Surgical Outcomes and Patients' Satisfaction with Suprapubic Phalloplasty

Abstract

Introduction Many techniques, specifically forearm free flap phalloplasty, are used in penile reconstructive surgery. Although satisfying, a major disadvantage is the large, stigmatizing scar on the donor site, which leads many patients to explore alternatives. Aim The aim of this study is to assess the outcomes and satisfaction of patients offered the choice between metaidioplasty, forearm free flap, and suprapubic phalloplasty. Methods Medical outcomes from the three-stage surgery were collected from the hospital files of 24 patients, who were also interviewed to assess their satisfaction, sexual function, and psychosexual well-being. Main Outcome Measures Medical complications, anthropometric measures, and interviewing questionnaire on satisfaction with appearance, sexual function, and psychological variables. Results Duration of surgery and of hospital stay was relatively short in the first (1 hour 30 minutes; 3 days) and last (1 hour 40 minutes; 3 days) stage of surgery involving tissue expansion and neophallus release. These two stages were associated with few complications (17% and 4% minor complications respectively, 12% additional complications with hospitalization for the first stage). The second stage involving tubing was associated with longer surgery and hospital stay (2 hour 15 minutes; 5 days) and had more complications (54% minor complications and 29% requiring hospitalization) although fewer than one-step surgery. No loss of neophallus was reported. Overall, 95% of patients were satisfied with their choice of phalloplasty, 95% with the appearance, 81% with the length (Mean = 12.83 cm), and 71% with the circumference (Mean = 10.83 cm) of their neophallus. Satisfactory appearance was significantly correlated (P < 0.01) with penile length (r = 0.69) and diameter (r = 0.77). Sexual satisfaction was significantly correlated with penile diameter (r = 0.758), frequency of orgasm (r = 0.71), perceived importance of voiding while standing (r = 0.56), presurgery satisfaction with sexuality (r = 0.58), current masculine–feminine scale (r = 0.58), attractive–unattractive scale (r = 0.69), and happy–depressed scale (r = 0.63). Conclusion Suprapubic phalloplasty, despite the lack of urethroplasty, offers an interesting alternative for patients concerned with the stigmatizing scar on the donor site.

Mystery and realities of phalloplasty: a systematic review

“…Timsit et al [21] reported 6 radial forearm free-flap phalloplasty operastions due to bladder exstrophy and unsatisfactory penile appearance and there were 3 complications in the postoperative period. Terrier et al [1] reported the results of 24 patients and 23 of them were due to female-to-male gender reassignment,1 of them was due to penile amputation. Neophallus survived in all patients and overall satisfaction was 95%.…”

“…Terrier et al [1] 24 23 Female-to-male transgender 1 Penil amputation Suprapubic phalloplasty (3 stages)…”

“…), surgical amputation of penis (penile cancer), traumatic penile amputation, female to male gender reassignment. [1,4] (Figure 1, 2). The bladder exstrophy ranges from 1/10000 to 1/50000 and males with bladder exstrophy may have ambiguus genitalia that requires surgical reconstruction.…”

“…[9] Neophallus should provide a satisfying and aesthetitc appearance and also neourethra should allow comfortable voiding while standing. [1,9,10] In addition, tactile and erogeneous sensibility, enough bulk for a stiffener insertion are also important features. [1,9,10] This study was designed for reviewing the literature for phalloplasty articles and comparing the results and complications of this surgery.…”

“…[1] Bogoras et al [2] reported the first penile reconstruction with successful micturation and coitus in 1936 by using a rib cartilage and an abdominal flap. Female to male gender reassignment surgery was firstly performed by Sir Harold Gillies.…”