Phallic Construction Research Articles

Management of penile amputation injuries.

Penile amputation is an uncommon injury resulting from self-mutilation, felonious assault, or accidental trauma. Management requires resuscitation and stabilization of the patient with particular attention to underlying psychiatric illness. Amputated tissue can be preserved under hypothermic conditions in preparation for surgical replantation. Current replantation techniques rely on microsurgical approximation of the dorsal structures and cavernosal arteries with uniformly good results. Phallic replacement may be necessary when the amputated segment is lost. Microsurgical free forearm flap phalloplasty is the current mainstay of penile replacement surgery. Although urethral complications remain problematic, the results continue to be acceptable with regard to appearance and function. A unique subset of patients sustaining amputation injury is children. Both replantation and phallic construction have been successful in children and represent an alternative to gender reassignment.

Vaginectomy and laparoscopically assisted vaginal hysterectomy as adjunctive surgery for female-to-male transsexual reassignment: preliminary report

Objective: Reassignment surgery of the female-to-male transsexual is a rarely performed surgical procedure that should involve a gynecologist’s consultation and expertise. This study examines the experience with this type of surgery at Baskent University Hospital, Ankara, Turkey, from the gynecologists’ point of view. Study design: Eight patients underwent laparoscopically assisted vaginal hysterectomy, bilateral salpingo-oophorectomy and total vaginectomy, followed by phallic construction. Patients were followed up for 9 to 30 months post-surgery. Results: The average operative time for total vaginectomy and laparoscopically assisted vaginal hysterectomy and bilateral salpingo-oophorectomy was 2 h and 20 min. The estimated average blood loss was 250 ml. Other than one bladder perforation, which was repaired immediately and healed uneventfully, we encountered no operative or postoperative complications linked to the gynecologic surgery. Conclusion: Laparoscopy seems to be useful in female-to-male transsexual surgery in allowing the preservation of structures vital for phallic construction, such as inferior epigastric vessels and the rectus abdominis muscle. The application of vaginectomy awaits justification through long-term follow-up studies of transsexuals who have undergone colpocleisis.

Penile reconstruction, phallic construction, and urethral reconstruction

Penile reconstruction, phallic construction, and urethral reconstruction require tissue transfer in the majority of cases. This article discusses the techniques of tissue transfer and presents illustrative cases of penile reconstruction, total phallic construction, and urethral reconstruction. The modified forearm flaps for penile reconstruction, the ulnar forearm flap as used for total phallic construction, and the dartos fascial flap and penile skin islands for urethral reconstruction are illustrated. Graft onlay techniques also are shown.

URETHROPLASTY FOLLOWING TOTAL PHALLIC RECONSTRUCTION

Purpose Total phallic reconstruction is often complicated by recalcitrant strictures particularly at the native-to-neourethral anastomosis, which may ultimately require definitive repair. Presumably these strictures form as a result of relative ischemia at the anastomosis of tissues of native urethra to fasciocutaneous tube flap, which is exacerbated by kinking at the neophallus base. The traditional approaches to urethroplasty, such as end-to-end anastomosis, and penile or preputial skin grafts and flaps, are not available for this population. Therefore, extragenital grafts and flaps become important for managing repair of urethral strictures in the neophallus. In addition, an unusual recipient bed of fat and fascia complicates the repair of these strictures. We review our experience with 15 patients who underwent penile reconstruction. Materials and Methods A total of 15 patients 17 to 50 years old had a radial forearm flap except 1 who had a fibula based flap. Nine urethroplasties were performed on 8 patients who were followed for a mean of 31.8 months. The approaches comprised 3, 2-stage mesh graft urethroplasties, 1 full-thickness skin tube graft, 1 bladder mucosa tube graft, 1 vagina labial pedicle tube flap and, most recently, 3 buccal mucosa onlay grafts. The length of strictures ranged from 3 to 12 cm. Urethroplasty was performed 2 to 34 months after phallic construction. Results Urinary flow rates in patients with buccal mucosa urethroplasty averaged 18 cc per second and no strictures recurred. These results are superior to those of other urethroplasty techniques in this patient population. Conclusions A full array of surgical options must be available to the reconstructive surgeon but buccal mucosa grafting seems to be a promising approach to strictures in this patient population.

Adjuvant Home Urethral Balloon Dilation for the Recalcitrant Urethral Stricture

Purpose We determined the efficacy of adjuvant home balloon self-dilation as an alternative to office dilation and to reduce the likelihood of recurrence in patients with recalcitrant urethral strictures. Materials and Methods A total of 31 men participated in a urethral self-dilating protocol following phallic construction, urethroplasty or visual internal urethrotomy, or as conservative management in 2 nonoperative candidates. Uroflow data and subjective information obtained by blinded questionnaire were reviewed. Results The 31 patients were followed for a mean of 18.7 months (range 3 to 45) after initial balloon dilation, and 25 (81%) were available for followup interviews. Of the 25 patients 24 (96%) found no difficulty in learning the technique and 21 (84%) thought they received adequate training with 1 office visit. Most patients noted improvement in voiding with balloon dilation, and peak uroflowmetry rates were preserved or improved with long-term followup. Six patients (19%) complained of discomfort with balloon placement, 3 (10%) noticed minor bleeding with dilation and 4 (13%) had urinary tract infections during followup. Following visual internal urethrotomy, no stricture recurrences were noted in 9 patients. Strictures recurred in 2 of 13 (15%) urethroplasty patients following balloon dilation. After radial forearm free flap phallic construction, a technique known to have a high re-stricture rate, 5 of 7 patients (71%) had recurrent urethral stricture. Conclusions Preliminary results indicate that adjuvant outpatient urethral self-dilation following surgical correction of urethral strictures in patients at high risk for recurrence is inexpensive and safe, as well as a potentially effective option in reducing stricture recurrence and maintaining urethral patency.

Phallic Construction and Penile Reconstruction

The term phallus originates from the Greek word meaning “penis-like,” or “primordial penis.” Thus, any manmade creation of a “penis” is correctly, by definition, a phallus. The reproductive function, combined with the need for a urethra, makes penile reconstruction and phallic construction challenging. Ideally, each should be done in a single stage that is reliably reproducible. The phallus or reconstructed penis should have both tactile and erogenous sensibility created or maintained. The organ must be created with a competent neourethra that will allow voiding while standing. In most patients, there are concerns about subsequent capacity for insertion of a prosthetic stiffener to allow for successful intercourse. The phallus must be aesthetically acceptable to both patient and partner, and in the case of prepubertal phallic construction the phallus must grow so that it will have an acceptable adult size. Modern tissue transfer and reconstructive surgical and microsurgical techniques allow achievement of these objectives; however, they have yet to be achieved in a single-stage procedure.

Straight Sex; the Politics of Pleasure

Book synopsis: Is heterosexual sex inherently damaging to women? Is it possible for women to enjoy sensuality and pleasure with men that does not increase male power? Lynne Segal's unflinching examination of feminist thinking on sexuality over the past twenty-five years tackles these questions head on. Straightforward and challenging, she invites an exploration of sex in our culture - an exploration that could reverse the traditional male gaze and phallic construction of the heterosexual woman. Only two decades ago, politically aware women often declared themselves both sexual liberationists and feminists - their right to sexual fulfillment symbolized their right to selfhood. However, the most positive women's writing on female sexuality in recent years has come primarily from the lesbian community.Segal addresses the silence of heterosexual feminists on questions of sex and love and notes the shift toward sexual conservatism. She looks at the trends that followed Sixties radicalism: sex as a subversive activity, the liberated orgasm, sex advice literature, gender uncertainties, Queer politics, antipornography campaigns, the rise of the moral right. The hidden anxieties of male sexuality are also discussed.For both men and women, says Segal, our wildest dreams and worst fears are often projected onto sex. She urges an understanding of how our personal pleasures and pains remain public issues, and how a rethinking of sexual liberation could inspire a truly progressive politics for our time. is always another whom we try to reach when we experience desire, it is their physical contact we want - sometimes, any sort of contact will suffice ...and by whom we yearn to feel ourselves desired. It is the very greatest of joys, as I experience it ...simply to know that we are able to desire, maybe even able to love, some other human adult. - from the book.

Prosthetic implantation after phallic construction.

Prosthetic implantation after phallic construction.

Staged approach to phallic construction and penile reconstruction

MicrosurgeryVolume 16, Issue 5 p. 309-313 Original Article Staged approach to phallic construction and penile reconstruction Ph. Legaillard M.D., Corresponding Author Ph. Legaillard M.D. Department of Plastic and Reconstructive Surgery, Hôpital du Tondu, Bordeaux, FranceDepartment of Plastic and Reconstructive Surgery, Hôpital du Tondu, 33076 Bordeaux, FranceSearch for more papers by this authorPh. Pelissier M.D., Ph. Pelissier M.D. Department of Plastic and Reconstructive Surgery, Hôpital du Tondu, Bordeaux, FranceSearch for more papers by this authorD. Martin M.D., D. Martin M.D. Department of Plastic and Reconstructive Surgery, Hôpital du Tondu, Bordeaux, FranceSearch for more papers by this authorJ. Baudet M.D., J. Baudet M.D. Department of Plastic and Reconstructive Surgery, Hôpital du Tondu, Bordeaux, FranceSearch for more papers by this author Ph. Legaillard M.D., Corresponding Author Ph. Legaillard M.D. Department of Plastic and Reconstructive Surgery, Hôpital du Tondu, Bordeaux, FranceDepartment of Plastic and Reconstructive Surgery, Hôpital du Tondu, 33076 Bordeaux, FranceSearch for more papers by this authorPh. Pelissier M.D., Ph. Pelissier M.D. Department of Plastic and Reconstructive Surgery, Hôpital du Tondu, Bordeaux, FranceSearch for more papers by this authorD. Martin M.D., D. Martin M.D. Department of Plastic and Reconstructive Surgery, Hôpital du Tondu, Bordeaux, FranceSearch for more papers by this authorJ. Baudet M.D., J. Baudet M.D. Department of Plastic and Reconstructive Surgery, Hôpital du Tondu, Bordeaux, FranceSearch for more papers by this author First published: 1995 https://doi.org/10.1002/micr.1920160505Citations: 4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume16, Issue51995Pages 309-313 RelatedInformation

Ulnar forearm phallic construction and penile reconstruction.

Ulnar forearm phallic construction and penile reconstruction.

Penile Prosthesis Implantation in Total Phalloplasty

A series is presented of 8 patients who had undergone either total phalloplasty or free flap penile reconstruction. Our experience with prosthetic implantation is reviewed as is a brief history of phallic construction, including previously reported efforts at achieving rigidity with prosthetic implantation, autologous material implantation and so forth. We present in detail our current technique of implantation in these 8 patients, who underwent 10 attempts at implantation. In 4 patients infection necessitated removal of the prosthesis (2 have since undergone successful reimplantation). Of the 8 patients in whom implantation was attempted 6 (60%) currently have prostheses in place.

Phallic construction in prepubertal and adolescent boys : D.A. Gilbert, G.H. Jordan, C.J. Devine, Jr, et al. J Urol 149:1521–1526, (June), 1993

Phallic construction in prepubertal and adolescent boys : D.A. Gilbert, G.H. Jordan, C.J. Devine, Jr, et al. J Urol 149:1521–1526, (June), 1993

Phallic Construction in Female-to-Male Transsexuals Using a Lateral Upper Arm Sensate Free Flap and a Bladder Mucosa Graft

We devised a technique for phalloplasty in a female-to-male transsexual combining the lateral upper arm free flap with a bladder mucosa graft, to address the ideal requirements of phalloplasty in the best possible way. The surgical techniques are described. Healing of the phallus has been uneventful, but postoperative bladder spasms, meatal stenosis, and an intraurethral valve were encountered. The cosmetic result of the phalloplasty is pleasing. Sensibility is still increasing after a 14-month follow-up. Scarring of the upper arm donor site can be camouflaged easily. Although the actual phalloplasty as described in this article is a one-stage microsurgical procedure that appears to be reproducible, the construction of a phallus meeting all requirements still implies more than one stage.

A New Design for the Radial Forearm Free-Flap Phallic Construction

One-stage phallic construction using the radial forearm free flap was originally reported in 1984. This potentially sensate, thin, minimally hair-bearing flap, whose design incorporated a vascularized urethra, provided significant advantages over previously described multistaged insensate phallic reconstructions. The original design, as described by Chang and Hwang, is limited in size and has the propensity to develop meatal stenosis. This article describes a new design of the radial forearm flap for phallic construction performed on four patients. The techniques described incorporates a centrally located neourethra in continuity with a neoglans. It eliminates the circumferential meatal suture line and, therefore, meatal stenosis without sacrificing phallic length.

A New Design for the Radial Forearm Free-Flap Phallic Construction

Discussion by Charles E. Horton, M.D. Charles E. Horton, M.D. Horton-Adamson Plastic Surgeons, P. C. Suite 900, Wainwright Building 229 West Bute Street Norfolk, Va. 23510

Phallic Construction in Prepubertal and Adolescent Boys

During the last 10 years we performed microsurgical phallic reconstruction in 7 prepubertal and 4 adolescent boys. Indications for surgery included post-traumatic amputation, circumcision accident, developmental anomalies and micropenis. In addition, we performed phalloplasty on 5 other patients 18 to 24 years old. Total phallic reconstruction consisted of 1-stage microsurgical tissue transfers that included urethral reconstruction, coaptation of erogenous nerves, aesthetic refinement and, in some cases, scrotal reconstruction. All postpubertal patients recovered erogenous sensibility in the reconstructed phallus and the ability to masturbate. Surgical indications, techniques and results are discussed.

Preconstruction of the Pars Pendulans Urethrae for Phalloplasty in Female-to-Male Transsexuals

One of the goals of phallic construction in female-to-male transsexuals should be the creation of a competent neourethra that allows patients to void while standing. Apart from constructing the perineal fixed part of the neourethra, it is therefore necessary to create a phallus with a pendulant part of the neourethra to be connected to the pars fixa urethrae. In patients in whom we apply microsurgical free-flap techniques for phalloplasty, the pars pendulans is usually created the Chinese way (n = 8). If, on the other hand, pedicled abdominal or inguinal skin flaps are used, a skin-lined urethral tube to be incorporated in the phallus should already be extant in the donor area of the flap (n = 25). In the 20-year period 1971-1991, such a preconstruction of the pars pendulans urethrae has been attempted in 25 female-to-male transsexuals employing Snyder's technique. This has been successful in all and uneventful in 17 patients. If malelike micturition while standing is the goal and the use of microsurgical free-flap techniques is not indicated, this procedure seems to be the method of choice.

Single-stage phallic reconstruction

Phallic construction/reconstruction represents one of the most challenging areas of surgery. The multiplicity of aesthetic, functional, and structural problems set this field apart from most other areas of reconstructive surgery. Described herein is a procedure for total phallic construction in a single stage. The procedure utilizes a combination of local muscle or myocutaneous flaps and free microvascular transfer flaps. The procedure results in a cosmetically acceptable phallus which has erogenous sensibility. Erectile function currently is obtained by the implantation, in a separate stage, of an erectile prosthesis.