Latissimus dorsi phalloplasty combined with urethral lengthening as a one stage surgery for female transsexuals

Total phalloplasty represents creation of a neophallus from an extragenital tissue, and is one of the most difficult surgical procedures in female-to-male gender confirmation surgery. Urethral lengthening in is usually... [ view full abstract ]

Total phalloplasty represents creation of a neophallus from an extragenital tissue, and is one of the most difficult surgical procedures in female-to-male gender confirmation surgery. Urethral lengthening in is usually performed in a second stage, using buccal mucosa graft. However, urethral reconstruction with all available vascularized genital flaps, performed simultaneously with total phalloplasty, can produce neourethra long enough to ultimately enable voiding in standing position, without additional urethroplasty.

We present our results in musculocutaneous latissimus dorsi (MLD) free flap phalloplasty and urethroplasty. [ view full abstract ]

We present our results in musculocutaneous latissimus dorsi (MLD) free flap phalloplasty and urethroplasty.

From 2012 to 2016, 72 female transsexuals underwent total MLD free flap phalloplasty, without previously performed metoidioplasty. Our technique included: removal of female genitalia using transvaginal approach, creation of... [ view full abstract ]

From 2012 to 2016, 72 female transsexuals underwent total MLD free flap phalloplasty, without previously performed metoidioplasty. Our technique included: removal of female genitalia using transvaginal approach, creation of neophallus using latissimus dorsi free flap, clitoral incorporation into the base of the neophallus, urethral lengthening and insertion of testicular implants into the new created scrotum. Urethroplasty was performed by combining vaginal flap, labia minora and majora flaps, clitoral skin flap, as well as variety of local genital flaps. Penile prosthesis implantation was done in the second stage.

We report postoperative results based on the neophallic size, length and function of the neourethra, cosmetic appearance of new genitalia, patient’s satisfaction and postoperative complications. [ view full abstract ]

We report postoperative results based on the neophallic size, length and function of the neourethra, cosmetic appearance of new genitalia, patient’s satisfaction and postoperative complications.

Follow-up ranged from 10 to 51 months (mean 23 months). The mean neophallic length was 14 cm (range 12.5 to 18 cm), and the mean length of the neourethra was 9 cm (range 8 to 12.5 cm). Voiding in standing position was achieved... [ view full abstract ]

Follow-up ranged from 10 to 51 months (mean 23 months). The mean neophallic length was 14 cm (range 12.5 to 18 cm), and the mean length of the neourethra was 9 cm (range 8 to 12.5 cm). Voiding in standing position was achieved in 58 patients (80%). There were no cases of complete flap necrosis. There were five urethral fistulas and three strictures that required minor revision, while four fistulas resolved spontaneously. Most patients (86%) reported satisfaction with cosmetic outcome. Preserved erogenous sensation was reported in all cases, based on the clitoris incorporated at the base of the neophallus.

Total MLD flap phalloplasty with urethral lengthening in female transsexuals is challenging and complex surgical procedure, with good cosmetic outcome and preserved sexual arousal. It results in neophallus large enough to... [ view full abstract ]

Total MLD flap phalloplasty with urethral lengthening in female transsexuals is challenging and complex surgical procedure, with good cosmetic outcome and preserved sexual arousal. It results in neophallus large enough to enable implantation of penile prostheses, and enables voiding while standing. The main advantage is complete simultaneous reconstruction of neophallus and neourethra, in order to avoid multi-staged gender reassignment surgery.