Penile reconstruction, or phalloplasty, is a surgical procedure to create the new penis for restoration of its functions i.e., urination and sexual activity. 

With phalloplasty, the surgery involves creation of a tube (the urethra) within a tube (the neophallus) with the help of tissues from other sites in the body. The neophallus contains nerves and blood vessels that are connected to the nerves and blood supply of the lower pelvis, with the inner tube being connected to the urethra. The head of the penis is sculpted out of the neophallus tissues.

INDICATION

• Partial or complete amputation of penis after trauma
• Removal of penis for treatment of penile cancer
• Buried penis(inadequate penis size to engage in sexual intercourse)
• Penile agenesis 
• Trans gender surgery(female to male)

GOALS

Creation of a functional and aesthetically pleasing phallus

BENEFITS

• Improves the quality of life
• Allow you to urinate properly
• Allow your clothes to fit as you remember them
• Give you the freedom to be in a locker room without feeling the need to hide
• Restore your masculinity
• Restore sexual confidence
• Improve your self-image

SURGICAL OPTIONS

Surgical options depend on the severity of trauma and the penile defect.  Usually more than one stage is needed. The absence of a substitute for the unique erectile tissue of the corpora render reconstruction difficult and challenging.

It requires microsurgical technique and transfer of tissue from other sites of the body to create the new penis. 

The most common donor site is the forearm, in which the forearm skin based on radial artery is used to create a tube within a tube structure of the penis. The inner tube forms the urethra(utilizing the non hair bearing part of the forearm skin) and the outer tube forms the structure of penis. It creates a cosmetically acceptable and sensate penis.

The other options are free osteon-cutaneous fibula flaps, anterolateral thigh flaps, latissimus dorsa flap and upper arm flaps but these are associated with poor cosmetic results.

Penile prosthesis implantation is performed after at least one year of phalloplasty to provide  adequate rigidity to allow patients to engage in penetrative sexual intercourse.

FAQs

1. What is the expected recovery?

 You need to avoid any strenuous activities, pushing, pulling, lifting, jumping, running, or straining for at least six weeks. Light activity encourages blood flow to your newly-reconstructed penis and is advised. You should not shower or wash your neophallus until advised.

2. What is the duration of the procedure?

The procedure involves microsurgical free tissue transfer and takes between 8-10 hours to be completed. It is performed under general anesthesia

3. How long is the hospital stay?

After microsurgical reconstruction, the new penile tissue needs monitoring to make sure the new penis has uninterrupted blood supply. You will need to stay in the hospital for 5-7 days.

4. What are the complications? Are there any long term effects?

The most feared complication is acute venous / arterial thrombosis of the microsurgical anastomosis(blockage of blood supply or drainage), which if not sorted in time, may lead to complete loss of the construct. The rest are infection, wound breakdown, fistula bleeding, cosmetic issues, sensory abnormalities, difficulty in urination and inability to perform sex.

The most common long-term complications are neo urethral stricture and fistulas. 

5. Is there any alternative to surgery?

No, the absent penis can only be reconstructed with surgery.

 

Written by :  Dr. Sobia Yasmeen

Copyrights: Pakistan association of Plastic Surgeons