Introduction: Phalloplasty is a masculinizing genital gender affirmation surgery, requested by 91% of patients seeking surgical transition. Due to the complexity of reconstruction involved, phalloplasty has been associated with high complications, with all cause urinary complications being reported as high as 70%1. The objective of our study is to observe the specific urinary, emergent, donor site, and aesthetic complications associated with this complex procedure.
Methods: Data was gathered via retrospective chart review of 280 transmasculine patients undergoing phalloplasty at our center between 7/17 and 10/20 (38 months).
Results: Patients had an average follow up period of 17 months. Average age at phalloplasty was 34 years (range 18-64). 66% (185/280) received a radial forearm flap, 34% (94/280) received anterolateral thigh flap, and 0.4% (1/280) received a musculocutaneous latissimus dorsi flap. The average phallus length was 5.7 inches (range 4.5-8.5). Patients with prior masculinizing genital gender affirming surgery included: 23 metoidioplasty, 3 phalloplasty, and 28 vaginectomy.
Thirty patients (11%) experienced a complication requiring urgent surgery or emergency room admission, and 19 patients (7%) experienced complications of the donor site requiring surgery. Many patients experienced urinary tract complications (Table 1) while 21 patients (7.5%) did not have urethral lengthening. No patients experienced rectal injury. Total phallus loss occurred in two cases (0.7%), due to vascular insufficiency and subsequent necrosis. Eighteen patients experienced infection of the phallus, which were resolved with antibiotics or minor incision/drainage. Seven patients (2.5%) had no phallic sensation.
There were a variety of procedures done for aesthetic and hygienic purposes post-phalloplasty (Table 1). Overall, patients experienced an average of 3.6 complications requiring surgery (range 0-18) and had an average of 2.8, usually planned, visits to the operating room after phalloplasty (range 0-12).
Conclusions: This is the first report of phalloplasty results from a US, high-volume (~90 cases year), dedicated phalloplasty unit. This detailed analysis of complications of this hypercomplex surgery should prove useful to practitioners, patients and payors alike.
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