Use of forearm free-flap phalloplasty in bladder exstrophy adults.
OBJECTIVE
To assess the long-term outcome and cosmetic results of forearm free-flap phalloplasty for correcting micropenis associated with bladder exstrophy in men.


METHODS
From 1992 to 2000, six men with bladder exstrophy and unsatisfactory penile appearance underwent phalloplasty at our institution. The mean (range) follow-up was 113 (62-153) months. The surgical procedure consisted of a modified radial free-flap phalloplasty and prosthesis implantation. One-stage urethroplasty was electively performed according to the patient's voiding pattern. Early and late complications were recorded and quality of life after phalloplasty was assessed.


RESULTS
The mean (range) age was 21.2 (17-26) years and flap survival was 100%. Two incontinent patients underwent immediate perineal urethrostomy. One sepsis occurred, requiring the removal of the penile prosthesis and a cutaneous continent urinary diversion; this patient was the only one to complain about the outcome. Two anastomotic urethral strictures were conservatively treated by endoscopic urethrotomy and only one patient underwent subsequent urethral self-dilatations. Five patients were very satisfied with the cosmesis of the neophallus and three patients reported having regular sexual intercourse.


CONCLUSIONS
Although short, this series indicates the low incidence of early complications and the excellent long-term satisfaction with forearm free-flap phalloplasty in bladder exstrophy. Phalloplasty has potential indications when adult exstrophy patients are dissatisfied with the cosmetic appearance of their external genitalia or have unsatisfactory sexual intercourse.
Timsit
Marc-Olivier
MO
Department of Paediatric Surgery, Necker Hospital, Paris, France.
Mouriquand
Pierre E
PE
Ruffion
Alain
A
Bouillot
Alain
A
Dembelé
Diala
D
Mejean
Arnaud
A
Lalloue
Fanny
F
Leriche
Albert
A
Morel-Journel
Nicolas
N
D000328:Adult; D001746:Bladder Exstrophy / Q000150:complications* / Q000601:surgery; D003075:Coitus; D005542:Forearm; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D015917:Penile Prosthesis; D010413:Penis / Q000002:abnormalities / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult