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Phalloplasty in biological men with penile insufficiency
Céline Sinatti1, Dylan Wolff2, Marlon Buncamper3
1PhD Student for the Department of Urology, Ghent University Hopsital, Supported by the Gianni Eggermont fonds, Belgium.
Introduction:
Phalloplasty for penile insufficiency in biological men differs from trans-men by incorporating native tissue. The study objective was to report surgical and functional outcomes of phalloplasty in biological men.
Patients & Methods:
Phalloplasty was performed with a radial free forearm (RFFA) or pedicled anterolateral thigh (ALT) flap. The tube-within-tube technique was used for urethroplasty. Complications <30 d postoperative were categorized according to Clavien-Dindo.
Results:
30 patients, median (IQR) age of 21 (18-30)y, were included. 17 patients (57%) had penile insufficiency due to exstrophy or hypospadias surgeries, 7 patients (23%) due to sexual development disorders. In 16 patients RFFA was used. 19 patients needed urethroplasty, the rest catheterized through stoma. Median follow-up was 33 (14-80)mo. Within 30 d postoperative, 1 patients (3.3%) had Clavien-Dindo II and 6 patients (20%) Clavien-Dindo III complications. On long-term, 10 patients (33%) developed fistula, 6 needing urethroplasty. 7 patients (23%) had urethral strictures, all needing surgical intervention. All patients but one (98%) had erogenous sensitivity in the neo-phallus. All urethroplasty patients reported antegrade ejaculation. 16 patients (84%) voided through the urethra. 21 patients (70%) had an erectile device implanted.
Conclusion:
RFFA and ALT result in good erogenous sensitivity but fistulas and strictures are frequent.
