Sexual and urological reconstruction following penectomy for penile cancer: phalloplasty

Phalloplasty following penectomy for penile cancer presents a complex reconstructive challenge, requiring restoration of urinary and sexual function while addressing anatomical and psychological sequelae. Unlike gender-affirming phalloplasty, this procedure is complicated by previous surgery and potential anatomical deficits. However, limited data exist to guide reconstruction in this cohort. This narrative review summarises available evidence on phalloplasty post-penectomy. A systematic search identified six relevant studies, including 48 patients, with follow-up ranging from 1 to 150 months. The radial artery free flap (RAP) and anterolateral thigh flap (ALTP) are the preferred techniques, each with distinct advantages and limitations. While RAP offers superior tactile recovery, ALTP reduces donor site morbidity. Complication rates are high, particularly urethral strictures and fistulae, affecting up to 64.3% of cases. Despite these risks, functional outcomes, including standing micturition and sexual activity, are achievable and patient satisfaction remains high. Challenges include extrapolating data from transgender cohorts and managing psychosocial concerns. A multidisciplinary approach is essential for optimising patient selection, counselling, and long-term outcomes. Further research is needed to refine surgical techniques, improve complication management, and explore innovative reconstructive strategies.