Primary and Secondary Reconstruction of the Neophallus Urethra

  • Miroslav L. DjordjevicEmail author
Part of the Current Clinical Urology book series (CCU)


Neophalloplasty is one of the most difficult surgical procedures in genital reconstructive surgery. It is indicated in men where the penis is missing due to either congenital or acquired reasons, as well in women with gender dysphoria. Many different tissues have been applied such as local vascularized flaps or microvascular free transfer grafts. The main goal of the neophalloplasty is to construct the functional and cosmetically acceptable penis. Urethral reconstruction in neophalloplasty presents a great challenge for surgeons who manage genital reconstruction. Different flaps (penile skin, scrotal skin, abdominal skin, labial skin, vaginal flaps, etc.) or grafts (skin, bladder, buccal mucosa) have been suggested for urethral lengthening. Although serious complications were reported in the past, new techniques and modifications for primary and secondary neophallus urethroplasty seem to be safe in experienced hands.


Gender Dysphoria Penile Cancer Penile Prosthesis Radial Forearm Flap Ilioinguinal Nerve 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This paper is supported by Ministry of Science, Republic of Serbia, Project No. 175048.


  1. 1.
    Bogoras N. Plastic construction of penis capable of accomplishing coitus. Zentral Chir. 1936;63:1271–6.Google Scholar
  2. 2.
    Chang TS, Hwang WY. Forearm flap in one-stage reconstruction of the penis. Plast Reconstr Surg. 1984;74:251–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Perovic S. Phalloplasty in children and adolescent using the extended pedicle island groin flap. J Urol. 1995;154:848–53.CrossRefPubMedGoogle Scholar
  4. 4.
    Sengezer M, Ozturk S, Deveci M, et al. Long-term follow-up of total penile reconstruction with sensate osteocutaneous free fibula flap in 18 biological male patients. Plast Reconstr Surg. 2004;114:439–50.CrossRefPubMedGoogle Scholar
  5. 5.
    Bettocchi C, Ralph DJ, Pryor JP. Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int. 2005;95:120–4.CrossRefPubMedGoogle Scholar
  6. 6.
    Stenzl A, Schwabegger A, Bartsch G, Prosser R, Ninkovic M. Free neurovascular transfer of latissimus dorsi muscle for the treatment of bladder acontractility. II. Clinical results. J Urol. 2003;169:1379–83.CrossRefPubMedGoogle Scholar
  7. 7.
    Djordjevic ML, Bumbasirevic MZ, Vukovic PM, Sansalone S, Perovic SV. Musculocutaneous latissimus dorsi free transfer flap for total phalloplasty in children. J Pediatr Urol. 2006;2:333–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Perovic SV, Djinovic R, Bumbasirevic M, Djordjevic M, Vukovic P. Total phalloplasty using a musculocutaneous latissimus dorsi flap. BJU Int. 2007;100:899–905.CrossRefPubMedGoogle Scholar
  9. 9.
    Gilbert DA, Jordan GH, Devine Jr CJ, Winslow BH, Schlossberg SM. Phallic construction in prepubertal and adolescent boy. J Urol. 1993;149:1521–6.PubMedGoogle Scholar
  10. 10.
    Monstrey S, Hoebeke P, Dhont M, Selvaggi G, Hamdi M, Van Landuyt K, Blondeel P. Radial forearm phalloplasty: a review of 81 cases. Eur J Plast Surg. 2005;28:206–12.CrossRefGoogle Scholar
  11. 11.
    Lumen N, Monstrey S, Selvaggi G, Ceulemans P, De Cuypere G, Van Laecke E, Hoebeke P. Phalloplasty: a valuable treatment for males with penile insufficiency. Urology. 2008;71:272–6.CrossRefPubMedGoogle Scholar
  12. 12.
    De Castro R, Merlini E, Rigamonti W, Macedo A. Phalloplasty and urethroplasty in children with penile agenesis: preliminary report. J Urol. 2007;177:1112–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Rohrmann D, Jakse G. Urethroplasty in female-to-male transsexuals. Eur Urol. 2003;44:611–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Dabernig J, Shelley OP, Cuccia G, Schaff J. Urethral reconstruction using the radial forearm free flap: experience in oncology cases and gender reassignment. Eur Urol. 2007;52:547–54.CrossRefPubMedGoogle Scholar
  15. 15.
    Johanson B. Reconstruction of the male urethra in strictures. Application of the buried intact epithelium tube. Acta Chir Scand. 1953;176:1.Google Scholar
  16. 16.
    Barbagli G, Palminteri E, De Stefani S, Lazzeri M. Penile urethroplasty. Techniques and outcomes using buccal mucosa grafts. Contemp Urol. 2006;18:25–33.Google Scholar
  17. 17.
    Lebovic GS, Laub DR. Metoidioplasty. In: Ehrlich RM, Alter GJ, editors. Reconstructive and plastic surgery of the external genitalia. Philadelphia: WB Saunders Co.; 1999. p. 355–60.Google Scholar
  18. 18.
    Hage JJ, Turnhout WM. Long-term outcome of metoidioplasty in 70 female to male transsexuals. Ann Plast Surg. 2006;57:312–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Djordjevic M, Stanojevic D, Bizic M, Kojovic V, Majstorovic M, Vujovic S, Milosevic A, Korac G, Perovic SV. Metoidioplasty as a single stage sex reassignment surgery in female transsexuals: Belgrade experience. J Sex Med. 2009;6:1306–13.CrossRefPubMedGoogle Scholar
  20. 20.
    Djordjevic ML, Bizic M, Stanojevic D, Bumbasirevic M, Kojovic V, Majstorovic M, Acimovic M, Pandey S, Perovic SV. Urethral lengthening in metoidioplasty (female-to-male sex reassignment surgery) by combined buccal mucosa graft and labia minora flap. Urology. 2009;74:349–53.CrossRefPubMedGoogle Scholar
  21. 21.
    Zielinski T. Phalloplasty using a lateral groin flap in female-to-male transsexuals. Acta Chir Plast. 1999;41:15–9.PubMedGoogle Scholar
  22. 22.
    Fang RH, Kao YS, Ma S, Lin JT. Phalloplasty in female-to-male transsexuals using free radial osteocutaneous flap. A series of 22 cases. Br J Plast Surg. 1999;52:217–22.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of UrologyUniversity Children’s HospitalBelgradeSerbia

Personalised recommendations