Phalloplasty: The dream and the reality

Area of Science:

• Reconstructive Surgery
• Microsurgery
• Urology

Background:

• Phalloplasty techniques have evolved significantly, transitioning from multistage tube pedicles to radial forearm flaps.
• Early innovations like prelamination and prefabrication for neo-urethras aimed to reduce complications but increased flap failure rates.
• Introduction of penile stiffeners, particularly artificial ones, presented challenges with infection and failure, necessitating careful timing of insertion.

Purpose of the Study:

• To review the evolution of phalloplasty techniques and flap choices.
• To highlight the advantages of the Anterolateral thigh flap in contemporary phalloplasty.
• To discuss complications associated with phalloplasty and penile stiffeners.

Main Methods:

• Review of historical and current phalloplasty techniques.
• Comparison of different flap options, including radial forearm and Anterolateral thigh flaps.
• Analysis of outcomes and complications related to neo-urethra creation and penile stiffeners.

Main Results:

• The Anterolateral thigh flap, particularly in its sensate pedicled form, is emerging as a preferred option over the radial forearm flap.
• This flap offers benefits such as a hidden donor site, reduced need for microsurgical expertise, and better tolerance for penile stiffeners.
• Aesthetic glans reconstruction is now feasible, enhancing patient satisfaction.

Conclusions:

• Modern phalloplasty increasingly utilizes the Anterolateral thigh flap for improved aesthetics and function.
• Key complications include flap failure, urethral issues (fistula, stricture), and problems related to penile stiffeners.
• Ongoing advancements aim to optimize reconstructive outcomes in phalloplasty.