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Total Phallic Reconstruction Using Radial Artery Based Forearm Free Flap Phalloplasty in Patients with Epispadias-Exstrophy Complex

Published on Sep 1, 2014in The Journal of Urology5.647
· DOI :10.1016/j.juro.2014.03.105
Giulio Garaffa19
Estimated H-index: 19
(UCL: University College London),
Marco Spilotros2
Estimated H-index: 2
(UCL: University College London)
+ 1 AuthorsDavid J. Ralph46
Estimated H-index: 46
(UCL: University College London)
Abstract
Purpose: We report our experience with total phallic construction using the radial artery forearm free flap in patients with bladder/cloacal exstrophy and micropenis-epispadias complex.Materials and Methods: We retrospectively reviewed notes on the 16 patients with bladder/cloacal exstrophy and micropenis-epispadias complex treated with total phallic construction using the radial artery based forearm free flap between January 2003 and October 2013. Surgical outcome, phallic cosmesis, complications, eventual need for revision surgery and patient satisfaction were recorded during followup.Results: This technique allowed reconstruction of a cosmetically acceptable phallus in 15 patients. In 1 patient the distal third of the phallus was lost due to acute thrombosis of the arterial anastomosis immediately postoperatively. At a median followup of 20.5 months (range 2 to 38) 15 patients (93%) were fully satisfied with phallic cosmesis and size. Urethral stricture and fistula were the most common complications, w...
  • References (29)
  • Citations (19)
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References29
Newest
#1Eric Z. Massanyi (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 8
#2Angela D. Gupta (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 6
Last. Richard J. Redett (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 23
view all 7 authors...
23 CitationsSource
#1Salvatore Sansalone (Sapienza University of Rome)H-Index: 21
#2Giulio Garaffa (UCL: University College London)H-Index: 19
Last. David J. Ralph (UCL: University College London)H-Index: 46
view all 9 authors...
ABSTRACT Introduction Implantation of a penile prosthesis in severely scarred corporal bodies represents a great challenge as fibrosis can compromise dilatation and subsequent closure of the corpora cavernosa and limit size, type, and function of the device. Aim The aim of this study is to report our experience of simultaneous corporeal reconstruction and penile prosthesis implantation in patients with severe penile contracture consequence of diffuse fibrosis. Methods Between March 2006 and Febr...
22 CitationsSource
#1Salvatore Sansalone (Sapienza University of Rome)H-Index: 21
#2Giulio Garaffa (UCL: University College London)H-Index: 19
Last. David J. Ralph (UCL: University College London)H-Index: 46
view all 8 authors...
ABSTRACT Introduction Due to loss of length, patients who had penile prosthesis implantation for Peyronie's disease (PD) show a statistically significant reduction in their levels of satisfaction when compared with the general implant population. Aim The aim of this study is to report our experience of penile lengthening with circumferential graft during penile prosthesis implantation in patients with PD and severe penile shortening. Methods Between March 2006 and February 2008, 23 patients with...
52 CitationsSource
#1Giulio GaraffaH-Index: 19
#2A. Nim ChristopherH-Index: 16
Last. David J. RalphH-Index: 46
view all 3 authors...
Abstract Background The goal of total phallic construction is the creation of a sensate and cosmetically acceptable phallus. An incorporated neourethra allows the patient to void while standing, and the insertion of a penile implant allows the patient to resume sexual activities, thus improving quality of life. Objective To report our experience of total phallic construction with the use of the radial artery free flap in female-to-male transsexuals. Design, settings, and participants The notes o...
57 CitationsSource
#1Piet Hoebeke (Ghent University Hospital)H-Index: 45
#2Karel Decaestecker (Ghent University Hospital)H-Index: 15
Last. Stan Monstrey (Ghent University Hospital)H-Index: 49
view all 6 authors...
Abstract Background The combination of a neourethra and erection prosthesis in a single neophallus in the female-to-male transsexual remains a challenge. No good data are available on this subject. Objective To report the outcome in 129 female-to-male transsexuals with a neophallus after the implantation of an erectile prosthesis. Design, setting, and participants From March 1996 until October 2007, 129 female-to-male transsexuals with a neophallus underwent the implantation of an erectile prost...
76 CitationsSource
#1Giulio GaraffaH-Index: 19
#2Amr Abdel RaheemH-Index: 11
Last. David J. RalphH-Index: 46
view all 4 authors...
57 CitationsSource
#1Stan MonstreyH-Index: 49
#2Piet HoebekeH-Index: 45
Last. Griet De CuypereH-Index: 24
view all 10 authors...
Sir:Having been involved in genitourinary reconstruction for the past 30 years, I read with interest the article entitled “Penile Reconstruction: Is the Radial Forearm Flap Really the Standard Technique?” by Monstrey et al. (Plast Reconstr Surg. 2009;124:510–518).The authors represent a well-recogni
117 CitationsSource
#1Marc-Olivier TimsitH-Index: 20
#2P. MouriquandH-Index: 5
Last. Nicolas Morel-JournelH-Index: 5
view all 9 authors...
OBJECTIVE To assess the long-term outcome and cosmetic results of forearm free-flap phalloplasty for correcting micropenis associated with bladder exstrophy in men. PATIENTS AND METHODS From 1992 to 2000, six men with bladder exstrophy and unsatisfactory penile appearance underwent phalloplasty at our institution. The mean (range) follow-up was 113 (62–153) months. The surgical procedure consisted of a modified radial free-flap phalloplasty and prosthesis implantation. One-stage urethroplasty wa...
18 CitationsSource
#1Carlo Bettocchi (University of Bari)H-Index: 19
#2David J. RalphH-Index: 46
Last. John P. PryorH-Index: 19
view all 3 authors...
OBJECTIVE To describe a novel phalloplasty technique and to study the results and complications in female patients with gender dysphoria. PATIENTS AND METHODS Between 1989 and 2000, 85 female-to-male transsexual patients had a phalloplasty fashioned from suprapubic abdominal wall flap that was tubed to form the phallus, and which incorporated the neourethra made from a pedicled tube of labial skin. The complete neourethral reconstruction was in one stage in 32 patients and in two in 48; five pat...
85 CitationsSource
#1William G. Reiner (Johns Hopkins University)H-Index: 21
#2John Phillip Gearhart (Johns Hopkins University)H-Index: 51
Last. Robert D. Jeffs (Johns Hopkins University)H-Index: 39
view all 3 authors...
ABSTRACT Objective To assess psychosexual function in adolescent males with genital anomalies. Method Fourteen consecutive males with bladder exstrophy-epispadias, 14 to 19 years old, Tanner stages IV to VI, were assessed along with their parents, using a developmental questionnaire, Hollingshead socioeconomic status rating, Child Behavior Checklist, Youth Self-Report, semistructured psychiatric interview, detailed sexual history, and 5 written, open-ended questions. Results All subjects showed ...
59 CitationsSource
Cited By19
Newest
#1Céline Sinatti (Ghent University Hospital)
#2M. Waterschoot (Ghent University Hospital)
Last. Anne-Françoise Spinoit (Ghent University Hospital)H-Index: 8
view all 6 authors...
Exstrophy-epispadias complex (EEC) is a spectrum of genitourinary malformations that ranges in severity and affects external genitalia and the lower urinary tract. The aim of this study was to determine the long-term sexual outcomes of patients with EEC. Sexual outcomes were hypothesized to be related to those of urinary ones. A retrospective database including all patients with EEC who had surgery at a tertiary referral institution from 1990 to 2019 was created. Data based on patient’s charts w...
Source
#1Maurice M. Garcia (UCSF: University of California, San Francisco)H-Index: 19
Many patients who identify as transgender and gender non-binary describe being unable to engage in a fulfilling sexual life before genital gender-affirming surgery. Negative feelings patients may have toward their own genitals may make it difficult (for some, impossible) to find any pleasure in activity related to their genitals (Garcia, Transl Androl Urol. 3(2):156–62, 2014, Garcia et al. Genital gender affirming surgery for transgender patients: American Urologic Association; 2017. AUA Update ...
Source
#1Marco Falcone (UNITO: University of Turin)H-Index: 9
#2Giulio Garaffa (UCL: University College London)H-Index: 19
To date several conditions may require a total phallic reconstruction (TPR). Among them, the most frequent are gender dysphoria, penile trauma, penile cancer and congenital micropenis.
Source
#2Jason E. Cohn (PCOM: Philadelphia College of Osteopathic Medicine)H-Index: 1
Last. Yadranko DucicH-Index: 9
view all 5 authors...
Phalloplasty can be a challenging plastic surgery procedure associated with complications and unsatisfactory results. Phalloplasty has become an important procedure in the setting of trauma, partial or complete excision of the penis, and gender affirmation. Advances in microsurgery has expanded penile reconstruction through free tissue transfer techniques which include the radial forearm free flap, fibular osteocutaneous flap, anterolateral thigh flap, latissimus dorsi flap, scapular flap, and a...
Source
#1Amy Yao (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 4
#2Michael J. Ingargiola (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 3
Last. Peter J. Taub (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 16
view all 7 authors...
Summary Background Phalloplasty poses a unique challenge to the plastic and reconstructive surgeon. The development of advanced microsurgical techniques has greatly augmented the range of surgical approaches available. Methods A systematic review of the MEDLINE and Cochrane databases was performed to identify clinical studies of total penile reconstruction published within the last 10 years using the search algorithm: “(phallus or penis or penile) and (reconstruction or phalloplasty or transplan...
3 CitationsSource
#1Geolani W. Dy (UW: University of Washington)H-Index: 5
#2Jeff Sun (NYU: New York University)H-Index: 1
Last. Lee C. Zhao (NYU: New York University)H-Index: 17
view all 4 authors...
Purpose of Review A growing number of transgender patients are seeking gender-affirming genital reconstructive surgery (GRS). These complex procedures have high complication rates. We describe common surgical pitfalls in GRS and approaches for minimizing complications.
5 CitationsSource
#1Marco Falcone (UCL: University College London)H-Index: 9
#2Giulio Garaffa (UCL: University College London)H-Index: 19
Last. David J. Ralph (UCL: University College London)H-Index: 46
view all 6 authors...
Objectives To assess the oucomes of penile prosthesis (PP) implantation after total phallic reconstruction secondary to gender dysphoria (GD). Subject/patients and methods We conducted a retrospective single center analysis of 247 consecutive patients. The recruitment time was between January 2001 and October 2015. A total of 328 inflatable PP were implanted. A two-staged inflatable PP implantation was carried out. As a first step, an extraperitoneal reservoir placement was performed simultaneou...
8 CitationsSource
#1Marco FalconeH-Index: 9
#2M. SibonaH-Index: 4
Last. Giulio Garaffa (UCL: University College London)H-Index: 19
view all 10 authors...
Purpose of Review The aim of this manuscript is to systematically review the current literature on surgical management of the short penis, focusing on surgical and functional outcomes and postoperative complications.
Source
#1Geolani W. Dy (UW: University of Washington)H-Index: 5
#2Aaron C. Weinberg (NYU: New York University)H-Index: 2
Last. Lee C. Zhao (NYU: New York University)H-Index: 17
view all 3 authors...
Purpose of Review Phalloplasty may be performed in patients with acquired or congenital penile insufficiency or transgender individuals who desire phallic construction. Demand for neophallus creation and prosthesis placement has increased in recent years with growing coverage for gender affirming surgery among transgender patients. This report describes consideration of prosthetic implantation in neophallic reconstruction.
1 CitationsSource
#1Javier C. Angulo (UEM: European University of Madrid)H-Index: 32
#2I. Arance (UEM: European University of Madrid)H-Index: 9
view all 6 authors...
Abstract Introduction The iatrogenic loss of the penis is a rare situation. We present a challenging case of deferred total penile reconstruction in a genetic male. Material and methods A 57-year-old man with the loss of the penis due to a penile abscess and necrosis secondary to penile curvature surgery. The reconstruction was performed over several operations using a radial forearm free flap (RFFF) and placement of a customized inflatable prosthesis a year later. Results During the first opera...
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