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Phalloplasty in cis-men with penile insufficiency: evaluation of outcomes and surgical complications

Good ability to achieve orgasm, high urinary complication rate

International Journal of Impotence Research volume 33, pages 178–183 (2021)Cite this article

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Abstract

Phalloplasty is the gold-standard treatment for cis-men with penile insufficiency, which is often secondary to congenital conditions. The study-objective is to evaluate the functional outcomes and surgical complications in this population. A retrospective database comprised of cis-men undergoing a phalloplasty at a tertiary referral center from 2004 to 2019 was created. Phalloplasty was performed with various flaps. The tube-within-tube-technique was used for urethroplasty when possible. Complications <30 days postoperative were categorized according to Clavien–Dindo. Functional outcomes were assessed by bladder emptying and ability to achieve orgasm. Thirty patients were included. Nineteen of them needed urethroplasty, the remaining 11 patients had a catheterizable stoma. Within 30 days postoperative, 3 patients (10%) developed partial-flap necrosis (Clavien-Dindo III), 1 patient (3.3%) developed graft failure (Clavien-Dindo III), 2 patients (6.6%) developed infected hematomas (Clavien–Dindo III) and 1 phalloplasty (3.3%) was complicated by hematuria (Clavien-Dindo II). In the long-term, 10 patients (33%) developed fistulae, 6 (20%) requiring urethroplasty. Seven patients (23%) had urethral strictures, all needing urethroplasty or urethrotomy. Sixteen patients (84%) emptied their bladder per urethra, the three remaining necessitated conversion to perineostomy. Median (IQR) Qmax on uroflow was 15.7 (11.9–19.2)mL/s with median (IQR) voiding volume of 259 (137–307) mL and median (IQR) residual volume of 11.5 (0–20) ml on ultrasound. All patients but 1 (97%) reported ability to achieve orgasm. RFFA and ALT result in phalli with great ability to achieve orgasm but urethral complications are frequent.

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Fig. 1: Neophalloplasty in cis-males.

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Acknowledgements

The Ghent University Hospital’s Department of Urology is accredited by the European Reference Network (ERN) in the eUrogen sub-section (urologic rare diseases), specifically for the EEC complex, making the Department a European referral center.

Funding

This research was made possible thanks to the Research Fund for Pediatric Urology ‘Gianni Eggermont fonds ter bevordering van de kinderurologie’.

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Authors and Affiliations

  1. Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium

    Céline Sinatti, Wesley Verla, Nicolaas Lumen, Marjan Waterloos, Piet Hoebeke & Anne-Françoise Spinoit

  2. Ghent University Hospital, Ghent, Belgium

    Dylan Wolff

  3. Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium

    Marlon Buncamper, Karel Claes & Stan Monstrey

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  1. Céline Sinatti
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Correspondence to Anne-Françoise Spinoit.

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Sinatti, C., Wolff, D., Buncamper, M. et al. Phalloplasty in cis-men with penile insufficiency: evaluation of outcomes and surgical complications. Int J Impot Res 33, 178–183 (2021). https://doi.org/10.1038/s41443-020-00385-5

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