Objectives: Gender related genitourinary surgery can play a critical role improving quality-of-life in individuals with gender dysphoria seeking to undergo female-to-male (FtM) transition.
Introduction: Desired outcomes should result in an aesthetically pleasing phallus with both tactile and erogenous sensation, the ability to void in standing position, minimization of donor-site morbidity, an aesthetic scrotum, and the ability to engage in penetrative sexual intercourse. Various techniques have been used in order to meet these requirements.
Materials / method: For trans men who desire to void in the standing position but are not interested in penetrative intercourse, metoidioplasty may suit their needs. Patients undergoing metoidioplasty are either discharged home later that day, rarely do patients require longer hospital stays. There is a lower risk of complications associated with urethral reconstruction. Most fistulas are small and heal spontaneously. On rare occasion, surgical repairs are required. Furthermore the decision to pursue metoidioplasty does not eliminate the option for phalloplasty at a later date.
Results: The second most common donor site is the antero-lateral thigh (ALT) pedicled or free flap. Advantages of this sensory flap include its more concealable donor site, color match, retained bulkiness, high potential for the development of erogenous sensation, and no necessity for microsurgery with the pedicled option unless neurorrhaphy is completed. The main disadvantage is that it’s only possible in thin patients with minimal subcutaneous tissue and few patients have the anatomy sufficient for a single staged “tube in tube” ALT phalloplasty as this flap is frequently thicker
Conclusion: The choice of the appropriate surgical technique should be tailored to meet the needs of the individual, and the surgeon should consider the goals of the patient, the patient’s personal preferences, and the anatomy when making recommendations.
Despite the high rate of complications and surgical revisions associated with phalloplasty and its secondary procedures, patient satisfaction remains high after a tailored surgery. Refining existing techniques and developing new approaches, scaffolds and prosthesis for minimizing complications is the current goal to improve FtM transition surgery outcome
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