Neourethra Creation in Gender Phalloplasty: Differences in Techniques and Staging

Area of Science:

• Urology
• Plastic Surgery
• Gender-Affirming Care

Background:

• Phalloplasty aims to create a sensate, aesthetic, and functional phallus for transgender individuals.
• Neourethra reconstruction presents significant challenges and high complication rates in phalloplasty.
• Surgical approaches vary widely in technique and staging among different providers.

Purpose of the Study:

• To provide an overview of principles and technical details for penile and bulbar urethra creation during phalloplasty.
• To discuss three common phalloplasty strategies: single-stage, two-stage (metoidioplasty-first), and two-stage (phalloplasty-first/Big Ben method).
• To present various options with their respective advantages and disadvantages, rather than advocating for a single "best" method.

Main Methods:

• Expert opinion article synthesizing current knowledge and techniques.
• Detailed explanation of surgical principles for neourethra construction.
• Focus on three distinct phalloplasty approaches: single-stage, metoidioplasty-first staged, and phalloplasty-first staged.

Main Results:

• Neourethra reconstruction is the most complex aspect of phalloplasty, with diverse techniques.
• Single-stage phalloplasty with full-length urethroplasty is one approach.
• Staged phalloplasty, separating perineal masculinization from phallus reconstruction, is another viable strategy.

Conclusions:

• Phalloplasty for transgender men involves high complication rates, particularly with neourethra reconstruction.
• Surgeons should select phalloplasty variations suited to their setting and expertise.
• This review compiles different phalloplasty strategies to inform surgical decision-making.