Vice-President, Sexual Health UK and Past Chairman, BAUS Andrology
and BSSM. St Peter"s Andrology Centre and Institute of Urology,
University College, London
This talk details the management of 68 men who requested a
total phallic reconstruction with the forearm flap phalloplasty.
The indications for surgery were amputation for cancer
(22) or trauma 12 and the remainder had a micropenis, the
commonest etiology being exstrophy.
The non dominant arm was used for the flap and the recipient
site covered with full thickness skin harvested from the buttocks.
Microvascular anastamoses were performed to the epigastric
artery, the long saphenous veins and ilioinguinal nerves with
variations depending on the original pathology. A primary
urethral anastamosis was performed where possible. Once
stabilized patients then proceeded to a glans sculpture and the
insertion of a penile prosthesis.
There was a phallus loss in one patient and a partial loss
in another requiring a second phalloplasty. The commonest
complications were urethral with fistulae and strictures occurring
in 25%, however a third of patients did not use their urethra as
they had a mitroffanoff channel.
Despite the multiple stages and high complication rates the
satisfaction was very high 90%.