Functional and surgical outcomes after phalloplasty in cis men

Purpose: Evaluate the surgical outcomes along with a comprehensive assessment of functional outcomes in cis men (non-trans) who underwent phalloplasty.

Methods: All consecutive cis men who underwent phalloplasty from 2008 to 2018 for penile insufficiency due to various causes were included. These underwent phalloplasty by either a radial forearm free flap (RFFF) or suprapubic phalloplasty (SPP). Data were collected from medical files. A questionnaire was sent a minimum of 1 year after surgery to each patient to evaluate sexual function and self-esteem, satisfaction with genitals, and urinary function.

Results: Among the 19 patients included, 12 underwent RFFF and 7 SPP; 25% of those who had RFF and 14.3% of those with SPP had a Clavien-Dindo ≥ 2 complication. A total of 16 patients had a urethroplasty procedure, 50.0% of whom had a Clavien-Dindo ≥ 2 complication. Penile prostheses were implanted in 14 patients; 64.3% of whom had a complication. Seven patients answered the questionnaire (36.8%); the relationship satisfaction score was 89.5/100 and the confidence score was 100/100. Among the 5 patients who had a sexual relationship, all reported having a lot of pleasure during sexual intercourse and reached orgasm at least "regularly". At least 66.7% of the patients were "satisfied" or "very satisfied" about the size and the appearance of genitals. Among the 5 patients who answered questions regarding urinary function, 60.0% had standing micturition, and 80.0% reported being comfortable in public toilets.

Conclusion: Despite the high frequency of complications and the need for revision surgery, phalloplasty seems to allow a satisfying psychosexual and urinary functions for cis men suffering from penile insufficiency.