Megalourethra is a rare spectrum of urologic malformations of penile corporal structures frequently associated with multiple congenital anomalies, such as prune belly syndrome or vertebral, anorectal, cardiac, trachea-esophageal, renal, and limb (VACTERL association) defects. A 6-year-old boy with VACTERL association and proximal urethral atresia with distal fusiform megalourethra underwent staged reconstruction, including appendicovesicostomy, perineal urethrostomy, and first-stage urethroplasty with a dorsal inlay free graft of megalourethra tissue to the proximal urethral atretic region, followed by second-stage urethroplasty. At 2.6 years of follow-up, he was continent, voids per urethra without postvoid residual urine volume, and no longer performs clean intermittent catheterization by way of the appendicovesicostomy. UROLOGY 78: 1417-1419, 2011. (C) 2011 Elsevier Inc.