Functional outcomes after supra-pubic phalloplasty

Abstract

BACKGROUNDA thorough evaluation of the functional outcomes resulting from supra-pubic phalloplasty (SPP) assessing different aspects of the phalloplasty has not been reported. PURPOSE OF THE STUDYTo report the outcomes on sexuality, urinary function, satisfaction, and regrets following an SPP performed at our centre. SUBJECTS STUDIEDAll consecutive patients who underwent the 3-steps technique of pre-expanded SPP between 2007 and 2018 and who had at least 1 year of follow-up. METHODSQuestionnaires were sent to analyse several domains of penile reconstruction: sexuality, urinary function, perceived sensitivity, and satisfaction. Sexuality was evaluated using the Self Esteem and Relationship (SEAR) questionnaire. Urinary function was analysed based on the urethral stricture surgery PROM (USS-PROM) questionnaire. MAIN FINDINGSA total of 77 patients were included, 92.2% were transmen, and 33 (42.9%) responded to the questionnaire. Urethral lengthening (UL) was performed in 28 (36.4%) procedures and erectile prosthesis was implanted in 42 patients (54.5%). The mean length of the neophallus was 15.3cm (SD 2.6) and the mean girth was 11.8cm (SD 2.1). The mean total SEAR score (/100) was 73.8 (SD 26.7). The mean six-item LUTS score (/24) was 8.4 (SD 4.6). The standing position was the usual voiding position reported by 11 patients (73.3%). CONCLUSIONPre-expanded SPP is a robust technique that can achieve substantial flap dimensions, leading to high satisfaction with neophallus appearance and the choice of the phalloplasty technique. Overall sexual outcomes are mostly favourable. UL is feasible and effective in terms of voiding in a standing position.