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Phalloplasty: Difference between revisions
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There are different techniques for phalloplasty. Construction of a new penis (sometimes called a neophallus) typically involves taking a tissue flap from a donor site (such as the forearm). Extending the urethra through the length of the neophallus is another goal of phalloplasty.<ref>{{Cite journal|last=Morrison|first=Shane D.|last2=Shakir|first2=Afaaf|last3=Vyas|first3=Krishna S.|last4=Kirby|first4=Johanna|last5=Crane|first5=Curtis N.|last6=Lee|first6=Gordon K.|date=September 2016|title=Phalloplasty: A Review of Techniques and Outcomes|journal=Plastic and Reconstructive Surgery|volume=138|issue=3|pages=594–615|doi=10.1097/PRS.0000000000002518|pmid=27556603|issn=0032-1052}}</ref>. | There are different techniques for phalloplasty. Construction of a new penis (sometimes called a neophallus) typically involves taking a tissue flap from a donor site (such as the forearm). Extending the urethra through the length of the neophallus is another goal of phalloplasty.<ref>{{Cite journal|last=Morrison|first=Shane D.|last2=Shakir|first2=Afaaf|last3=Vyas|first3=Krishna S.|last4=Kirby|first4=Johanna|last5=Crane|first5=Curtis N.|last6=Lee|first6=Gordon K.|date=September 2016|title=Phalloplasty: A Review of Techniques and Outcomes|journal=Plastic and Reconstructive Surgery|volume=138|issue=3|pages=594–615|doi=10.1097/PRS.0000000000002518|pmid=27556603|issn=0032-1052}}</ref>. | ||
Temporary lengthening can also be gained by a procedure that releases the suspensory ligament where it is attached to the pubic bone, thereby allowing the penis to be advanced toward the outside of the body. The procedure is performed through a discreet horizontal incision located in the pubic region where the pubic hair will help conceal the incision site. However, scar formation can cause the penis to retract. Therefore, the American Urological Association "considers the division of the suspensory ligament of the penis for increasing penile length in adults to be a procedure which has not been shown to be safe or efficacious."<ref>{{Cite web|url=http://www.auanet.org/guidelines/penile-augmentation-surgery|title=American Urological Association - Penile Augmentation Surgery|website=www.auanet.org|access-date=2018-03-14}}</ref> | Temporary lengthening can also be gained by a procedure that releases the suspensory ligament where it is attached to the pubic bone, thereby allowing the penis to be advanced toward the outside of the body. The procedure is performed through a discreet horizontal incision located in the pubic region where the pubic hair will help conceal the incision site. However, scar formation can cause the penis to retract. Therefore, the American Urological Association "considers the division of the suspensory ligament of the penis for increasing penile length in adults to be a procedure which has not been shown to be safe or efficacious."<ref>{{Cite web|url=http://www.auanet.org/guidelines/penile-augmentation-surgery|title=American Urological Association - Penile Augmentation Surgery|website=www.auanet.org|access-date=2018-03-14|archive-url=https://web.archive.org/web/20230522060033/http://www.auanet.org/guidelines/penile-augmentation-surgery|archive-date=17 July 2023}}</ref> | ||
As of November 2009, there is research in progress to synthesize ''corpora cavernosa'' (erectile tissue) in the lab on rabbits for eventual use in patients requiring penile construction surgery. Of the rabbits used in the preliminary studies, 8 of 12 had biological responses to sexual stimuli that were similar to the control, and four caused impregnation.<ref>[http://www.pnas.org/content/early/2009/11/12/0909367106.full "Bioengineered corporal tissue for structural and functional restoration of the penis" by Kuo-Liang Chen, Daniel Eberli, James J. Yoo, and Anthony Atala (''Proceedings of the National Academy of Sciences'', Vol. 106 No. 45, November 9, 2009)]</ref> | As of November 2009, there is research in progress to synthesize ''corpora cavernosa'' (erectile tissue) in the lab on rabbits for eventual use in patients requiring penile construction surgery. Of the rabbits used in the preliminary studies, 8 of 12 had biological responses to sexual stimuli that were similar to the control, and four caused impregnation.<ref>[http://www.pnas.org/content/early/2009/11/12/0909367106.full "Bioengineered corporal tissue for structural and functional restoration of the penis" by Kuo-Liang Chen, Daniel Eberli, James J. Yoo, and Anthony Atala (''Proceedings of the National Academy of Sciences'', Vol. 106 No. 45, November 9, 2009)]</ref> | ||
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===Subcutaneous soft silicone implant=== | ===Subcutaneous soft silicone implant=== | ||
This phalloplasty procedure involves the insertion of a subcutaneous soft silicone implant under the penile skin.<ref>{{cite journal|title=Shortened penis post penile prosthesis implantation treated with subcutaneous soft silicone penile implant: case report|journal=International Journal of Impotence Research|volume=26|issue=3|pages=100–104|doi=10.1038/ijir.2013.44|pmid=24305609|year=2014|last1=Shirvanian|first1=V.|last2=Lemperle|first2=G.|last3=Araujo Pinto|first3=C.|last4=Elist|first4=J. J.}}</ref><ref>{{cite web|title=Shortened penis post penile prosthesis|url=http://www.mdlinx.com/urology/medical-news-article/2013/12/09/erectile-dysfunction-penile-augmentation-penile-enlargement/4991292/|publisher=MDLinx|accessdate=16 February 2016}}</ref><ref>{{cite web|title=A Retrospective Evaluation of the Safety and Effectiveness of a Silicone Block Implant for Elective Cosmetic Surgery of the Penis|url=http://www.smsna.org/lasvegas2015/posters/view.php?pid=039|publisher=SMSNA.org|access-date=2016-02-18|archive-url=https://web.archive.org/web/20160301052106/http://www.smsna.org/lasvegas2015/posters/view.php?pid=039|archive-date=2016-03-01|url-status=dead}}</ref><ref>{{cite web|title=Penis Implants Exist Now, and They Start at a Size Large|url=http://www.cosmopolitan.com/sex-love/news/a52737/penis-implants-are-here-and-they-start-at-a-size-large/|website=Cosmopolitan.com|author=Hannah Smothers|date=January 27, 2016}}</ref> | This phalloplasty procedure involves the insertion of a subcutaneous soft silicone implant under the penile skin.<ref>{{cite journal|title=Shortened penis post penile prosthesis implantation treated with subcutaneous soft silicone penile implant: case report|journal=International Journal of Impotence Research|volume=26|issue=3|pages=100–104|doi=10.1038/ijir.2013.44|pmid=24305609|year=2014|last1=Shirvanian|first1=V.|last2=Lemperle|first2=G.|last3=Araujo Pinto|first3=C.|last4=Elist|first4=J. J.}}</ref><ref>{{cite web|title=Shortened penis post penile prosthesis|url=http://www.mdlinx.com/urology/medical-news-article/2013/12/09/erectile-dysfunction-penile-augmentation-penile-enlargement/4991292/|publisher=MDLinx|accessdate=16 February 2016|archive-url=https://web.archive.org/web/20230405125925/https://www.mdlinx.com/urology/medical-news-article/2013/12/09/erectile-dysfunction-penile-augmentation-penile-enlargement/4991292/|archive-date=17 July 2023}}</ref><ref>{{cite web|title=A Retrospective Evaluation of the Safety and Effectiveness of a Silicone Block Implant for Elective Cosmetic Surgery of the Penis|url=http://www.smsna.org/lasvegas2015/posters/view.php?pid=039|publisher=SMSNA.org|access-date=2016-02-18|archive-url=https://web.archive.org/web/20160301052106/http://www.smsna.org/lasvegas2015/posters/view.php?pid=039|archive-date=2016-03-01|url-status=dead}}</ref><ref>{{cite web|title=Penis Implants Exist Now, and They Start at a Size Large|url=http://www.cosmopolitan.com/sex-love/news/a52737/penis-implants-are-here-and-they-start-at-a-size-large/|website=Cosmopolitan.com|author=Hannah Smothers|date=January 27, 2016|archive-url=https://web.archive.org/web/20230405125923/https://www.cosmopolitan.com/sex-love/news/a52737/penis-implants-are-here-and-they-start-at-a-size-large/|archive-date=17 July 2023}}</ref> | ||
===No-touch surgical technique=== | ===No-touch surgical technique=== | ||
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A 3-cm scrotal incision is made on the penoscrotal raphe and carried down through the subcutaneous tissue to the Buck's fascia. A Scott retractor, a flexible device that holds open the skin of the surgical site, is applied to the area. | A 3-cm scrotal incision is made on the penoscrotal raphe and carried down through the subcutaneous tissue to the Buck's fascia. A Scott retractor, a flexible device that holds open the skin of the surgical site, is applied to the area. | ||
Up until this stage of the surgery, the process has been consistent with the sanitary practices associated with standard surgical sterility.<ref>Richard Pearcy & Raj Persad, publication date unknown, "Inflatable penile prosthesis," in BJU International Website Atlas of Surgery and Surgical Devices, see [http://www.bjui.org/%5CBJUI_IMAGES%5CSurgicalAtlas%5C234Inflatable%20www%20MD%20formatted.pdf], accessed 31 May 2014</ref> At this stage of the "No-Touch" Technique, after the incision has been made, all instruments, including surgical gloves that have touched skin are discarded. A loose drape is then deployed over the entire surgical field and secured at the periphery with adhesive strips. A small opening in the drape is then made overlying the incision and yellow hooks utilized to secure the edges of the opening to the edges of the incision, completely covering and isolating the patient's skin. At this point, new instruments and equipment are replaced and the entire prosthesis is inserted through the small opening of the loose drape. The loose drape allows for manipulation of the penis and scrotum required for this procedure without touching the skin. | Up until this stage of the surgery, the process has been consistent with the sanitary practices associated with standard surgical sterility.<ref>Richard Pearcy & Raj Persad, publication date unknown, "Inflatable penile prosthesis," in BJU International Website Atlas of Surgery and Surgical Devices, see [http://www.bjui.org/%5CBJUI_IMAGES%5CSurgicalAtlas%5C234Inflatable%20www%20MD%20formatted.pdf], accessed 31 May 2014 [https://web.archive.org/web/20230404151137/http://www.bjui.org//BJUI_IMAGES/SurgicalAtlas/234Inflatable%20www%20MD%20formatted.pdf Archived] on 17 July 2023</ref> At this stage of the "No-Touch" Technique, after the incision has been made, all instruments, including surgical gloves that have touched skin are discarded. A loose drape is then deployed over the entire surgical field and secured at the periphery with adhesive strips. A small opening in the drape is then made overlying the incision and yellow hooks utilized to secure the edges of the opening to the edges of the incision, completely covering and isolating the patient's skin. At this point, new instruments and equipment are replaced and the entire prosthesis is inserted through the small opening of the loose drape. The loose drape allows for manipulation of the penis and scrotum required for this procedure without touching the skin. | ||
Implantation of the device continues with an incision and dilation of corpora, sizing and placing the penile cylinders, and placement of the pump in the scrotum and the reservoir in the retropubic space. Saline is used throughout the implantation for irrigation. Once the corporotomies are closed and all of the tubing and components of the prosthesis covered with a layer of Buck's fascia, subcutaneous tissues are closed and the "No-Touch" drape is removed and the skin closed.<ref name="Eid 2011 5-8" /> | Implantation of the device continues with an incision and dilation of corpora, sizing and placing the penile cylinders, and placement of the pump in the scrotum and the reservoir in the retropubic space. Saline is used throughout the implantation for irrigation. Once the corporotomies are closed and all of the tubing and components of the prosthesis covered with a layer of Buck's fascia, subcutaneous tissues are closed and the "No-Touch" drape is removed and the skin closed.<ref name="Eid 2011 5-8" /> | ||
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==Sources== | ==Sources== | ||
* {{cite journal| doi=10.1111/j.1464-410X.2007.07084.x|title=Total phalloplasty using a musculocutaneous latissimus dorsi flap|url=https://bjui-journals.onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2007.07084.x |journal=BJU International |volume=100|issue=4|date=October 2007}} by Sava V. Perovic, Rados Djinovic | * {{cite journal| doi=10.1111/j.1464-410X.2007.07084.x|title=Total phalloplasty using a musculocutaneous latissimus dorsi flap|url=https://bjui-journals.onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2007.07084.x |journal=BJU International |volume=100|issue=4|date=October 2007|archive-url=False|archive-date=17 July 2023}} by Sava V. Perovic, Rados Djinovic | ||
* {{cite journal |url=https://journals.lww.com/annalsplasticsurgery/Abstract/2007/05000/New_Technique_of_Total_Phalloplasty_With.15.aspx |title=New Technique of Total Phalloplasty With Reinnervated Latissimus Dorsi Myocutaneous Free Flap in Female-to-Male Transsexuals |journal=Annals of Plastic Surgery |volume=58 |issue=5 |date=May 2007 |doi=10.1097/01.sap.0000245123.16757.15 |authors=}} by Vesely, Jiri; Hyza, Petr; Ranno, Raul; Cigna, Emanuele; Monni, Nicola; et al. | * {{cite journal |url=https://journals.lww.com/annalsplasticsurgery/Abstract/2007/05000/New_Technique_of_Total_Phalloplasty_With.15.aspx |title=New Technique of Total Phalloplasty With Reinnervated Latissimus Dorsi Myocutaneous Free Flap in Female-to-Male Transsexuals |journal=Annals of Plastic Surgery |volume=58 |issue=5 |date=May 2007 |doi=10.1097/01.sap.0000245123.16757.15 |authors=|archive-url=https://web.archive.org/web/20230404203242/https://journals.lww.com/annalsplasticsurgery/Abstract/2007/05000/New_Technique_of_Total_Phalloplasty_With.15.aspx |archive-date=17 July 2023 }} by Vesely, Jiri; Hyza, Petr; Ranno, Raul; Cigna, Emanuele; Monni, Nicola; et al. | ||
* [http://journals.lww.com/plasreconsurg/Citation/1997/04000/Simultaneous_Penis_and_Perineum_Reconstruction.35.aspx Simultaneous Penis and Perineum Reconstruction Using a Combined Latissimus Dorsi-Scapular Free Flap with Intraoperative Penile Skin Expansion] by Rohrich, Rod J.; Allen, Terry; Lester, Fred; Young, Jonathan P.; Katz, Scott L. (Journal of Plastic and Reconstructive Surgery, Volume 99 Issue 4, April 1997) | * [http://journals.lww.com/plasreconsurg/Citation/1997/04000/Simultaneous_Penis_and_Perineum_Reconstruction.35.aspx Simultaneous Penis and Perineum Reconstruction Using a Combined Latissimus Dorsi-Scapular Free Flap with Intraoperative Penile Skin Expansion] by Rohrich, Rod J.; Allen, Terry; Lester, Fred; Young, Jonathan P.; Katz, Scott L. (Journal of Plastic and Reconstructive Surgery, Volume 99 Issue 4, April 1997) | ||
* [http://journals.lww.com/plasreconsurg/Abstract/2000/05000/Neophalloplasty_in_Female_to_Male_Transsexuals.12.aspx Neophalloplasty in Female-to-Male Transsexuals with the Island Tensor Fasciae Latae Flap] by Santanelli, Fabio M.D., Ph.D.; Scuderi, Nicolò (Journal of Plastic and Reconstructive Surgery, Volume 105 Issue 6, May 2000) | * [http://journals.lww.com/plasreconsurg/Abstract/2000/05000/Neophalloplasty_in_Female_to_Male_Transsexuals.12.aspx Neophalloplasty in Female-to-Male Transsexuals with the Island Tensor Fasciae Latae Flap] by Santanelli, Fabio M.D., Ph.D.; Scuderi, Nicolò (Journal of Plastic and Reconstructive Surgery, Volume 105 Issue 6, May 2000) | ||
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* [https://archive.today/20121021165141/http://www3.interscience.wiley.com/journal/121581796/abstract Use of forearm free-flap phalloplasty in bladder exstrophy adults] by Marc-Olivier Timsit, Pierre Mouriquand, Alain Ruffion, Alain Bouillot, Diala Dembelé, Arnaud Mejean, Fanny Lalloue, Albert Leriche and Nicolas Morel-Journel (BJU International, Volume 103 Issue 10, Dec 2008) | * [https://archive.today/20121021165141/http://www3.interscience.wiley.com/journal/121581796/abstract Use of forearm free-flap phalloplasty in bladder exstrophy adults] by Marc-Olivier Timsit, Pierre Mouriquand, Alain Ruffion, Alain Bouillot, Diala Dembelé, Arnaud Mejean, Fanny Lalloue, Albert Leriche and Nicolas Morel-Journel (BJU International, Volume 103 Issue 10, Dec 2008) | ||
* {{cite journal|title=Phalloplasty for female transsexuals with sensate free forearm flap|doi=10.1002/micr.1920150512 |journal=Microsurgery| volume=15| issue=5|date=1994}} by Rong-Hwang Fang, Jin-Teh Lin, Shiuh Ma (Microsurgery, Volume 15 Issue 5) | * {{cite journal|title=Phalloplasty for female transsexuals with sensate free forearm flap|doi=10.1002/micr.1920150512 |journal=Microsurgery| volume=15| issue=5|date=1994}} by Rong-Hwang Fang, Jin-Teh Lin, Shiuh Ma (Microsurgery, Volume 15 Issue 5) | ||
* {{cite journal |url=https://bjui-journals.onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2008.08286.x |title=Long-term outcome of forearm flee-flap phalloplasty in the treatment of transsexualism |journal=BJU International |volume=101 |issue=10 |date=Jan 2008 |doi=10.1111/j.1464-410X.2008.08286.x |authors=Albert Leriche, Marc-Olivier Timsit, Nicolas Morel-Journel, André Bouillot, Diala Dembele and Alain Ruffion}} | * {{cite journal |url=https://bjui-journals.onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2008.08286.x |title=Long-term outcome of forearm flee-flap phalloplasty in the treatment of transsexualism |journal=BJU International |volume=101 |issue=10 |date=Jan 2008 |doi=10.1111/j.1464-410X.2008.08286.x |authors=Albert Leriche, Marc-Olivier Timsit, Nicolas Morel-Journel, André Bouillot, Diala Dembele and Alain Ruffion|archive-url=False |archive-date=17 July 2023 }} | ||
* [http://journals.lww.com/plasreconsurg/Abstract/2009/08000/Penile_Reconstruction__Is_the_Radial_Forearm_Flap.22.aspx Penile Reconstruction: Is the Radial Forearm Flap Really the Standard Technique?] by Monstrey, Stan; Hoebeke, Piet; Selvaggi, Gennaro; al etc. (Journal of Plastic and Reconstructive Surgery, Volume 124 Issue 2, August 2009) | * [http://journals.lww.com/plasreconsurg/Abstract/2009/08000/Penile_Reconstruction__Is_the_Radial_Forearm_Flap.22.aspx Penile Reconstruction: Is the Radial Forearm Flap Really the Standard Technique?] by Monstrey, Stan; Hoebeke, Piet; Selvaggi, Gennaro; al etc. (Journal of Plastic and Reconstructive Surgery, Volume 124 Issue 2, August 2009) | ||
* {{cite journal |url=https://onlinelibrary.wiley.com/doi/abs/10.1002/micr.1920140910 |title=Addressing the ideal requirements by free flap phalloplasty: Some reflections on refinements of technique |journal=Microsurgery |volume=14 |issue=9|date=1993 |authors= |doi=10.1002/micr.1920140910}} | * {{cite journal |url=https://onlinelibrary.wiley.com/doi/abs/10.1002/micr.1920140910 |title=Addressing the ideal requirements by free flap phalloplasty: Some reflections on refinements of technique |journal=Microsurgery |volume=14 |issue=9|date=1993 |authors= |doi=10.1002/micr.1920140910|archive-url=https://web.archive.org/web/20210702181311/https://onlinelibrary.wiley.com/doi/abs/10.1002/micr.1920140910 |archive-date=17 July 2023 }} | ||
* {{cite journal |url=https://www.karger.com/Article/Abstract/253373 |title=Total Phallic Construction in Female to Male Transsexuals |journal=Current Urology |volume=3 |issue=3 |date=2009 |doi=10.1159/000253373 |authors=}} | * {{cite journal |url=https://www.karger.com/Article/Abstract/253373 |title=Total Phallic Construction in Female to Male Transsexuals |journal=Current Urology |volume=3 |issue=3 |date=2009 |doi=10.1159/000253373 |authors=|archive-url=https://web.archive.org/web/20220729194735/https://www.karger.com/Article/Abstract/253373 |archive-date=17 July 2023 }} | ||
* {{cite journal|title=Gender Reassigment|author1=Dan Greenwald|author2=Wayne Stadelmann|journal=eMedicine Journal|volume=2|number=7|date=July 6, 2001}} | * {{cite journal|title=Gender Reassigment|author1=Dan Greenwald|author2=Wayne Stadelmann|journal=eMedicine Journal|volume=2|number=7|date=July 6, 2001}} | ||
* {{cite journal|url=https://archive.today/20130105104921/http://www3.interscience.wiley.com/journal/118496243/abstract|title= Gender Identity Disorders: Diagnostic and Surgical Aspects|journal=Journal of Sexual Medicine}}by Michael Sohn, and Hartmut Bosinski, MD (, Volume 4 Issue 5, Aug 2007) | * {{cite journal|url=https://archive.today/20130105104921/http://www3.interscience.wiley.com/journal/118496243/abstract|title= Gender Identity Disorders: Diagnostic and Surgical Aspects|journal=Journal of Sexual Medicine|archive-url=https://web.archive.org/web/20230404182248/https://archive.today/20130105104921/http://www3.interscience.wiley.com/journal/118496243/abstract|archive-date=17 July 2023}}by Michael Sohn, and Hartmut Bosinski, MD (, Volume 4 Issue 5, Aug 2007) | ||
* {{cite journal|url=http://www.journals.elsevierhealth.com/periodicals/bjps/article/S0007-1226%2897%2990220-4/abstract|title= Glans sculpting in phalloplasty — experiences in female-to-male transsexuals}} by Rong-Hwang Fang, Yi-Sheng Kaoa, Shiuh Ma, Jin-Teh Lin (Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 51, Issue 5, July 1998) | * {{cite journal|url=http://www.journals.elsevierhealth.com/periodicals/bjps/article/S0007-1226%2897%2990220-4/abstract|title= Glans sculpting in phalloplasty — experiences in female-to-male transsexuals|archive-url=https://web.archive.org/web/20230405070627/https://www.journals.elsevierhealth.com/periodicals/bjps/article/S0007-1226(97)90220-4/abstract|archive-date=17 July 2023}} by Rong-Hwang Fang, Yi-Sheng Kaoa, Shiuh Ma, Jin-Teh Lin (Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 51, Issue 5, July 1998) | ||
* {{cite journal|url=http://www.cirp.org/library/complications/perovic2005/|title=Severe Penile Injuries: Etiology, Management and Outcomes|journal=Urologia Polska (Polish Journal of Urology)|issn=0500-7208}} by Sava V. Perovic, 2005/58/3. <!--note: linked to that site only because they had the full version of the text--> | * {{cite journal|url=http://www.cirp.org/library/complications/perovic2005/|title=Severe Penile Injuries: Etiology, Management and Outcomes|journal=Urologia Polska (Polish Journal of Urology)|issn=0500-7208|archive-url=https://web.archive.org/web/20230603040312/https://www.cirp.org/library/complications/perovic2005/|archive-date=17 July 2023}} by Sava V. Perovic, 2005/58/3. <!--note: linked to that site only because they had the full version of the text--> | ||
==External links== | ==External links== | ||