Foreskin transplantation between monozygotic twins discordant for hypospadias

This is a case report of monozygotic twins discordant for hypospadias, where the afflicted twin, a 33-year-old male, needed extensive redo urethral reconstruction. A two-stage reconstruction was planned by using the twin brother's prepuce. The scarred urethra was replaced by the isograft, and one year later the second stage was completed. At five-year follow-up, there was good cosmesis, and the index patient reported excellent voiding and no fistulae or stenosis. Despite its rarity, foreskin transplantation between discordant monozygotic twins is possible and offers a unique and durable management opportunity.