Acquired or congenital absence of the penis can lead to severe physical limitations and psychological outcomes. Phallic reconstruction can restore various functional aspects of the penis and reduce psychosocial sequelae. Moreover, some female-to-male transsexuals desire creation of a phallus as part of their gender transition. Because of the complexity of phalloplasty, there is not an ideal technique for every patient. This review sets out to identify and critically appraise the current literature on phalloplasty techniques and outcomes.
A comprehensive literature search of the MEDLINE, PubMed, and Google Scholar databases was conducted for studies published through July of 2015 with multiple search terms related to phalloplasty. Data on techniques, outcomes, complications, and patient satisfaction were collected.
A total of 248 articles were selected and reviewed from the 790 identified. Articles covered a variety of techniques on phalloplasty. Three thousand two hundred thirty-eight patients underwent phalloplasty, with a total of 1753 complications reported, although many articles did not explicitly comment on complications. One hundred four patients underwent penile replantation and two underwent penile transplantation. Satisfaction was high, although most studies did not use validated or quantified approaches to address satisfaction.
Phalloplasty techniques are evolving to include a number of different flaps, and most techniques have high reported satisfaction rates. Penile replantation and transplantation are also options for amputation or loss of phallus. Further studies are required to better compare different techniques to more robustly establish best practices. However, based on these studies, it appears that phalloplasty is highly efficacious and beneficial to patients.
Video Discussion by Paul S. Cederna, M.D., is Available Online for this Article.
Seattle, Wash.; Palo Alto and San Francisco, Calif.; and Lexington, Ky.
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington Medical Center; the Division of Plastic and Reconstructive Surgery, Department of General Surgery, Stanford University Medical Center; Brownstein and Crane Surgical Services; and the Division of Plastic Surgery, Department of Surgery, University of Kentucky College of Medicine.
Received for publication November 11, 2015; accepted April 28, 2016.
The first two authors contributed equally to this work.
Disclosure:The authors have no financial interest to declare in relation to the content of this article. No funding was used in the preparation of this article.
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A Video Discussion by William M. Kuzon Jr. M.D., Ph.D., accompanies this article. Go to PRSJournal.com and click on “Video Discussions” in the “Videos” tab to watch.
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