Female to Male Genital Reconstruction

Curtis Crane MD

Introduction

• Phalloplasty and metoidioplasty

• Free flap or pedicled flap from the forearm,

back (lat flap) or thigh

• Local tissue rearrangement

Epidemiology

• Prevalence Transsexual men undergoing surgery

• 1 : 30,000

• Note: 1996 study

• Prevalence Transsexuals medical treatment

• VA study: 0.03% of VA population (1/3333)

• 700,000 transgender individuals in US

An epidemiological and demographic study of transsexuals in The Netherlands. 1996.

In my practice

• More than 300 phalloplasties, largest volume

in the world

• Meta, ~150

Results

• >300 phalloplasties performed

– 35% ALTs, 65% RF phalloplasties (2 MLD’s)

• Urethral Strictures

– MLD: 1 of 2 (50%) developed stricture

– ALT: 19%

– RF: 15%

• Urethrocutaneous fistulas

– ALT: 19%

– RF: 7%

Management• Urethral strictures:

• Two predictable locations: distal, proximal penile urethra

• Distal: first stage Johanson

• Proximal: anastomotic urethroplasty

• Followup 1.2 years: 3 recurrences requiring repair

• Fistulas:

• Primary closure

• Adjacent tissue transfers

• Followup of 1.2 years, two recurrences requiring repair

RUG

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Metiodioplasty

• Release dorsal ligament

• Ventral chordee

• Options for the cadillac

– urethra

– scrotum

– vaginectomy

Complications

• Urethral lengthening

– Stricture

– Fistula

• Delayed wound healing

• Infection

• NO LOSS OF SENSATION !