XVI Harry Benjamin International Gender Dysphoria Association Symposium
17 - 21 August 1999, London

Reflections on "Transsexualism and Sex Reassignment" 1969 -1999

Pubic Phalloplasty for Surgical Gender Assignment in 85 Female-to-Male Transsexuals.

*Bettocchi, C., D.J. Ralph, J.P. Pryor

Institute of Urology, The Middlesex Hospital, U.C.H. London, U.K. and *Cattedra di Urologia, University of Bari, Italy

• Introduction
• Material and Methods
• Results
• Discussion

INTRODUCTION: Since the first reported description of phalloplasty in 1936, a considerable number of techniques has been described, such as metaidoplasty, pedicled flaps and free flaps since the late forties. Although a variety of operations has been performed, this surgery still remains a major challenge for surgeons. We demonstrate a new technique of phallic construction for female-to-male transsexuals using a pubic pedicled flap.

MATERIAL & METHODS: Technique: the phallus was formed by anterior abdominal wall skin, and the flap fashioned 10 cm wide and 11 cm length measured from the clitorid. The abdominal wall skin is completely mobilized up to the costal margin in order to cover the defect created by the flap. The neourethra was fashioned in one stage at the same time of the phalloplasty up to 1993 and subsequently in 2 stages, in order to avoid urinary tract complications. In the first stage, the phallic urethra was fashioned using the right major labial flap, and turned through a skin tunnel into the neophallus. The second stage involves the isolation of the opposite major labia flap in a similar fashion.

RESULTS: Eighty-five patients underwent a pubic phalloplasty. Thirty-seven of them had a one-stage phalloplasty and 48 had a two-stage operation. Three patients had a complete loss of the phallus. The cosmetic outcome was considered good by the surgeon and the patient in 58 cases (68%). The incidence of neourethra complications, such as strictures and fistulas, was lower in the two-stage group (58%) than in the one-stage (95%). At the present time, 15 (60%) patients have completed the second stage of the urethroplasty. The cosmetic outcome was considered good in 73% of patients.

DISCUSSION: Pubic phalloplasty is a simple and relatively quick procedure, leading to minimal scarring or disfigurements in the donor area, esthetically acceptable to the patient and his partner, occasionally rigid enough for penetrative sexual intercourse. There is still a major problem to be resolved with the neourethra, as for all the other techniques. The ideal technique for phalloplasty still has to come.