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Phalloplasty Journal Articles


General Phalloplasty

Mystery and realities of phalloplasty: a systematic review. [FULL TEXT]
Sarikaya S, Ralph DJ. Turk J Urol. 2017 Sep, epub 2017 Aug 3.
This comprehensive review of literature regarding phalloplasty and penile reconstructive surgery between January 2008 and May 2016 includes 191 FTM transgender patients and concluded that phalloplasty is a reliable and useful operation with good functional and aesthetical results.

An overview of female-to-male gender-confirming surgery
Morrison SD, Chen ML, Crane CN. Nat Rev Urol. 2017 May 16.
Phalloplasty, with a resultant aesthetic and sensate phallus along with implantable prosthetic, can take upwards of a year to accomplish, and is associated with a considerable risk of complications. Urethral complications are most frequent, and can be addressed with revision procedures. A number of scaffolds, implants, and prostheses are now in development to improve outcomes in FtM patients

Gender Confirmation Surgery: Guiding Principles
Schechter LS, D'Arpa S, Cohen MN, Kocjancic E, Claes KEY, Monstrey S. J Sex Med. 2017 May 03
At this time, no formal training or educational programs exist for surgeons or surgery residents interested in performing gender confirmation surgeries. This article represents the first step in the formation of educational and technical guidelines for training surgeons in gender confirmation procedures.

Phalloplasty: Microsurgical options and management algorithm
Boucher F, Brosset S, Mojallal AA, Braye F, Chateau J, Morel Journel N. Ann Chir Plast Esthet. 2017 Apr 26
The free radial forearm flap is considered as the gold standard in penile reconstruction for good functional and aesthetic results. The scar on donor site could be considered as pathognomonic of their situation by transsexual patients. The development of microsurgical flaps provides new therapeutic options. In case of non-feasibility of this flap, phalloplasty with pedicle ALT flap or free MSLD flap will be proposed. Microsurgical phalloplasty options are not limited to the forearm flap. Satisfactory results can be obtained using alternative procedure. The use of a therapeutic algorithm allows to choose the most optimal solution for each patient.

Free Flap Phalloplasty For Female To Male Gender Dysphoria
Garaffa G, Ralph DJ. J Sex Med. 2016 Dec.

Phalloplasty and Urethral (Re)construction: A Chronological Timeline [FULL TEXT]
Samuel Golpanian, Kenneth A Guler, Ling Tao, Priscila G Sanchez, Klara Sputova and Christopher J Salgado. Anaplastology 5:159. (September 2016)
In this article we present the methods of phalloplasty and urethral (re)construction that have been developed in chronological order, starting from the initial reports in the literature to the most recent and commonly used techniques.

Phalloplasty: A Review of Techniques and Outcomes.
Morrison SD, Shakir A, Vyas KS, Kirby J, Crane CN, Lee GK. Plast Reconstr Surg. 2016 Sep;138(3):594-615.
Because of the complexity of phalloplasty, there is not an ideal technique for every patient. This review sets out to identify and critically appraise the current literature on phalloplasty techniques and outcomes. Phalloplasty techniques are evolving to include a number of different flaps, and most techniques have high reported satisfaction rates. Penile replantation and transplantation are also options for amputation or loss of phallus. Further studies are required to better compare different techniques to more robustly establish best practices. However, based on these studies, it appears that phalloplasty is highly efficacious and beneficial to patients.

Difference In Outcomes After Total Phallic Reconstruction In the Transgender and Non-Transgender Population
Oscar Suarez Fernandez De Lara, Jack M. Zuckerman, Ramon Virasoro, Jeremy Tonkin, Jessica Delong, Kurt A. McCammon. The Journal of Urology , Volume 195 , Issue 4 , e790 (April 2016)
Researchers from Norfolk, Virginia set out to compare total phallic reconstruction outcomes, for both transgender (TG) and non-transgender (NTG) individuals, via data analysis of those who underwent total phallic reconstruction (at their institution) between the years of 1983 to 2015. Based on indication of surgery, 47 percent of the nearly 100 who underwent the procedure were assigned as transgender and 53 percent were assigned as non-transgender. Additionally, most opted for a procedure known as the "forearm free flap;" however, three selected a local pedicled flap.

Transgender Surgery in Denmark From 1994 to 2015: 20-Year Follow-Up Study.
Aydin D, Buk LJ, Partoft S, Bonde C, Thomsen MV, Tos T. J Sex Med. 2016 Feb 24.
The first nationwide single-center review on transsexual patients in Denmark undergoing gender-confirming surgery performed by a single surgical team and to assess whether age at time of gender-confirming surgery decreased during a 20-year period.

Pre- and Post-operative Care With Associated Intra-operative Techniques for Phalloplasty in Female-to-male Patients
Shane D. Morrison, MD, MS; Marcelina G. Perez; Cayden K. Carter; Curtis N. Crane, MD. Urol Nurs. 2015;35(3):134-138.
The most common techniques for phalloplasty, along with the pre-operative and post-operative care are discussed.

Postoperative Imaging of Phalloplasties and Their Complications
Blaschke E, Bales GT, Thomas S. AJR Am J Roentgenol. 2014 Aug;203(2):323-328.
A review of imaging techniques used in postoperative evaluation of the neophallus and and complications associated with phalloplasty.

Overall satisfaction, sexual function, and the durability of neophallus dimensions following staged female to male genital gender confirming surgery: the Institute of Urology, London U.K. experience
Maurice M. Garcia, Nim A. Christopher, Francesco De Luca, Marco Spilotros, David J. Ralph. Translational Andrology and Urology, Vol 3, No 2 (June 2014), doi: 10.3978/j.issn.2223-4683.2014.04.10.
Assessment of patient satisfaction, regret, pre/post-op sexual function, genital preferences, and genital measurements post-op. Overall, FTM Phalloplasty is associated with exceedingly high overall satisfaction and, in this series, without any overall regret.

Sexual Desire in Trans Persons: Associations with Sex Reassignment Treatment.
Wierckx K, Elaut E, Van Hoorde B, Heylens G, De Cuypere G, Monstrey S, Weyers S, Hoebeke P, T'sjoen G. J Sex Med. 2013 Oct 24. doi: 10.1111/jsm.12365.

Phalloplasty: The Dream and the Reality
Mamoon Rashid, Muhammad Sarmad Tamimy. Indian Journal of Plastic Surgery, 46:2, 283-293, Sept 21 2013.
Review of the various methods used for phalloplasty, including common complications and how they can be avoided.

Penile Reconstruction [Full PDF]
Christopher J Salgado, Sarah Eidelson, Rachael Madalon and Zhongyi Sun (Oct 2012) Anaplastology 1:e105.

Quality of Life and Sexual Health after Sex Reassignment Surgery in Transsexual Men [Full Text PDF]
Katrien Wierckx, Eva Van Caenegem, Els Elaut, David Dedecker, Fleur Van de Peer, Kaatje Toye, Steven Weyers MD, Piet Hoebeke MD, Stan Monstrey MD, Griet De Cuypere MD, Guy T'Sjoen MD .The Journal of Sexual Medicine, Volume 8, Issue 12, pages 3379–3388, December 2011

Is It Worth It? What Trans Healthcare Providers Should Know About Phalloplasty [PDF]
Adams, N.; & Grenier, F. (2011, September). Poster session presented at the 2012 Canadian Professional Association for Transgender Health conference, Winnipeg, Manitoba. Retrieved from

Sex Reassignment Surgery in the Female-to-Male Transsexual
Stan J. Monstrey, M.D., Ph.D., Peter Ceulemans, M.D., and Piet Hoebeke, M.D., Ph.D. Semin Plast Surg. 2011 August; 25(3): 229–244.

Bioengineered corporal tissue for structural and functional restoration of the penis
Kuo-Liang Chen, Daniel Eberli, James J. Yoo, and Anthony Atala (Proceedings of the National Academy of Sciences, Vol. 106 No. 45, November 9, 2009)

Evaluation of surgical procedures for sex reassignment: a systematic review
P.A. Sutcliffe, S. Dixon, R.L. Akehurst, A. Wilkinson, A. Shippam, S. White, R. Richards, C.M. Caddy (Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 62, Issue 3 , Pages 294-306, March 2009)

Phalloplasty: a valuable treatment for males with penile insufficiency.
Lumen N, Monstrey S, Selvaggi G, Ceulemans P, De Cuypere G, Van Laecke E, Hoebeke P. Urology. 2008 Feb;71(2):272-6.

Gender Identity Disorders: Diagnostic and Surgical Aspects
Michael Sohn, and Hartmut Bosinski, MD (Journal of Sexual Medicine, Volume 4 Issue 5, Aug 2007)

Genital sensitivity after sex reassignment surgery in transsexual patients.
Selvaggi G, Monstrey S, Ceulemans P, T'Sjoen G, De Cuypere G, Hoebeke P. Ann Plast Surg. 2007 Apr;58(4):427-33.
To obtain a good tactile sensitivity in the reconstructed phallus, we believe that the coaptation of the cutaneous nerves of the flap with the ilioinguinalis nerve and with one of the 2 nerves of the clitoris is essential in obtaining this result. To obtain orgasm after phalloplasty, we believe that preservation of the clitoris beneath the reconstructed phallus and some preservation of the clitoris hood are essential.

Severe Penile Injuries: Etiology, Management and Outcomes
Sava V. Perovic, Urologia Polska (Polish Journal of Urology) 2005/58/3, ISSN 0500-7208.

Gender Reassigment - Dan Greenwald and Wayne Stadelmann (eMedicine Journal, Volume 2 Number 7, July 6, 2001)

Peniplastica Totalis to Reassignment Surgery of the External Genitalia in Female-to-Male Transsexuals.
Hage, J. Joris. 1992. ISBN 9053831150

Free Radial Forearm Flap Phalloplasty

MatriDerm Decreases Donor Site Morbidity After Radial Forearm Free Flap Harvest in Transgender Surgery.
Watfa W, di Summa PG, Meuli J, Raffoul W, Bauquis O. J Sex Med. 2017 Aug 23.
This study compares two methods of donor site closure for functional and cosmetic long-term results: full-thickness skin grafting vs split-thickness skin grafting with MatriDerm. Pressure perception values showed better sensory return in the MatriDerm group. Split-thickness skin grafting with MatriDerm achieved superior results in skin sensibility, superficial radial nerve recovery, and cosmetic aspect. Our experience showed that the combination of a split-thickness skin graft with MatriDerm substantially decreases postoperative complications at the donor site defect on the forearm of transgender patients.

fMRI after Phalloplasty with Nerve Anastomosis in a Trans-Man Patient [FULL TEXT]
Doria-Medina R, Carlsson Å, Jönsson EH, et al. Plastic and Reconstructive Surgery Global Open. 2017;5(6):e1353.
This is the first case showing genital cortex representation on fMRI after RFF phalloplasty with nerve anastomosis on a trans-man patient, similar to previous reports on imaging related to genital sensitivity. It contradicts the classic Penfield and Rasmussen homunculus, that is, the activations were bilateral with a left-sided dominance in the lateral parts of the medial postcentral gyrus (overlapping the groin region), and no activations were observed in the mesial parts of the postcentral gyrus.

Minimising the donor area morbidity of radial forearm phalloplasty using prefabricated thigh flap: A new technique [FULL TEXT]
Aggarwal A, Singh H, Mahendru S, et al.  Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India. 2017;50(1):91-95.
This new technique of using prefabricated thigh flap has significantly reduced the donor site morbidity both aesthetically and functionally without the use of skin grafting in whole procedure. The use of prefabricated flap has shown good aesthetic result but at the cost of multiple surgeries.

An Update on the Surgical Treatment for Transgender Patients.
Colebunders B, Brondeel S, D'Arpa S, Hoebeke P, Monstrey S. Sex Med Rev. 2016 Sep 10.
A review of the literature was performed focusing on the most recent techniques of gender reassignment surgery. The gold standard for a phalloplasty remains the free radial forearm flap.

Immediate pedicled gracilis flap in radial forearm flap phalloplasty for transgender male patients to reduce urinary fistula.
Salgado CJ, Nugent AG, Moody AM, Chim H, Paz AM, Chen HC. J Plast Reconstr Aesthet Surg. 2016 Jun 2. This paper was in part presented at the American Society of Reconstructive Microsurgery in Scottsdale Arizona on January 18, 2016.
Radial forearm phalloplasty is accompanied by high rates of fistula formation. In our patient series, inclusion of a pedicled myofascial gracilis flap at the time of radial forearm phalloplasty with urethroplasty was associated with an absence of fistula formation. Therefore, we have since made inclusion of this flap a standard practice for all transmales undergoing phalloplasty with urethroplasty.

The Free Microvascular Groin Flap - Optimizing the Donor Site after Free Radial Forearm Flap Phalloplasty - a Comparative Study.
Rieger UM, Majenka P, Wirthmann A, Sohn M, Bozkurt A, Djedovic G. Urology. 2016 Sep;95:192-6. Epub 2016 Apr 22.
To improve the donor-site-morbidity of the radial forearm flap through coverage with a free vascularized groin flap and comparing this flap coverage to the current standard, a full thickness skin graft (FTSG). We suggest that the free microvascular groin flap should be considered for immediate defect closure after phalloplasty with a radial forearm flap due to its beneficial functional and aesthetic results and the low rate of complications.

Long-Term Evaluation of Donor-Site Morbidity after Radial Forearm Flap Phalloplasty for Transsexual Men
Van Caenegem, E., Verhaeghe, E., Taes, Y., Wierckx, K., Toye, K., Goemaere, S., Zmierczak, H.-G., Hoebeke, P., Monstrey, S. and T'Sjoen, G. (2013), Journal of Sexual Medicine, 10: 1644–1651. doi: 10.1111/jsm.12121.

Second free radial forearm flap for urethral reconstruction after partial flap necrosis of tube-in-tube phalloplasty with radial forearm flap: A report of two cases
Tchang, L. A.H., Largo, R. D., Babst, D., Wettstein, R., Haug, M. D., Kalbermatten, D. F. and Schaefer, D. J. (2013) Microsurgery. doi: 10.1002/micr.22168

The Etiology and Treatment of the Softened Phallus after the Radial Forearm Osteocutaneous Free Flap Phalloplasty. [Full Text PDF]
The use of a rib bone with cartilaginous tip graft could be an option for improvement of the softened phallus. Silicon rod insertion is also worth considering for rigidity of the softened phallus. Decreased rigidity due to soft tissue atrophy could be alleviated with repeated fat injection and artificial dermis grafting.
Kim SK, Kim TH, Yang JI, Kim MH, Kim MS, Lee KC. Arch Plast Surg. 2012 Jul;39(4):390-396.

Radial Forearm Flap Phalloplasty
Monstrey, Stan, Philippe Houtmeyers, Nicolaas Lumen, and Piet Hoebeke. 2012. In Penile Reconstructive Surgery, ed. Miroslav Djordjevic and Richard Santucci, 254–275. Saarbrücken, Germany: Lambert Academic Publishing.

Penile Reconstruction with the Radial Forearm Flap: An Update.
M Doornaert, P Hoebeke, P Ceulemans, G T'sjoen, G Heylens, S Monstrey
Department of Plastic Surgery, Gent University Hospital, Gent, Belgium. (Handchir Mikrochir Plast Chir. 2011 Aug ;43 (4):208-214 21837613)

Phalloplasty in female-to-male transsexuals: experience from 259 cases
Baumeister S, Sohn M, Domke C, Exner K. Handchir Mikrochir Plast Chir. 2011 Aug;43(4):215-21. doi: 10.1055/s-0030-1267965. Epub 2011 Aug 11. [Article in German]
The radial forearm flap can be performed in various designs. If the patient wishes a glans plasty the Gottlieb design is favoured. In obese patients with a short forearm the Chang design is recommended as it provides a sufficient pedicle length for anastomosis without a venous interpositional graft.

Phalloplasty using radial forearm osteocutaneous free flaps in female-to-male transsexuals.
We have been able to construct a good phallus with radial forearm osteocutaneous free flaps that is aesthetically and functionally acceptable. In addition, complications have been minimal.
Kim SK, Lee KC, Kwon YS, Cha BH. J Plast Reconstr Aesthet Surg. 2009 Mar;62(3):309-17. doi: 10.1016/j.bjps.2007.11.011. Epub 2008 Mar 4.

Total Phallic Construction in Female to Male Transsexuals
Giulio Garaffa, Nim A. Christopher, David J. Ralph (Current Urology, Vol. 3, No. 3, 2009)

Penile Reconstruction: Is the Radial Forearm Flap Really the Standard Technique? -
Monstrey, Stan; Hoebeke, Piet; Selvaggi, Gennaro; al etc. (Journal of Plastic and Reconstructive Surgery, Volume 124 Issue 2, August 2009)

Use of forearm free-flap phalloplasty in bladder exstrophy adults
Marc-Olivier Timsit, Pierre Mouriquand, Alain Ruffion, Alain Bouillot, Diala Dembelé, Arnaud Mejean, Fanny Lalloue, Albert Leriche and Nicolas Morel-Journel (BJU International, Volume 103 Issue 10, Dec 2008)

Reconstructive Surgery for Severe Penile Inadequacy: Phalloplasty with a Free Radial Forearm Flap or a Pedicled Anterolateral Thigh Flap
N. Lumen, S. Monstrey, P. Ceulemans, E. van Laecke, and P. Hoebeke. Adv Urol. 2008; 2008: 704343.
Phallic reconstruction using the free radial forearm flap (RFF) or the pedicled anterolateral thigh flap (ALTF) has been routinely used in female-to-male transsexuals. Sensitivity in the RFF was superior compared to the ALTF.

Free Radial Forearm Flap for Phalloplasty [Full Text PDF]
Abdel-Hamid Abdel-Khalek, M.D.; Abdel Mohsen Allam, M.D.; Amged Hendy, M.D. and Helmy Shalaby, M.D. Egypt, J. Plast. Reconstr. Surg., Vol. 32, No. 2, July: 169-173, 2008.

Long-term outcome of forearm flee-flap phalloplasty in the treatment of transsexualism
Albert Leriche, Marc-Olivier Timsit, Nicolas Morel-Journel, André Bouillot, Diala Dembele and Alain Ruffion (BJU International, Volume 101 Issue 10, Jan 2008)

Closure of radial forearm free flap donor site defect with a local meshed full-thickness skin graft: a retrospective study of an original technique.
Karimi A, Mahy P, Reychler H. J Craniomaxillofac Surg. 2007 Dec;35(8):369-73. Epub 2007 Nov 26.

One-Stage Sex Reassignment Surgery from Female to Male
Kruegera M., Yekania S.A.H., Hundta G., Daverio P. International Journal of Transgenderism, Volume 10, Issue 1, 2007.
A detailed description of the one-step sex reassignment surgery performed by Dr. Daverio and Dr. Krueger successfully more than 350 times. The surgery itself consists of several steps: the removal of the mammae, the uterus, the adnexes, the ovaries and the vagina, the prolongation of the urethra, the creation of a sensate neo-phallus containing a neo-urethra from a radial free forearm flap and the transplantation of the same.

Donor-Site Morbidity of the Radial Forearm Free Flap after 125 Phalloplasties in Gender Identity Disorder - [longer article preview]
Selvaggi, G., Monstrey, S., Hoebeke, P. | Plast Reconstr Surg | vol. 118, 1171 - 1177, 2006
This was the largest series to date of donor-site morbidity after harvest of a very large radial forearm free flap with the specific indication of constructing a phallus in the female-to-male transsexual.

Phalloplasty for female transsexuals with sensate free forearm flap
Rong-Hwang Fang, Jin-Teh Lin, Shiuh Ma (Microsurgery, Volume 15 Issue 5, Oct 2005)

Addressing the ideal requirements by free flap phalloplasty: Some reflections on refinements of technique
J. Joris Hage, Floris H. De Graaf. Microsurgery, Volume 14 Issue 9, Oct 2005.

A New Surgical Procedure for Phallic Reconstruction: Istanbul Flap
Mutaf, Mehmet. Journal of Plastic and Reconstructive Surgery, Volume 105 Issue 4, April 2000.

Phalloplasty in female-to-male transsexuals using free radial osteocutaneous flap: a series of 22 cases
R.H. Fang, Y.S. Kao, S. Ma, J.T. Lin, British Journal of Plastic Surgery, Volume 52, Issue 3, April 1999, Pages 217-222, ISSN 0007-1226.

Closure of radial forearm free flap donor site with local full-thickness skin graft.
van der Lei B, Spronk CA, de Visscher JG. Br J Oral Maxillofac Surg. 1999 Apr;37(2):119-22.

ALT Phalloplasty and Related

Outcomes of Single-Staged Phalloplasty by Pedicled Anterolateral Thigh Flap versus Radial Forearm Free Flap in Gender-Confirming Surgery
Ascha M, Massie JP, Morrison SD, Crane CN, Chen ML. J Urol. 2017 Jul 29.
This study examines outcomes between transmales who had phalloplasty with vaginectomy and full-length urethroplasty utilizing the anterolateral thigh pedicled flap (pALT) or radial forearm free flap (RFFF). There were 213 patients included: 149 RFFF and 64 pALT phalloplasties. RFFF patients had a significantly higher body mass index (BMI) than pALT patients. The overall urethral complication rate for RFFF phalloplasty was 31.5%; the overall pALT rate was 32.8%. The rate of partial or total neophallus loss was 7.8% for pALT and 3.4% for RFFF. Patients in the pALT cohort experienced significantly greater odds of urethral fistula (OR=2.50, p=0.024), non-urethral complications (OR=2.38, p=0.027), and phallus wound dehiscence (OR=5.03, p=0.026). pALT phalloplasty was associated with overall greater odds of urethral and other complications at six months follow-up.

Double flap phalloplasty in transgender men: Surgical technique and outcome of pedicled anterolateral thigh flap phalloplasty combined with radial forearm free flap urethral reconstruction.
van der Sluis WB, Smit JM, Pigot GLS, Buncamper ME, Winters HAH, Mullender MG, Bouman MB. Microsurgery. 2017 May 29. doi: 10.1002/micr.30190.
In experienced hands, one-stage pedicled ALT phalloplasty combined with RFFF urethral reconstruction is a feasible alternative surgical option in eligible transgender men, who desire a less conspicuous forearm scar. Possible drawbacks comprise flap-related complications, difficult inner flap monitoring and urethral complications.

Pre-Expanded Anterolateral Thigh Perforator Flap for Phalloplasty [full text]
Salvatore D'Arpa, Britt Colebunders, Filip Stillaert, Stan Monstrey. October 2 2016.
The anterolateral thigh (ALT) perforator flap for phalloplasty is gaining popularity because it avoids the well-known scars of the radial forearm flap. However, scars are not eliminated, just moved to a different location, the thigh, that can for some patients be of great sexual value. Preexpansion of the ALT flap allows primary donor site closure, thus avoiding not only the unsightly appearance of a skin grafted ALT donor site, but also the skin graft donor site scar. Preoperative perforator location by means of computed tomography angiography allows safe expander placement through 2 small remote incisions.

[The pedicled anterolateral thigh flap for penile reconstruction].
Zhe Y, Yangqun L, Yong T, Muxin Z, Wen C, Ning M, Weixin W. Zhonghua Zheng Xing Wai Ke Za Zhi. 2015 Nov;31(6):406-10. [Article in Chinese]
From May 2011 to May 2015, 12 male patients presented with absence of the penis or congenital malformation received phalloplasty with the pedicled ALT flap. An acceptable reconstructed phallus was achieved in 10 patients. These flaps were primarily healed with satisfactory functional and cosmetic results. The reconstructed penis was completely necrosis because of the flap failure in one case. The distal half of the phallus was lost due to infection in one case. Both of them were treated with pedicled ALT flap from the other side. Reliable results were achieved. At a median follow-up of 1.5 year (range 1 to 4 years), 9 patients (90%) were fully satisfied with phallic cosmesis and size, and 4 patients who was married had successful sexual intercourse. 8 patients had normal urinate function. Fistula was developed in 2 patients (20%) which was treated with delayed repair at 6-12 months with local scrotal flaps.

The pedicled ALT flap can be simply used to reconstruct an entire penis as well as a urethra. It has several advantages including a less conspicuous donor site, greater bulk, better color match and no necessary for microsurgery.

Modification of the Tube-in-Tube Pedicled Anterolateral Thigh Flap for Total Phalloplasty: The Mushroom Flap.
Morrison SD, Son J, Song J, Berger A, Kirby J, Ahdoot M, Lee GK. Ann Plast Surg. 2014 May;72 Suppl 1:S22-6.
The pedicled ALT flap can be used to reconstruct an entire penis, as well as a urethra, without the need for microsurgery. By modifying the original tube-in-tube design to include a semicircular extension (a.k.a. the "mushroom flap"), we feel that we have been able to achieve a more natural-appearing neoglans. (Note: Not FTM-specific.)

Phalloplasty with an Innervated Island Pedicled Anterolateral Thigh Flap in a Female-to-Male Transsexual [Full PDF]
Hasegawa K, Namba Y, Kimata Y. Acta Med Okayama. 2013 Oct;67(5):325-31.
As compared to a forearm flap, use of an innervated island-pedicled flap may have the following advantages in phalloplasty:1) no need for a microsurgical technique; 2) no scars at noticeable sites; 3) small functional loss in the flap donor area; 4) no sacrifice of major blood vessels.

Preoperative planning of a pedicled anterolateral thigh (ALT) flap for penile reconstruction with the multidetector CT scan.
Preoperative evaluation of ALT perforators and the subcutaneous fat tissue layer is feasible with an MDCT scan and provides precise data to make an adequate patient and perforator selection and determine the exact flap size.
Sinove Y, Kyriopoulos E, Ceulemans P, Houtmeyers P, Hoebeke P, Monstrey S. Handchir Mikrochir Plast Chir. 2013 Aug;45(4):217-22. doi: 10.1055/s-0032-1333271. Epub 2013 Mar 6.

A systematic review of anterolateral thigh flap donor site morbidity
The anterolateral thigh (ALT) flap is widely used in reconstruction. Its advantage over other flaps is its purported minimal donor site morbidity. The present systematic review summarizes the types of complications and their incidence with this flap. A secondary objective is to delineate factors that influence these complications and make recommendations to avoid them.
Jessica Collins, Olubimpe Ayeni, and Achilleas Thoma.
Can J Plast Surg. 2012 Spring; 20(1): 17–23.

Phalloplasty with pedicled anterolateral thigh flap ("ALT-Flap")
T. Holzbach, R. E. Giunta, H.-G. Machens, D. Müller. Handchir Mikrochir plast Chir 2011; 43(4): 227-231
DOI: 10.1055/s-0030-1269908.
Phalloplasty by means of a pedicled anterolateral-thigh-flap ("ALT-flap") in a patient who underwent unsuccessful groin-flap-phalloplasty. Innervation was via coaptation to a branch of the pudendal nerve. The operative time was a reasonable 360 min. The benefit of a pedicled transposition vs. a free transplantation becomes obvious. The shortened operating time and the lack of possible complications of microvascular anastomoses bear advantages.

A Novel Single-Flap Technique for Total Penile Reconstruction: The Pedicled Anterolateral Thigh Flap -
Lee, Gordon K.; Lim, Angeline F.; Bird, Erin (Journal of Plastic and Reconstructive Surgery, Volume 124 Issue 1, July 2009)

Innervated island pedicled anterolateral thigh flap for neo-phallic reconstruction in female-to-male transsexuals
Rubino, C.; Figus, A.; Dessy, L.A.; Alei, G.; Mazzocchi, M.; Trignano, E.; Scuderi, N. Journal of Plastic, Reconstructive & Aesthetic Surgery vol. 62 issue 3 March, 2009. p. e45-e49

Reconstructive Surgery for Severe Penile Inadequacy: Phalloplasty with a Free Radial Forearm Flap or a Pedicled Anterolateral Thigh Flap
N. Lumen, S. Monstrey, P. Ceulemans, E. van Laecke, and P. Hoebeke. Adv Urol. 2008; 2008: 704343.
Phallic reconstruction using the free radial forearm flap (RFF) or the pedicled anterolateral thigh flap (ALTF) has been routinely used in female-to-male transsexuals. Sensitivity in the RFF was superior compared to the ALTF.

Neophalloplasty in Female-to-Male Transsexuals with the Island Tensor Fasciae Latae Flap
Santanelli, Fabio M.D., Ph.D.; Scuderi, Nicolò (Journal of Plastic and Reconstructive Surgery, Volume 105 Issue 6, May 2000)

FFF Phalloplasty

A new protocol for complete phalloplasty with free sensate and prelaminated osteofasciocutaneous flaps: experience in 37 patients.
Schaff J, Papadopulos NA. Microsurgery. 2009;29(5):413-9.

Free Fibula Donor-Site Morbidity: Clinical and Biomechanical Analysis
Farhadi, Jian MD; Valderrabano, Victor MD, PhD; Kunz, Christoph MD, DDS; Kern, Reinhard MD; Hinterman, Beat MD; Pierer, Gerhard MD. Annals of Plastic Surgery: April 2007 - Volume 58 - Issue 4 - pp 405-410
The aim of this study was the quantitative assessment of donor-site morbidity after fibula harvest. The overall donor-side morbidity was low, but an eversion torque deficit could initiate or support a progressive functional ankle instability and in long-term cause or accelerate a ligamentous secondary ankle osteoarthritis. (Editor's Note: This study is not specific to FFF phalloplasty.)

Enlarged Range of Free Flaps for Phalloplasty in Transsexual Reassignment Surgery
Description of our concept for complete phalloplasty, applied in 66 female-to-male transsexuals using free prelaminated osteofasciocutaneous fibula or fasciocutaneous forearm flaps.
Schaff J., International Journal of Transgenderism, Volume 10, Issue 1, 2007. Published online: 15 Oct 2008

Phalloplasty With Free (Septocutaneous) Fibular Flap Sine Fibula
Dabernig J, Chan LKW, Schaff J, J Urol. 2006:176 (5):2085-88

Long-Term Follow-Up of Total Penile Reconstruction with Sensate Osteocutaneous Free Fibula Flap in 18 Biological Male Patients
Sengezer, Mustafa; Öztürk, Serdar; Deveci, Mustafa; Odabasi, Zeki (Journal of Plastic and Reconstructive Surgery, Volume 114 Issue 2, August 2004)

Long-Term Fate of the Bony Component in Neophallus Construction with Free Osteofasciocutaneous Forearm or Fibula Flap in 18 Female-to-Male Transsexuals
Papadopulos, Nikolaos A.; Schaff, Juergen; Biemer, Edgar (Journal of Plastic and Reconstructive Surgery, Volume 109 Issue 3, March 2002)

Usefulness of free sensate osteofasciocutaneous forearm and fibula flaps for neophallus construction.
Papadopulos NA, Schaff J, Biemer E. J Reconstr Microsurg. 2001 Aug;17(6):407-12.
Patients with fibula flaps had better sexual intercourse, although their neophallus sensibility was minor, when compared to the forearm flap patients.

Phalloplasty with free osteocutaneous fibular flap in a transsexual case.
Yavuzer, Reha. Plastic & Reconstructive Surgery: September 1999 - Volume 104 - Issue 3 - p 890

Fibula free flap phalloplasty: modifications and recommendations. [Full PDF]
Hage JJ, Winters HA, Van Lieshout J. Microsurgery. 1996;17(7):358-65.

One-stage total penile reconstruction with a free fibula osteocutaneous flap.
Sadove RC, Sengezer M, McRoberts JW, Wells MD. Plastic and Reconstructive Surgery 92:1314–1323, 1993.

Total phallic reconstruction with the free fibula osteocutaneous flap.
Sadove RC, McRoberts JW. Plastic and Reconstructive Surgery 89: 1001, 1992.

MLD Phalloplasty and Related

Surgical Therapy: Total Phalloplasty Using Latissimus Dorsi Flap
Rados P. Djinovic. Management of Gender Dysphoria pp 271-279. First online January 2, 2015.
Developed in 1996, Musculocutaneous latissimus dorsi flap phalloplasty is a staged procedure with flap transfer in the first stage, urethroplasty in the second, and implantation of penile implants in the third. Implantation of testicular implants and glansplasty are done in the second or third stage. The majority patients get a satisfactory functional and esthetic outcome.

Total Phalloplasty Combined with Metoidioplasty As a One-Stage Procedure in Female[-to-Male] Transsexuals: Is It Possible?
M. Djordjevic, D. Stanojevic, V. Kojovic, M. Bizic and M. Majstorovic. Belgrade Gender Dysphoria Team, School of Medicine, University of Belgrade, Serbia. Poster (PDF) presented at the 13th Congress of the European Society for Sexual Medicine.

Total phalloplasty in female transsexuals: technique and outcomes.
Djordjevic M., Kojic S., Stanojevic D., Jocic D., Bizic M. Eur Urol Suppl 2011;10(9):579.
Total phalloplasty is feasible and safe surgical procedure. The main advantage is complete reconstruction of neophallus that avoids multi-staged gender reassignment surgery in female transsexuals. Our results confrmed successful outcome.

Total phalloplasty combined with metoidioplasty as a single stage procedure in female to male gender reassignment surgery: preliminary report.
Djordevic M, Stanojevic D, Kojovic V, Bizic M, Majstorovic M, Pandey S, XXI Biennial Symposium WPATH, Oslo, Norway, 2009; p40.

Combined total phalloplasty and metoidioplasty as a single stage procedure in female to male gender reassignment surgery.
Kojovic V, Bizic M, Majstorovic M, Kojic S, Stanojevic D, Korac G, Djordjevic M. EurUrolSuppl, 2009;8(8):648
Combined total phalloplasty and metoidioplasty is feasible and safe surgical procedure. The main advantage is complete reconstruction of neophallus that avoids multi-staged gender reassignment procedures in female to male transsexuals. Our results confirmed successful outcome.

Neophalloplasty With a Reinnervared Latissimus Dorsi Free Flap: A Functional Study Of a Novel Technique
Ranno R., Veselý J., Hýža P., Stupka I., Justan I., Dvorák Z., Monni N., Novák P., Ranno S., Scripta Medica (BRNO) – 81 (1): 1#–22, April 2008

An Objective Evaluation of the Contraction Power of a Neophallus Reconstructed with Free Reinnervated LD in Female-to-Male Transsexuals Ranno R., Hýža P., Veselý J., Dessy L.A., Kadaňka Z., Scripta Medica (BRNO) – 81 (1): 1#–22, April 2008

Total Phalloplasty Using a Musculocutaneous Latissimus Dorsi Flap
Sava V. Perovic, Rados Djinovic (British Journal of Urology, Reconstructive Urology, Volume 100 Issue 4, Sep 2007)

Penile Reconstruction by the Free Scapular Flap and Malleable Penis Prosthesis
Yang, Mingyong; Zhao, Muxin; Li, Senkai; Li, Yangqun (Journal of Plastic and Reconstructive Surgery, Volume 59 Issue 1, July 2007)

New Technique of Total Phalloplasty With Reinnervated Latissimus Dorsi Myocutaneous Free Flap in Female-to-Male Transsexuals
Vesely, Jiri; Hyza, Petr; Ranno, Raul; Cigna, Emanuele; Monni, Nicola; al etc. (Annals of Plastic Surgery, Volume 58 Issue 5, May 2007)

Musculocutaneouslatissimusdorsi free transfer flap for total phalloplasty.
Djordjevic M, Perovic S, Djinovic R. Urology, 2006; 68(suppl.5):168 (abs.MP17.22)

Complications of microsurgical phalloplasty in transsexuals.
R.T. Adamyan, N.O. MIlanov, T.V. Kazaryan. 2000. National Research Centre of Surgery, Russian Academy of Medical Sciences, Moscow, Russia.
A thoracodorsal flap cut from the broadest muscle of the back appears to be the most promising material among free microsurgical autografts employed in phalloplasty. Its feeding pedicle contains the motor thoracodorsal nerve (apart from an artery and a vein) which is indispensable for the reinnervation of the muscular portion of the flap and thus the restoration of its motor function.

Simultaneous Penis and Perineum Reconstruction Using a Combined Latissimus Dorsi-Scapular Free Flap with Intraoperative Penile Skin Expansion
Rohrich, Rod J.; Allen, Terry; Lester, Fred; Young, Jonathan P.; Katz, Scott L. (Journal of Plastic and Reconstructive Surgery, Volume 99 Issue 4, April 1997)

Pedicled Groin / Hip / Abdominal Flap Phalloplasty

Surgical Outcomes and Patients' Satisfaction with Suprapubic Phalloplasty
Terrier, J.-É., Courtois, F., Ruffion, A. and Morel Journel, N. (2014), Journal of Sexual Medicine, 11: 288–298. doi: 10.1111/jsm.12297
The aim of this study was to assess the outcomes and satisfaction of patients offered the choice between metaidioplasty, forearm free flap, and suprapubic phalloplasty. Suprapubic phalloplasty, despite the lack of urethroplasty, offers an interesting alternative for patients concerned with the stigmatizing scar on the donor site.

"Bird-Wing" abdominal phalloplasty: A novel surgical technique for penile reconstruction.
Bajpai M. J Indian Assoc Pediatr Surg 2013;18:49-52

Penile reconstruction with bilateral superficial circumflex iliac artery perforator (SCIP) flaps.
Koshima I, Nanba Y, Nagai A, Nakatsuka M, Sato T, Kuroda S. J Reconstr Microsurg. 2006 Apr;22(3):137-42.
The advantages of this method are minimal donor-site morbidity with a concealed donor scar, and possible one-stage reconstruction for a longer urethra of 22 cm in length without insufficiency, even for GID female-to-male patients. A disadvantage is poor sensory recovery.

Pedicled pubic phalloplasty in females with gender dysphoria.
Bettocchi C, Ralph DJ, Pryor JP. BJU Int. 2005 Jan;95(1):120-4.
Between 1989 and 2000, 85 female-to-male transsexual patients had a phalloplasty fashioned from suprapubic abdominal wall flap that was tubed to form the phallus, and which incorporated the neourethra made from a pedicled tube of labial skin.

Phalloplasty in a female-to-male transsexual using a double-pedicle composite groin flap.
Tayfun Aköz, Eksal Kargi. Annals of Plastic Surgery (impact factor: 1.32). 05/2002; 48(4):423-7; discussion 427.

Phalloplasty using a lateral groin flap in female-to-male transsexuals.
Zielinski T. Acta Chir Plast. 1999;41(1):15-9.
The paper presents a one-stage procedure for neophallus construction using a lateral groin flap. 127 female-to-male transsexuals underwent surgery in the Department of Plastic Surgery of the Medical University of Lódz (Poland) using this method.

One-Stage Reconstruction of the Penis with Composite Iliac Crest and Lateral Groin Skin Flap
Sun, Guang-ci M.D.; Huang, Jin-jing. Annals of Plastic Surgery, Volume 15 Issue 6, December 1985.

Construction of Male Genitalia in the Transsexual, Using a Tubed Groin Flap for the Penis and a Hydraulic Inflation Device
Puckett, Charles L., Montie, Joseph E. Plastic and Reconstructive Surgery, April 1978.


NEW! Robot-assisted laparoscopic colpectomy in female-to-male transgender patients; technique and outcomes of a prospective cohort study [Full text]
Freek Groenman, Charlotte Nikkels, Judith Huirne, Mick van Trotsenburg, Hans Trum
Surgical Endoscopy, August 2017, Volume 31, Issue 8, pp 3363–3369.
Study results show that [robot-assisted laparoscopic Vaginectomy] combined with [robot-assisted laparoscopic Hysterectomy] is feasible as a single-step surgical procedure in FtM transgender surgery.

Laparoscopic Vaginal-Assisted Hysterectomy With Complete Vaginectomy for Female-To-Male Genital Reassignment Surgery.
Gomes da Costa, Valentim-Lourenço, Santos-Ribeiro, Carvalho Afonso, Henriques, Ribeirinho, Décio Ferreira. J Minim Invasive Gynecol. 2016 Mar-Apr;23(3):404-9.
This study suggests the feasibility of laparoscopic vaginectomy in genital reassignment surgery. The procedure can be executed as a continuation of the hysterectomy with the potential advantage of the laparoscopy providing better exposure of the anatomic structures with low blood losses (less than 500 mL) and few complications. Furthermore, using this approach, adequate-sized vaginal mucosa flaps were obtained for the urethral reconstruction.

Outcome and Risk Factors for Vaginectomy in Female to Male Transsexuals
M. Spilotros, DJ Ralph, N Christopher, Institute of Urology London, presented at the World Meeting on Sexual Medicine. 2013.
This presentation includes reasons, treatment and results for vaginectomy. Complications are few and easy to manage. The severity of bleeding is directly related to vaginal length. Patients report high satisfaction rates.

Effects of long-term high dose testosterone administration on vaginal epithelium structure and estrogen receptor-α and -β expression of young women.
Baldassarre M, Giannone FA, Foschini MP, Battaglia C, Busacchi P, Venturoli S, Meriggiola MC. Int J Impot Res. 2013 Sep;25(5):172-7.

Effect of long-term testosterone administration on the endometrium of female-to-male (FtM) transsexuals.
Perrone AM, Cerpolini S, Maria Salfi NC, Ceccarelli C, De Giorgi LB, Formelli G, Casadio P, Ghi T, Pelusi G, Pelusi C, Meriggiola MC. J Sex Med. 2009 Nov;6(11):3193-200.

The role of colpocleisis with urethral lengthening in transsexual phalloplasty.
Chesson RR, Gilbert DA, Jordan GH, Schlossberg SM, Ramsey GT, Gilbert DM. Am J Obstet Gynecol. 1996 Dec;175(6):1443-9; discussion 1449-50.
Extending the urethra during colpocleisis allows for better healing and significantly decreased fistula formation. Proper blood supply for microvascular surgery and adequate tissue for the anastomosis site contribute to better results.


NEW! Outcomes After Phalloplasty: Do Transgender Patients and Multiple Urethral Procedures Carry a Higher Rate of Complication?
Remington AC, Morrison SD, Massie JP, Crowe CS, Shakir A, Wilson SC, Vyas KS, Lee GK, Friedrich JB. Plast Reconstr Surg. 2017 Oct 10.
Cismale patients undergoing phalloplasty had lower urethral and flap complication rates when compared to transmale patients. Staged urethroplasty had more flap complications, as well as worse outcomes and patient satisfaction compared to primary urethroplasty.

Urologic Sequelae Following Phalloplasty in Transgendered Patients.
Nikolavsky D, Yamaguchi Y, Levine JP, Zhao LC. Urol Clin North Am. 2017 Feb;44(1):113-125.
Transgender patients at various stages of their transformation will present to urologic clinics requiring general or specialized urologic care. Knowledge of specifics of reconstructed anatomy and potential unique complications of the reconstruction will become important in providing urologic care to these patients. In this article, we have concentrated on describing diagnosis and treatment of the more common urologic complications after female-to-male reconstructions: urethrocutaneous fistulae, neourethral strictures, and symptomatic persistent vaginal cavities.

Fasciocutaneous Flap Reinforcement Of Ventral Onlay Buccal Mucosa Grafts Enables Neophallus Revision Urethroplasty [full text]
Zhao, Lee C, Khurana, Kiranpreet, KWilson, Stelios C et al. The Journal of Urology, Volume 195, Issue 4, e790 - e791.
Urethral strictures or fistulas are common complications after phalloplasty. Neourethral defects pose a difficult reconstructive challenge using standard techniques as there is generally insufficient ventral tissue to support a graft urethroplasty. We report our experience with local fasciocutaneous flaps for support of ventrally-placed buccal mucosal grafts (BMGs) in phalloplasty.

Men's health and transgender surgery: a urologist's perspective. [full text]
Garcia MM. Translational Andrology and Urology. 2016;5(2):225-227.
Because the principal long-term complications associated with GCS are decidedly urologic—sexual function, genital prosthetics, and urinary function—transgender patients will often follow-up with their urologist for years to come. It is especially important for the urologist to inform and help guide patients' expectations regarding their reconstruction—as this helps optimize long-term outcome quality and patient satisfaction.
(Includes: Neophallus length and surgical options, Pitfalls related to genital dimensions; Surgical strategies to optimize erogenous sensation.)

Prelamination of Neourethra with Uterine Mucosa in Radial Forearm Osteocutaneous Free Flap Phalloplasty in the Female-to-Male Transgender Patient [Full article]
Christopher J. Salgado, Lydia A. Fein, Jimmy Chim, Carlos A. Medina, Stephanie Demaso, Christopher Gomez. Case Reports in Urology, Volume 2016.
The aim of this case report is to describe the successful use of uterine mucosa for prelamination of the penile urethra within a radial forearm osteocutaneous free flap for phalloplasty in the FtM transgender patient.

Fasciocutaneous Flap Reinforcement of Ventral Onlay Buccal Mucosa Grafts Enables Neophallus Revision Urethroplasty [FULL TEXT]
Lee C Zhao, Kiranpreet K Khurana, Stelios C Wilson, John T Stranix, Jamie P Levine. The Journal of Urology , Volume 195 , Issue 4 , e790 - e791 (April 2016)
Urethral strictures or fistulas are common complications after neophallus surgery. These urethral defects are difficult to reconstruct using standard urological techniques because there is insufficient ventral tissue to support a graft. We report our experience with local fasciocutaneous flaps for support of ventrally placed buccal mucosal grafts (BMG) in neophallus reconstruction.

Is vaginal mucosal graft the excellent substitute material for urethral reconstruction in female-to-male transsexuals?
Zhang YF, Liu CY, Qu CY, Lu LX, Liu AT, Zhu L, Wang H, Lin ZH, Zhao YZ, Zhu XH, Hua-Jiang.
World J Urol. 2015 Apr 26.
With prefabrication of vaginal mucosal graft, we reconstruct a competent phallic neourethra in these FTM transsexuals. According to its histological similarities and source character, the vaginal mucosa is the excellent substitute material for promising urethral reconstruction in FTM transsexuals.

[Variety of the radial forearm phalloplasty with respect to urethral construction - a review].
[Article in German]
Scholten MM, Grundentaler R, Bull S, Küntscher MV. Handchir Mikrochir Plast Chir. 2013 Aug;45(4):211-6. Epub 2013 Jul 11.
The radial forearm flap is an established procedure for phalloplasty. 3 different methods concerning flap design and urethral construction are reported in the literature. The results show a higher rate of urological complications for the technique with urethra prefabrication so far. However, this technique presents with a lower incidence of partial flap loss and smaller donor sites compared to the Chang design phalloplasty. No conclusions can be drawn for the Gottlieb design penile construction because only few and incomplete data are available in the literature.

A Case of Urethral Reconstruction Using a Superficial Circumflex Iliac Artery. [full text]
Yoo, K.-W., Shin, H.-W., & Lee, H. K. (2012). Archives of Plastic Surgery, 39(3), 253–256.
For the reconstruction of the penis, a SCIP flap and anterolateral thigh free flap was performed [in a cis gender man.] SCIP flap is appropriate for urethral reconstruction. Because of its proximity to the recipient sites, it makes surgical preparation easier and the primary closure at the donor site available. It is also advantageous in that its location is almost unnoticeable.

Buccal mucosa urethroplasty for adult urethral strictures
W. Britt Zimmerman and Richard A. Santucci
Indian J Urol. 2011 Jul-Sep; 27(3): 364–370.
Buccal repair of bulbar urethral strictures have gained popularity and has replaced the anastomotic urethroplasty in our hands, even for short strictures. With its ease of technical performance, reliability, and overall high success rate, it is our procedure of choice in management of most bulbar urethral strictures. (Note: Study was done with cis gender subjects.)

Urethroplasty for Strictures After Phallic Reconstruction: A Single-Institution Experience [FULL TEXT]
Nicolaas Lumen, Stan Monstrey, An-Sofie Goessaert, Willem Oosterlinck, Piet Hoebeke. European Urology, Volume 60, issue 1, pages e1-e8, July 2011.
The main stricture location after phalloplasty is the anastomosisbetween the phallic and the fixed part. Urethroplasty for strictures after phallo-plasty is associated with a relatively high recurrence rate.

Long anterior urethral reconstruction using a jejunal free flap
Tourbach SA1, Hunter-Smith D, Morrison WA. J Plast Surg Hand Surg. 2011 Feb;45(1):54-6.
The case of a transgender patient requiring correction of chronic strictures of his neophalloplasty.

A new method of urethroplasty for prevention of fistula in female-to-male gender reassignment surgery.
Kim SK, Moon JB, Heo J, Kwon YS, Lee KC. Ann Plast Surg. 2010 Jun;64(6):759-64.
For construction of the urethra, an anteriorly based vaginal wall flap and labium minoral flaps were used in this technique. Urethrocutaneous fistulas at the level of the female external urethral orifice can be successfully reduced using this new method.
Also see: Kim FTM Phalloplasty

Total urethral construction with the radial artery-based forearm free flap in the transsexual [FULL TEXT]
Giulio Garaffa, David J. Ralph and Nim Christopher. St Peter's Andrology Centre and the Institute of Urology, London, UK. Accepted for publication 27 November 2009.
To report our experience of using a radial artery-based forearm free flap urethroplasty (RAFFFU) inside a pre-fashioned pedicled pubic phalloplasty for female-to-male gender reassignment. The RAFFFU is the best technique of total urethral construction in female-to-male transsexuals who opt not to undergo a
RAFFF phalloplasty.

Urethral reconstruction using the radial forearm free flap: experience in oncologic cases and gender reassignment.
Dabernig J, Shelley OP, Cuccia G, Schaff J. Eur Urol. 2007 Aug;52(2):547-53. Epub
Many reconstructive techniques currently in use recreate the urethra but are prone to recurrent stricture formation and fail to achieve micturition with a good stream when standing. The authors propose using the radial forearm fasciocutaneous free flap as a single-stage technique of male urethral reconstruction.

Treatment of urethral stricture in a female-to-male transsexual with a tubulized flap from the labia minora.
Cavadas PC, Landin L. J Reconstr Microsurg. 2005 Apr;21(3):153-6.
After one unsuccessful attempt at direct repair and a failed grafting procedure, a tubulized island flap from the remnants of the labia minora was successfully used to reconstruct the urethral stenosis. Current options for treatment of urethral stenoses in female-to-male transsexuals are discussed.

Impact of sex reassignment surgery on lower urinary tract function.
Hoebeke P, Selvaggi G, Ceulemans P, De Cuypere G, T'Sjoen G, Weyers S, Decaestecker K, Monstrey S. Eur Urol. 2005 Mar;47(3):398-402. Epub 2004 Dec 2.
Post-void dribbling was reported by 79% of the FTM transsexuals who had phalloplasty. SRS can cause minor changes in urinary habits. Even if they do not result in patients seeking medical help, transsexuals should be warned about these eventual discomforts pre-operatively.

Urethroplasty in female-to-male transsexuals.
Rohrmann D, Jakse G. Eur Urol. 2003 Nov;44(5):611-4.
One-stage total phalloplasty and urethroplasty is associated with a significant rate of fistulas and strictures. However, these complications can be corrected by the techniques used in modern urethral surgery.

Urethral Complications During Phalloplasty
David J. Ralph. Polare 33, Article 5, October 1999.
Great advances have now been made with the urethral formation in patients having a phalloplasty procedure. The urethra should be harvested from vascular areas of the body to have a uniform structure to prevent stone formation and spraying at micturition.

Review of the literature on construction of a neourethra in female-to-male transsexuals.
Hage JJ, Bloem JJ. Ann Plast Surg. 1993 Mar;30(3):278-86.
A review of the literature on the construction of a pars pendulans and a pars fixa urethrae in phalloplasty is given. The use of local tissue for lengthening of the fixed part of the urethra can be successful in case a vaginal flap is incorporated.


Scrotal reconstruction in female-to-male transsexuals: a novel scrotoplasty.
Selvaggi G, Hoebeke P, Ceulemans P, Hamdi M, Van Landuyt K, Blondeel P, De Cuypere G, Monstrey S
Plast Reconstr Surg. 2009 Jun;123(6):1710-8.

Testicular Prostheses: Development and Modern Usage
D Bodiwala, DJ Summerton, and TR Terry. Ann R Coll Surg Engl. 2007 May; 89(4): 349–353.
Testicular prostheses produced from various materials have been in use since 1941. The most common substance used around the world in the manufacture of these implants is silicone; however, in the US, this material is currently banned because of theoretical health risks. This has led to the development of saline-filled prostheses as an alternative. The long-term fears associated with silicone implants, namely connective tissue or autoimmune diseases and carcinogenesis, have not been substantiated. Longer-term quality-of-life results are still pending.


Sculpturing the glans in phalloplasty.
Hage JJ, de Graaf FH, Bouman FG, Bloem JJ. Plast Reconstr Surg. 1993 Jul;92(1):157-61; discussion 162.
One of the goals of phalloplasty is the construction of an aesthetically appealing neophallus with a urethral meatus at its tip. Aesthetic considerations imply the creation of a glanslike structured tip. A review of the scarce literature on sculpturing of a glans is given. The Norfolk technique of coronal ridge and sulcus construction has best results. We consider Munawar's technique to be obsolete, since it tends to lead to flattening of the coronal ridge.

Glans sculpting in phalloplasty — experiences in female-to-male transsexuals - Rong-Hwang Fang, Yi-Sheng Kaoa, Shiuh Ma, Jin-Teh Lin (Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 51, Issue 5, July 1998)

Penile Implants

Sexual Function and Quality of Life before and after Penile Prosthesis Implantation Following Radial Forearm Flap Phalloplasty.
Young EE, Friedlander D, Lue K, Anele UA, Khurgin JL, Bivalacqua TJ, Burnett AL, Redett RJ, Gearhart JP. Urology. 2017 Feb 2. pii: S0090-4295(17)30112-7. doi: 10.1016/j.urology.2017.01.031. (Not FTM-specific.)
Among patients who have undergone flap phalloplasty, the subsequent placement of penile prosthesis appears to effectively allow for both intercourse and masturbation, resulting in measurable improvements in orgasmic function, intercourse satisfaction and overall sexual satisfaction. Despite these important benefits, prosthesis placement does not appear to result in improvements in penile perception scores, or general or sexual quality of life.

Midline Infrapubic Penile Implant Insertion in Transmen after Phalloplasty may Decrease Complication Rates and Operative Times
Vollstedt, A.J. et al., The Journal of Sexual Medicine, Volume 14, Issue 2, e25 (Feb 2017)
The complication rate for penile implant insertion in transmen after phalloplasty is high overall. We have observed shorter operative times and lower complication rates using a lower midline infrapubic approach for penile implant insertion when compared to prior studies.

Surgical Outcomes of Erectile Implants After Phalloplasty: Retrospective Analysis of 95 Procedures.
Neuville P, Morel-Journel N, Maucourt-Boulch D, Ruffion A, Paparel P, Terrier JE. J Sex Med. 2016 Sep 29.
The aim of the study was to report the outcome of patients with phalloplasty after implantation of erectile implants using standardized surgical techniques and the use of recent prosthesis types with or without a vascular graft. Almost 90% of the subjects were transsexual men. The erectile prostheses used were the two-piece AMS Ambicor, the Ambicor with a vascular graft, and the AMS 700CXR, AMS 700CX, or AMS600-650. Early-onset complications were always related to infection. Late-onset complications were erosion, infection, dysfunction, and malpositioning.

Penile Prosthesis Implantation in Patients with a History of Total Phallic Construction.
Zuckerman JM, Smentkowski K, Gilbert D, Storme O, Jordan G, Virasoro R, Tonkin J, McCammon K. J Sex Med. 2015 Dec;12(12):2485-91. doi: 10.1111/jsm.13067. Epub 2015 Dec 8.
The aim of this study was to evaluate outcomes following neophallus penile prosthesis placement [in cis male patients.]

Titanium-bone-anchored penile epithesis: Preoperative planning and immediate postoperative results
Selvaggi G, Branemark R, Elander A, Liden M, Stalfors J. J Plast Surg Hand Surg. 2014 Jun 16;:1-5

Erectile Implants in Female-to-Male Transsexuals: Our Experience in 129 Patients
Piet B. Hoebeke, Karel Decaestecker, Matthias Beysens, Yasmin Opdenakker, Nicolaas Lumen and Stan M. Monstrey. European Urology, February 2010

Novel technique for proximal anchoring of penile prostheses in female-to-male transsexual.
Large MC, Gottlieb LJ, Wille MA, DeWolfe M, Bales GT. Urology. 2009 Aug;74(2):419-21.

Penile Prosthesis Implantation: Past, Present and Future
M. Simmons, D.K. Montague. Int J Impot Res. 2008;20(5):437-444.
This review examines the past, present and future of penile prosthesis implantation. Advances in prosthetic design and implantation techniques have resulted today in devices that produce nearly normal flaccid and erect states, and have remarkable freedom from mechanical failure.

Use of Erectile Prostheses in Patients with Free Forearm Flap Phalloplasty
Kruegera M., Yekania S.A.H., Hundta G., Daverio P. International Journal of Transgenderism, Volume 10, Issue 1, 2007.
Our experiences with more than 100 patients that we provided with erectile prostheses show that the complication rate in transsexual patients is not significantly higher than in biological males. We therefore recommend the use of erectile prostheses in transsexual patients as a safe, reliable and successful way of obtaining the ability to have sexual intercourse.

Use of penile implants in the constructed neophallus.
Mulcahy JJ.Int J Impot Res. 2003 Oct;15 Suppl 5:S129-31.
The hydraulic nondistally expanding penile implants provide the best support with less chance of distal erosion. Covering the device with cadaver pericardium or porcine small intestinal submucosa has been helpful in creating a neocorpus cavernosum.

Obtaining rigidity in total phalloplasty: experience with 35 patients.
Hoebeke P, de Cuypere G, Ceulemans P, Monstrey S. J Urol. 2003 Jan;169(1):221-3.
Good results were observed after implantation of the Dynaflex prosthesis in patients who underwent total phalloplasty. This model is no longer available today. For the more complex 3-piece CX and CXM prostheses implantation results are comparable to those of the 1-piece model.

Penile prosthesis implantation in a transsexual neophallus.
Tan HM. Asian J Androl. 2000 Dec;2(4):304-6.
Successful insertion of an inflatable prosthesis is described. The AMS CX prosthesis is used in a 45 year old transsexual, who had a large bulky neophallus constructed from the anterior abdominal subcutaneous fat 9 years previous.

Dynaflex prosthesis in total phalloplasty.
Hage JJ. Plast Reconstr Surg. 1997 Feb;99(2):479-85.
Promising results have been obtained with self-contained Dynaflex hydraulic penile implants. The results and complications observed in five cases are reported.

Osseous fixation of a penile prosthesis after transsexual phalloplasty: a case report.
Fisch M, Wammack R, Ahlers J, Sennerich T, Müller SC, Hohenfellner R. J Urol. 1993 Jan;149(1):122-5.
Report on a patient who had undergone female-to-male transsexual surgery and subsequent phalloplasty by means of a free latissimus dorsi muscle graft with pudendal nerve coaptation elsewhere 10 years ago. The surgical strategy for implantation and osseous fixation of a penile prosthesis is described.

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Last updated: 11/03/17