Microvascular Staged Phalloplasty Preserving Original Glans in a Severe Hypospadias

Abstract

Summary:Penile reconstruction is usually performed in patients with gender dysphoria; with penile loss because of trauma, infection, and tumors; and with congenital deformities like severe hypospadias, in which standard techniques do not achieve a good result. Hypospadias are one of the most common inherent genital anomalies in boys. Many surgical procedures have been published for total phallic reconstruction aiming at a functionally and aesthetically pleasing. We present a case of reconstruction of the penis in a severe hypospadias in a 40-year-old man by transferring the original glans to the forearm flap and a stiffening procedure with an osteocutaneous fibular flap 3 months after first surgery. Three months postoperatively, the final result was an acceptable sexual intercourse, normal voiding, and quite normal appearance. Microvascular staged phalloplasty preserving original glans in a severe hypospadia could be considered a surgical option for micropenis. Technical difficulties and microsurgical advanced skills are the main drawback of this approach.

Mystery and realities of phalloplasty: a systematic review

“…This reconstructive operation is usually performed for gender reassignment and penile amputation(usually postoncologic). [25] Micropenis, epispadias, hypospadias are the less frequent indications. [25] Different surgical techniques would be used and for each techniques there are several benefits and limitations.…”

“…[25] Micropenis, epispadias, hypospadias are the less frequent indications. [25] Different surgical techniques would be used and for each techniques there are several benefits and limitations. [26] Metoidioplasty is one of these techniques and easier when comparing to other techniques but there are some important limitations like short phallus that does not allow for sexual penetration.…”