Abstract
An increasing number of transgender and gender non-conforming patients are seeking genital gender affirming surgeries in order to better align their physical characteristics with their innate gender identity and treat gender dysphoria. Phalloplasty is the most complex of these surgeries, and this complexity creates a wide range of potential complications. Some of the most common complications and therefore, targets for improvement in outcomes, concern neourethral fistula/stricture, efficacy of reinnervation of the phalloplasty flap, postoperative flap monitoring, and donor site morbidity. In the setting of no established “gold standard”, this review seeks to describe the components and staging of phalloplasty, with an emphasis on established and experimental solutions to the most common and vexing problems.
Highlights
Gender dysphoria is the distress resulting from a marked incongruence between a patient’s natal sex and their innate gender identity
Treatment of gender dysphoria in transgender (TG), non-binary, and gender non-conforming patients (TGNC) may include both medical and surgical interventions using shared decision making to customize treatment plans according to individual patient goals
We have created an experimental protocol for patients with thick anterolateral thigh flaps (ALT) flap donor sites who request ALT phalloplasty and will not/cannot consider radial forearm flaps (RFF) phalloplasty
Summary
Gender dysphoria is the distress resulting from a marked incongruence between a patient’s natal sex and their innate gender identity. Some targets for improvement in outcomes concern neourethral fistula/stricture, efficacy of reinnervation of the phalloplasty flap, postoperative flap monitoring, and donor site morbidity. Centers like ours that usually perform phalloplasty, vaginectomy, scrotoplasty and urethral lengthening in a single stage have shown decreased rates of flap-related complications and increased patient satisfaction[10].
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