Conventional surgical techniques and emerging transplantation in complex penile reconstruction

Abstract

Complex penile reconstruction continues to pose a significant challenge to surgeons and patients alike. The ideal phalloplasty is one that can be reproducibly performed in a single stage, creates a neourethra that allows for voiding while standing, produces a phallus with tactile and erogenous sensation, allows for penetrative sexual intercourse, and offers satisfactory aesthetic results. With recent advances in microsurgery and perforator flap dissection, several techniques and modifications thereof have been described that aim to achieve these reconstructive goals. All of these now conventional techniques, however, fall short in one way or another-often with regards to urinary transport, the ability to achieve an erection, and the need for multiple surgical stages and revision operations. These limitations of conventional reconstruction have led some surgeons to explore new avenues for complex penis reconstruction, giving birth to the novel field of penile transplantation. In this article, we discuss the complexities of male genitourinary reconstruction in the context of conventional methods for reconstruction as well as the burgeoning field of penile transplantation.

Lessons learned from the first 15 years of penile transplantation and updates to the Baltimore Criteria

“…Second, recipients should be seeking a reconstructive outcome that can only be provided by penile tissue: that is, spontaneous erections, capacity for penetrative intercourse without an implant, and penile function and cosmesis that parallels a native penis. These patients should not be candidates for traditional reconstructive modalities owing to substantial tissue loss at potential donor sites (such as forearm skin and neurovasculature used for radial forearm free flap) or other reasons such as previous failed attempts at reconstruction (such as graft-, flap-, or prosthesis-based approaches) 36 , 37 .…”