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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 Urology5.65
· DOI :10.1016/j.juro.2014.03.105
Giulio Garaffa18
Estimated H-index: 18
(UCL: University College London),
Marco Spilotros2
Estimated H-index: 2
(UCL: University College London)
+ 1 AuthorsDavid Ralph44
Estimated H-index: 44
(UCL: University College London)
Cite
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 (18)
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References29
Newest
Published on Oct 1, 2013in The Journal of Urology5.65
Eric Z. Massanyi7
Estimated H-index: 7
(JHUSOM: Johns Hopkins University School of Medicine),
Angela D. Gupta6
Estimated H-index: 6
(JHUSOM: Johns Hopkins University School of Medicine)
+ 4 AuthorsRichard J. Redett7
Estimated H-index: 7
(JHUSOM: Johns Hopkins University School of Medicine)
Purpose: Male patients with bladder and cloacal exstrophy are born with demure genitalia and often desire phalloplasty during late adolescence or early adulthood. Radial forearm free flap phalloplasty was used successfully for congenital aphallia in a few small series. We present a series of patients treated with phalloplasty using a radial forearm free flap after the repair of bladder and cloacal exstrophy.Materials and Methods: We reviewed the records of 10 patients who underwent radial forear...
Published on Jul 1, 2012in The Journal of Sexual Medicine3.65
Salvatore Sansalone19
Estimated H-index: 19
(Sapienza University of Rome),
Giulio Garaffa18
Estimated H-index: 18
(UCL: University College London)
+ 6 AuthorsDavid Ralph44
Estimated H-index: 44
(UCL: University College London)
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...
Published on Jan 1, 2012in The Journal of Sexual Medicine3.65
Salvatore Sansalone19
Estimated H-index: 19
(Sapienza University of Rome),
Giulio Garaffa18
Estimated H-index: 18
(UCL: University College London)
+ 5 AuthorsDavid Ralph44
Estimated H-index: 44
(UCL: University College London)
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...
Published on Apr 1, 2010in European Urology17.30
Giulio Garaffa18
Estimated H-index: 18
,
A. Nim Christopher15
Estimated H-index: 15
,
David Ralph44
Estimated H-index: 44
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...
Published on Feb 1, 2010in European Urology17.30
Piet Hoebeke43
Estimated H-index: 43
(Ghent University Hospital),
Karel Decaestecker14
Estimated H-index: 14
(Ghent University Hospital)
+ 3 AuthorsStan Monstrey47
Estimated H-index: 47
(Ghent University Hospital)
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...
Published on Sep 1, 2009in BJUI4.52
Giulio Garaffa18
Estimated H-index: 18
,
Amr Abdel Raheem11
Estimated H-index: 11
+ 1 AuthorsDavid Ralph44
Estimated H-index: 44
OBJECTIVE To report our experience of total phallic reconstruction (TPR) with the use of the radial-artery free flap (RAFF) in patients who have had a subtotal penectomy for penile or urethral cancer, as the goal of TPR is the creation of a sensate and cosmetically acceptable phallus with an incorporated neourethra that allows the patient to void while standing, and with the insertion of a penile implant to resume sexual activities, improving quality of life. PATIENTS AND METHODS The notes of th...
Published on Aug 1, 2009in Plastic and Reconstructive Surgery3.95
David A. Gilbert14
Estimated H-index: 14
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
Published on May 1, 2009in BJUI4.52
Marc-Olivier Timsit20
Estimated H-index: 20
,
Pierre Mouriquand2
Estimated H-index: 2
+ 6 AuthorsNicolas Morel-Journel5
Estimated H-index: 5
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...
Published on Jan 1, 2005in BJUI4.52
Carlo Bettocchi18
Estimated H-index: 18
(University of Bari),
David Ralph44
Estimated H-index: 44
,
John P. Pryor16
Estimated H-index: 16
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...
William G. Reiner21
Estimated H-index: 21
(Johns Hopkins University),
John Phillip Gearhart51
Estimated H-index: 51
(Johns Hopkins University),
Robert D. Jeffs38
Estimated H-index: 38
(Johns Hopkins University)
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 ...
Cited By18
Newest
Published on Feb 1, 2019in Seminars in Plastic Surgery0.56
Jason E. Cohn1
Estimated H-index: 1
(PCOM: Philadelphia College of Osteopathic Medicine),
Bradley Kropp + 2 AuthorsBradley Kropp
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...
Published on Jun 1, 2018in Current Urology Reports2.08
Geolani W. Dy5
Estimated H-index: 5
(UW: University of Washington),
Jeff Sun1
Estimated H-index: 1
(NYU: New York University)
+ 1 AuthorsLee C. Zhao16
Estimated H-index: 16
(NYU: New York University)
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.
Published on Feb 1, 2018in Journal of Plastic Reconstructive and Aesthetic Surgery2.23
Amy Yao3
Estimated H-index: 3
(ISMMS: Icahn School of Medicine at Mount Sinai),
Michael J. Ingargiola3
Estimated H-index: 3
(ISMMS: Icahn School of Medicine at Mount Sinai)
+ 4 AuthorsPeter J. Taub15
Estimated H-index: 15
(ISMMS: Icahn School of Medicine at Mount Sinai)
Abstract 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 transpla...
Published on Jan 1, 2018in BJUI4.52
Marco Falcone7
Estimated H-index: 7
(UCL: University College London),
Giulio Garaffa18
Estimated H-index: 18
(UCL: University College London)
+ 3 AuthorsDavid Ralph44
Estimated H-index: 44
(UCL: University College London)
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...
Published on Dec 1, 2017in Current Sexual Health Reports
Geolani W. Dy5
Estimated H-index: 5
(UW: University of Washington),
Aaron C. Weinberg1
Estimated H-index: 1
(NYU: New York University),
Lee C. Zhao16
Estimated H-index: 16
(NYU: New York University)
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.
Published on Dec 1, 2017in Current Sexual Health Reports
Marco Falcone7
Estimated H-index: 7
,
M. Sibona3
Estimated H-index: 3
+ 7 AuthorsGiulio Garaffa18
Estimated H-index: 18
(UCL: University College London)
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.
Published on Sep 1, 2017in Actas Urologicas Espanolas1.14
J.C. Angulo32
Estimated H-index: 32
(UEM: European University of Madrid),
I. Arance8
Estimated H-index: 8
(UEM: European University of Madrid)
+ 3 AuthorsJ.L. Fernández-Cañamaque1
Estimated H-index: 1
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...
Published on Sep 1, 2017in Actas Urologicas Espanolas1.14
J.C. Angulo32
Estimated H-index: 32
(UEM: European University of Madrid),
I. Arance8
Estimated H-index: 8
(UEM: European University of Madrid)
+ 3 AuthorsJ.L. Fernández-Cañamaque1
Estimated H-index: 1
Resumen Introduccion La perdida del pene de causa iatrogenica es una circunstancia muy infrecuente. Se presenta un caso desafiante de reconstruccion peneana total diferida en varon genetico. Material y metodos Varon de 57 anos con perdida del falo por absceso peneano y necrosis secundaria a cirugia de incurvadura peneana. La reconstruccion se realizo en varios tiempos empleando colgajo libre de antebrazo radial (CLAR) y colocacion de protesis inflable personalizada un ano despues. Resultados En ...
Published on Sep 1, 2017in Microsurgery1.95
Alvin C. Kwok11
Estimated H-index: 11
(UofU: University of Utah),
Jayant P. Agarwal16
Estimated H-index: 16
(UofU: University of Utah)
Purpose We sought to use the NSQIP database to determine the national rate and predictors of free flap failure based upon flap sites and flap types. Methods Free flaps were identified using the 2005–2010 NSQIP database. We examined overall flap failure rates as well as failure rates based upon flap sites (head and neck, extremities, trunk, and breast) and flap types (muscle, fascial, skin, bone, and bowel flaps). Univariate and multivariate analyses were used to determine predictors of flap fail...
View next paperInflatable penile prosthesis technique and outcomes after radial forearm free flap neophalloplasty