Radial forearm free flap phalloplasty for penile inadequacy in patients with exstrophy

Eric Z. Massanyi, Angela Gupta, Sameer Goel, John P. Gearhart, Arthur L. Burnett, Trinity J. Bivalacqua, Richard J. Redett

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

Purpose Male patients with bladder and cloacal exstrophy are born with demure genitalia and often desire phalloplasty during late adolescence or early adulthood. Radial forearm free flap phalloplasty was used successfully for congenital aphallia in a few small series. We present a series of patients treated with phalloplasty using a radial forearm free flap after the repair of bladder and cloacal exstrophy. Materials and Methods We reviewed the records of 10 patients who underwent radial forearm free flap phalloplasty between 2007 and 2012. Indications for phalloplasty were classic bladder exstrophy in 8 cases and cloacal exstrophy in 2. Nine patients underwent prior urinary diversion and 1 underwent urethroplasty at phalloplasty. In each case we reviewed the details of prior exstrophy repair, flap size, donor and recipient vessels, complications, need for subsequent surgeries and self-reported sensation. Results The graft survived in all 10 patients. Short-term complications requiring surgical intervention developed in 2 patients. Five patients subsequently underwent placement of a penile prosthesis and 2 devices were removed secondary to erosion. All 10 patients reported protective sensation and erogenous sensation with ability to achieve orgasm at last followup. Conclusions Radial forearm free flap phalloplasty results in a sensate, cosmetic neophallus. No patient had long-term complications related to phalloplasty but complications related to penile prostheses continue to be a challenging aspect of phalloplasty. The long-term results of the forearm free flap are encouraging in this series of patients with bladder and cloacal exstrophy who desired phalloplasty.

Original languageEnglish (US)
Pages (from-to)1577-1582
Number of pages6
JournalJournal of Urology
Volume190
Issue number4 SUPPL
DOIs
StatePublished - Oct 2013

Keywords

  • penis
  • prostheses and implants
  • reconstructive surgical procedures bladder exstrophy
  • surgical flaps

ASJC Scopus subject areas

  • Urology

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