PS 04. Phalloplasty for the genetic male

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%.