Total phallic reconstruction in the genetic male
BAUS ePoster online library. Chiriaco G. Jun 24, 2019; 259537; P4-8 Disclosure(s): none
Giovanni Chiriaco
Giovanni Chiriaco
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Abstract
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INTRODUCTION: Total phallic reconstruction (TPR) for the genetic male with congenital or acquired penile inadequacy is performed using a radial artery-based forearm free flap (RAFFF).
METHODS:
108 genetic male patients underwent a TPR using a RAFFF as a multiple staged procedure 1) TPR with RAFFF 2) glans sculpting 3) penile prosthesis implantation. A urethroplasty was performed in one (80.6%) or two stages (19.4%) depending on the quality of the previously reconstructive native urethra. Patient reported outcomes measures (PROM) were assessed through a 4-items 'ad hoc' created questionnaire and a 5-point Likert.
RESULTS:
The median age at the time of TPR was 32.5 years (IQR 24-46) and median follow-up was 78.5 mths (IQR 30-129). The aetiologies were: penile cancer (26%), bladder exstrophy (30%), micropenis (26%) and traumatic amputation (18%). 77 patients completed all stages.
PROMS showed that 80% of patients were fully satisfied with the cosmetic appearance and size of the neo-phallus, 76% achieved orgasm through masturbation or sex intercourse, 76% would have the operation again and 90% would recommend the operation to a friend.
Complications included: acute arterial thrombosis(n = 4) with complete phallus loss in 2, partial necrosis of the neo-phallus due to venous ischemia (n=21) managed by local flap reconstruction or grafting. The overall incidence of urethral complications was 60% (32% fistula and 28% stricture) with 2 patients ending up with a permanent perineal urostomy.
CONCLUSIONS:
Despite the high incidence of postoperative, TPR in the genetic male using a RAFFF yields excellent aesthetic and functional results
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