Abstract
Phalloplasty for severe penile insufficiency is indeed a possible treatment for the complex group of patients having had several reconstructive surgeries for hypospadias, epispadias, bladder exstrophy, and cloacal exstrophy. Because of the possible complications of phalloplasty (urethral stenosis, fistula, and infection of penile stiffener) this treatment should only be reserved for patients in whom standard reconstructive techniques will be insufficient for adequate penile size and function. In case of a changed pelvic and inguinal anatomy, which is frequently the case after surgery for bladder or cloacal exstrophy, we highly recommend the anterolateral thigh flap to avoid microsurgical problems. If the patient wishes to avoid a visible scar at the forearm, the anterolateral thigh flap is a valuable option.
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