Development of surgical phalloplasty techniques: Is there a gold standard?

SummaryIntroductionIn the field of penile reconstruction surgery there is a range of techniques, including fasciocutaneous, septocutaneous, myocutaneous, osteocutaneous and osteomyocutaneous flaps, taken from the suprapubic, abdominal, inguinal, scapular, deltoid, thoracodorsal, fibular or anterolateral thigh areas or from the forearm or arm. Among this wide variety of techniques, is there a gold standard treatment to identify best practice, and what are the criteria that should be used to define such a standard? The aim of this article is to provide an overview of the main phalloplasty techniques and to show their advantages and drawbacks, in order to answer the ultimate question, of whether a gold standard can be identified or not.MethodLiterature review using Pubmed and selection of articles about the most common types of phalloplasty, and how these have changed over time. Selection of articles that evaluate the main techniques.ResultsSix phalloplasty techniques (flaps from the suprapubic, abdominal, inguinal, forearm, fibular and anterolateral thigh areas) are described. There have been few studies that formally evaluate these techniques, other than studies of complications, even though it is suggested that some techniques preserve erogenous sensitivity.DiscussionThe criteria that an ideal phalloplasty must fulfil are: 1) satisfactory aesthetic appearance; 2) creation of a neourethra which enables urination while standing up; 3) sufficient rigidity to have sexual relations; 4) tactile and erotic sensitivity; 5) surgery carried out in just one stage; 6) low levels of donor site morbidity and site must be easy to hide; 6) density, texture and colour to match the perineum. No technique currently meets all these criteria and thus no gold standard treatment can easily be identified. Any standard, if one is to exist, must stress the need to inform and educate patients in order that their needs be met and in order to reduce unrealistic expectations and postoperative disappointment.