Revision Phalloplasty: Evaluation, Algorithms, and Techniques for Salvage after Major Complications

Area of Science:

• Reconstructive surgery
• Microsurgery
• Urology

Background:

• Phalloplasty is a complex procedure with a growing number of surgeons performing it.
• An increasing number of patients are experiencing major phalloplasty complications.
• Limited data exist on managing multiple, severe post-surgical issues, including flap salvage versus redo procedures.

Purpose of the Study:

• To analyze critical factors in managing severe phalloplasty complications.
• To develop algorithms for secondary revision of the neophallus.
• To provide guidance for surgeons treating complex post-phalloplasty issues.

Main Methods:

• Literature review on phalloplasty complications.
• Analysis of experience from two high-volume phalloplasty teams.
• Development of algorithms for secondary revision.

Main Results:

• Common complications include urethral strictures/fistulas, diverticula, bulk, malposition, scarring, and flap loss.
• Severe cases may necessitate local flaps, free flaps, or complete redo phalloplasty.
• Multidisciplinary collaboration is crucial for comprehensive management plans.

Conclusions:

• Preserving the original flap is preferred when possible.
• Additional flaps or complete redo phalloplasty may be required for significant tissue loss or severe complications.
• Proposed algorithms offer a framework for analyzing and managing severe phalloplasty complications.