Technical advances in penile reconstruction have been highlighted. The few long-term follow-up studies available confirm the difficulty of such surgery, in terms of complications and the limits of the final achievable outcomes. The surgery necessitates several steps and a high number of revisions. Scientific progress in penile reconstruction seems slow, with a lack of controlled studies, high rate of loss to follow-up (especially in sex reassignment surgery) and a lack of validated assessment measures. However, a few recent studies are making the problems clearer, especially in patient selection and the avoidance of raising false expectations in patients.