Experience with Urogenital Reconstruction of Ischiopagus Conjoined Twins

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Abstract
Ischiopagus conjoined twins are joined at the lower chest or abdomen down to the pelvis. We review our experience with such patients at Children's Hospital of Philadelphia. Six sets of ischiopagus twins were separated and their treatment is discussed. In addition, reports on 36 sets of ischiopagus twins are reviewed. If a shared bladder is present, 1 twin retains it while the other receives a temporary urinary drainage system. Later, the twin without a bladder undergoes reconstruction to create a continent catheterizable pouch. When 4 kidneys are present the opposite ureter is reimplanted or crossed with transureteroureterostomy. Twins with 2 sets of genitalia can usually undergo separation and reconstruction appropriately. Occasionally single external genitalia are present and secondary reconstructive genitoplasty is required. Multiple staged genital reconstructions are required but with proper planning satisfactory outcomes will result.