomes an adult.” 

The boy’s urethral catheter was removed after the reconstructive surgery. He is currently doing well and has returned to his country. He will be coming back after 6 months for the third stage of surgery. 

Mr. Akshay Oleti, Fortis Hospitals, Bangalore said, “Fortis Hospital Bannerghatta Road is known for handling complex cases. This was a critical and unique case which came to us, the team here after necessary assessments, devised a proper approach for a two-stage surgery and successfully carried it out. Fortis Hospital has always been on the forefront of offering the very best in the medical field backed by the latest medical technology, medical infrastructure and skilled clinicians.”