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Comment on: Suprapubic pedicled phalloplasty in transgender men: multicentric retrospective cohort analysis

International Journal of Impotence Research volume 33, pages 860–861 (2021)Cite this article

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Multiple techniques have been described to create an aesthetic and functional neophallus in transgender men. The goals of phalloplasty have been well documented and include: a sensate, cosmetically acceptable phallus with an incorporated neourethra, and the ability to place an implantable penile prosthesis so as to allow rigidity for penetrative intercourse [1].

In the recent paper published by Falcone et al. [2], entitled “Suprapubic Pedicled Phalloplasty in Transgender Men: Multicentre Retrospective Cohort Analysis,” the authors outline their surgical approach to what they describe as “total phallic construction” in transgender men using a suprapubic pedicled (SPP) abdominal flap. The authors stated goals of “total phallic reconstruction” are consistent with previous reports and include “both tactile and erogenous sensation, an incorporated neourethra to enable urination from the tip of the neo-glans, as well as adequate bulk to facilitate the insertion of an internal stiffener…” Despite outlining these goals, the authors do not fully evaluate them. As such, they are not truly able to assess the results of “total phallic construction” as they had hoped to do. Specifically, not all of the study participants either opted for or underwent urethral reconstruction. Furthermore, the individuals who did undergo urethral reconstruction had either a radial artery-based forearm free flap urethroplasty (RAU) and/or a urethral advancement. Obviously, standing micturition would not be achieved in all patients evaluated in this study cohort (highlighting the fact that the goals of phalloplasty are often patient dependent). In addition, the authors make no mention of sensory recovery in the SPP flap. As described, the SPP would likely lack sensation (often a primary goal for patients). In reality, this study serves as a description of the authors’ preferred surgical technique as opposed to a description of “total phallic construction” and its functional outcomes.

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References

  1. Hage JJ, Bloem JJ, Suliman HM. Review of the literature on techniques for phalloplasty with emphasis on the applicability in female-to-male transsexuals. J Urol. 1993;150:1093–8.

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Authors and Affiliations

  1. Department of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL, 60612, USA

    R. Hontscharuk & B. Alba

  2. University of Illinois at Chicago, Chicago, IL, USA

    L. S. Schechter

  3. Rush University Medical Center, Chicago, IL, USA

    L. S. Schechter

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  1. R. Hontscharuk
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  2. B. Alba
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  3. L. S. Schechter
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Correspondence to R. Hontscharuk.

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RH and BA do not have any conflicts of interest. LS receives royalties from textbooks from Elsevier & Springer publishers.

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Hontscharuk, R., Alba, B. & Schechter, L.S. Comment on: Suprapubic pedicled phalloplasty in transgender men: multicentric retrospective cohort analysis. Int J Impot Res 33, 860–861 (2021). https://doi.org/10.1038/s41443-020-0273-1

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