Phalloplasty: techniques and outcomes

Aaron L Heston, Nick O Esmonde, Daniel D Dugi 3rd, Jens Urs Berli, Aaron L Heston, Nick O Esmonde, Daniel D Dugi 3rd, Jens Urs Berli

Abstract

Phalloplasty is an exceptionally complicated reconstructive procedure that attempts to create a structure that is penis-like. As patient goals vary widely, it is helpful to think about phalloplasty as a modular set of procedures that can be combined, mixed and matched to meet the needs of each individual patient while also taking into account their anatomy. Each module-but particularly the shaft and penile urethra-can be performed using a variety of techniques. To date, there is no consensus among surgeons regarding the optimum staging of the reconstructive steps. Our primary goal is to outline the most frequently performed and reported options in phallic reconstruction and outline the various considerations that go into choosing a given sequence of procedures for the specific patient. The secondary goal of this article is to describe the complications common to each of those modules and how they interact when combined.

Keywords: Phalloplasty; gender confirmation surgery (GCS); penis/surgery; reconstructive surgical methods; review; surgical flaps.

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Illustration of various flap designs used for phalloplasty. Illustration copyright Jourdan Carboy/Jens Berli.
Figure 2
Figure 2
Examples of shaft only phalloplasty. (A) Shaft only phalloplasty without perineal surgery in an elderly trans male; (B) shaft only phalloplasty using a radial forearm flap and creation of perineal urostomy as well as scrotoplasty; (C) shaft only phalloplasty using a pedicled anterolateral thigh flap and creation of scrotum with retention of vaginal canal. Clitoral frenulum has been transected and moved inferiorly to create a superior vulvar commissure; (D) shaft only phalloplasty in a patient with previous metoidioplasty using an abdominal flap.
Figure 3
Figure 3
Composite phalloplasty using a free ulnar forearm flap for urethral creation and a pedicled anterolateral thigh flap for shaft creation.
Figure 4
Figure 4
Radial forearm free flap phalloplasty using a tube within a tube flap design.
Figure 5
Figure 5
Second stage perineal masculinization with a pedicled ALT flap phallus. ALT, anterolateral-thigh.
Figure 6
Figure 6
Partial flap loss in a radial forearm free flap. Debridement and placement of Integra followed by full thickness skingraft. Below picture is at 1 year follow up. Patient has since had successful glansplasty.
Figure 7
Figure 7
Retrograde urethrogram examples. (A) Retrograde urethrogram at 4 weeks after urethroplasty showing a patient with fistula; (B) retrograde urethrogram at 4 weeks after urethroplasty showing a patient with stricture.

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Source: PubMed

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