Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Suprapubic phalloplasty in transmen: surgical results and critical review

International Journal of Impotence Research volume 33, pages 754–761 (2021)Cite this article

Subjects

Abstract

This article presents the surgical outcomes of a consecutive series of 71 transmen undergoing pre-expanded suprapubic phalloplasty (SPP) in a specialized center. The median [IQR] duration to finalize this three-stage phalloplasty procedure was 7 months [6–7]. Median [IQR] follow-up was 39.4 months [19.7–81.2]. Among those included, 25 (35.2%) had a urethroplasty, and 40 (56.3%) a penile prosthesis as additional procedures. Complications were the result of disorders of wound healing (dehiscence, infection, partial necrosis) or tissue expander (migration, infection). Sixty patients (84.5%) experienced at least one complication during the phalloplasty procedure, mostly minor complications Clavien < IIIa (81.8%). Among these, 16 (22.5%) underwent at least one reintervention, 2 of whom underwent two reinterventions (18 reinterventions in total for Clavien ≥ IIIa complication). There was no loss of phalloplasty. Among the wide variety of techniques developed for phalloplasty, the suprapubic technique seems to be a valuable option for transmen on the path to genital gender affirming surgery.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Three stages of pre-expanded suprapubic phalloplasty.

Similar content being viewed by others

References

  1. Hage JJ, Bout CA, Bloem JJ, Megens JA. Phalloplasty in female-to-male transsexuals: what do our patients ask for? Ann Plast Surg. 1993;30:323–6.

    Article  CAS  Google Scholar 

  2. Courtois F, Terrier J-é, Brassard P, Ruffion A, Morel-Journel N. Development of surgical phalloplasty techniques: Is there a gold standard? Sexologies. 2012;21:55–9.

    Article  Google Scholar 

  3. Morrison SD, Shakir A, Vyas KS, Kirby J, Crane CN, Lee GK. Phalloplasty: a review of techniques and outcomes. Plast Reconstr Surg. 2016;138:594–615.

    Article  CAS  Google Scholar 

  4. Hadj-Moussa M, Agarwal S, Ohl DA, Kuzon WM. Masculinizing genital gender confirmation surgery. Sex Med Rev. 2019;7:141–55.

    Article  Google Scholar 

  5. Xu KY, Watt AJ. The pedicled anterolateral thigh phalloplasty. Clin Plast Surg. 2018;45:399–406.

    Article  Google Scholar 

  6. Puckett CL, Montie JE. Construction of male genitalia in the transsexual, using a tubed groin flap for the penis and a hydraulic inflation device. Plast Reconstr Surg. 1978;61:523–30.

    Article  CAS  Google Scholar 

  7. Sun GC, Huang JJ. One-stage reconstruction of the penis with composite iliac crest and lateral groin skin flap. Ann Plast Surg. 1985;15:519–28.

    Article  CAS  Google Scholar 

  8. Bettocchi C, Ralph DJ, Pryor JP. Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int. 2005;95:120–4.

    Article  Google Scholar 

  9. Marco F, Massimiliano T, Marco O, Andrea C, Girolamo M, Mirko P, et al. Suprapubic pedicled phalloplasty in transgender men: a multicentric retrospective cohort analysis. Int J Impot Res. 2020. https://doi.org/10.1038/s41443-020-0238-4. Online ahead of print.

  10. Terrier J-É, Courtois F, Ruffion A, Morel, Journel N. Surgical outcomes and patients’ satisfaction with suprapubic phalloplasty. J Sex Med. 2014;11:288–98.

    Article  Google Scholar 

  11. Selvaggi G, Dhejne C, Landen M, Elander A. The 2011 WPATH standards of care and penile reconstruction in female-to-male transsexual individuals. Adv Urol. 2012;2012:581712.

    Article  Google Scholar 

  12. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  Google Scholar 

  13. Gilbert DA, Winslow BH, Gilbert DM, Jordan GH, Horton CE. Transsexual surgery in the genetic female. Clin Plast Surg. 1988;15:471–87.

    Article  CAS  Google Scholar 

  14. Heston AL, Esmonde NO, Dugi DD, Berli JU. Phalloplasty: techniques and outcomes. Transl Androl Urol. 2019;8:254–65.

    Article  Google Scholar 

  15. Monstrey S, Hoebeke P, Dhont M, Selvaggi G, Hamdi M, Van Landuyt K, et al. Radial forearm phalloplasty: a review of 81 cases. Eur J Plast Surg. 2005;28:206–12.

    Article  Google Scholar 

  16. Garaffa G, Christopher NA, Ralph DJ. Total phallic reconstruction in female-to-male transsexuals. Eur Urol. 2010;57:715–22.

    Article  Google Scholar 

  17. Monstrey SJ, Ceulemans P, Hoebeke P. Sex reassignment surgery in the female-to-male transsexual. Semin Plast Surg. 2011;25:229–44.

    Article  Google Scholar 

  18. Lee WG, Christopher N, Ralph DJ. Penile Reconstruction and the Role of Surgery in Gender Dysphoria. Eur Urol. Focus. 2019;5:337–9.

    Google Scholar 

  19. Morrison SD, Chen ML, Crane CN. An overview of female-to-male gender-confirming surgery. Nat Rev Urol. 2017;14:486–500.

    Article  Google Scholar 

  20. Frey JD, Poudrier G, Chiodo MV, Hazen A. A systematic review of metoidioplasty and radial forearm flap phalloplasty in female-to-male transgender genital reconstruction: is the “ideal” neophallus an achievable goal? Plast Reconstr Surg Glob Open. 2016;4:e1131.

    Article  Google Scholar 

  21. Monstrey S, Hoebeke P, Selvaggi G, Ceulemans P, Van Landuyt K, Blondeel P, et al. Penile reconstruction: is the radial forearm flap really the standard technique? Plast Reconstr Surg. 2009;124:510–8.

    Article  CAS  Google Scholar 

  22. Selvaggi G, Monstrey S, Hoebeke P, Ceulemans P, Van Landuyt K, Hamdi M, et al. Donor-site morbidity of the radial forearm free flap after 125 phalloplasties in gender identity disorder. Plast Reconstr Surg. 2006;118:1171–7.

    Article  CAS  Google Scholar 

  23. Van Caenegem E, Verhaeghe E, Taes Y, Wierckx K, Toye K, Goemaere S, et al. Long-term evaluation of donor-site morbidity after radial forearm flap phalloplasty for transsexual men. J Sex Med. 2013;10):1644–51.

    Article  Google Scholar 

  24. Garcia MM, Christopher NA, Luca FD, Spilotros M, Ralph DJ. 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. Transl Androl Urol. 2014;3:156.

    PubMed  PubMed Central  Google Scholar 

  25. Ascha M, Massie JP, Morrison SD, Crane CN, Chen ML. Outcomes of single stage phalloplasty by pedicled anterolateral thigh flap versus radial forearm free flap in gender confirming surgery. J Urol. 2018;199:206–14.

    Article  Google Scholar 

  26. Djordjevic ML, Bumbasirevic MZ, Vukovic PM, Sansalone S, Perovic SV. Musculocutaneous latissimus dorsi free transfer flap for total phalloplasty in children. J Pediatr Urol. 2006;2:333–9.

    Article  Google Scholar 

  27. Elfering L, van der Sluis WB, Bouman M-B, Buncamper ME, van de Grift TC, Lissenberg-Witte BI, et al. Preexpansion in phalloplasty patients: is it effective? Ann Plast Surg. 2019;83:687–92.

    Article  CAS  Google Scholar 

  28. Srivastava A, Vashishtha S, Singh UP, Srivastava A, Ansari MS, Kapoor R, et al. Preputial/penile skin flap, as a dorsal onlay or tubularized flap: a versatile substitute for complex anterior urethral stricture. BJU Int. 2012;110:E1101–1108.

    Article  Google Scholar 

  29. Papadopulos NA, Schaff J, Biemer E. The use of free prelaminated and sensate osteofasciocutaneous fibular flap in phalloplasty. Injury. 2008;39:S62–67.

    Article  Google Scholar 

  30. Chang TS, Hwang WY. Forearm flap in one-stage reconstruction of the penis. Plast Reconstr Surg. 1984;74:251–8.

    Article  CAS  Google Scholar 

  31. Dabernig J, Shelley OP, Cuccia G, Schaff J. Urethral reconstruction using the radial forearm free flap: experience in oncologic cases and gender reassignment. Eur Urol. 2007;52:547–53.

    Article  Google Scholar 

  32. Garaffa G, Ralph DJ, Christopher N. Total urethral construction with the radial artery-based forearm free flap in the transsexual. BJU Int. 2010;106:1206–10.

    Article  Google Scholar 

  33. Selvaggi G, Monstrey S, Ceulemans P, T’Sjoen G, De Cuypere G, Hoebeke P. Genital sensitivity after sex reassignment surgery in transsexual patients. Ann Plast Surg. 2007;58:427–33.

    Article  CAS  Google Scholar 

  34. De Cuypere G, T’Sjoen G, Beerten R, Selvaggi G, De Sutter P, Hoebeke P, et al. Sexual and physical health after sex reassignment surgery. Arch Sex Behav. 2005;34:679–90.

    Article  Google Scholar 

  35. Gilbert DA, Williams MW, Horton CE, Terzis JK, Winslow BH, Gilbert DM, et al. Phallic reinnervation via the pudendal nerve. J Urol. 1988;140:295–9.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Verena Landel for her proofreading and Vincent Meyer for the drawings.

Funding

The study received financial support from the French Association of Urology (AFU).

Author information

Authors and Affiliations

  1. Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France

    Manon Terrier, Nicolas Morel-Journel, Damien Carnicelli, Alain Ruffion, Jean-Etienne Terrier, Lena Paganelli & Paul Neuville

  2. Department of Biostatistics, Hospices Civils de Lyon, Lyon, France

    Delphine Maucort-Boulch

Authors
  1. Manon Terrier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicolas Morel-Journel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Damien Carnicelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alain Ruffion
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jean-Etienne Terrier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Delphine Maucort-Boulch
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lena Paganelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Paul Neuville
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Manon Terrier.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Terrier, M., Morel-Journel, N., Carnicelli, D. et al. Suprapubic phalloplasty in transmen: surgical results and critical review. Int J Impot Res 33, 754–761 (2021). https://doi.org/10.1038/s41443-021-00426-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-021-00426-7

This article is cited by

Search

Advanced search

Quick links