title: Radial forearm free flap phalloplasty for penile inadequacy in patients with exstrophy.
abstract: OBJECTIVE
  Male patients with bladder and cloacal exstrophy are born with demure genitalia and often desire phalloplasty during late adolescence or early adulthood. Radial forearm free flap phalloplasty was used successfully for congenital aphallia in a few small series. We present a series of patients treated with phalloplasty using a radial forearm free flap after the repair of bladder and cloacal exstrophy.
  
  
  METHODS
  We reviewed the records of 10 patients who underwent radial forearm free flap phalloplasty between 2007 and 2012. Indications for phalloplasty were classic bladder exstrophy in 8 cases and cloacal exstrophy in 2. Nine patients underwent prior urinary diversion and 1 underwent urethroplasty at phalloplasty. In each case we reviewed the details of prior exstrophy repair, flap size, donor and recipient vessels, complications, need for subsequent surgeries and self-reported sensation.
  
  
  RESULTS
  The graft survived in all 10 patients. Short-term complications requiring surgical intervention developed in 2 patients. Five patients subsequently underwent placement of a penile prosthesis and 2 devices were removed secondary to erosion. All 10 patients reported protective sensation and erogenous sensation with ability to achieve orgasm at last followup.
  
  
  CONCLUSIONS
  Radial forearm free flap phalloplasty results in a sensate, cosmetic neophallus. No patient had long-term complications related to phalloplasty but complications related to penile prostheses continue to be a challenging aspect of phalloplasty. The long-term results of the forearm free flap are encouraging in this series of patients with bladder and cloacal exstrophy who desired phalloplasty.
authors.affiliation: Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: emassan1@jhmi.edu.
authors.forename: Eric Z
authors.initials: EZ
authors.lastname: Massanyi
authors.forename: Angela
authors.initials: A
authors.lastname: Gupta
authors.forename: Sameer
authors.initials: S
authors.lastname: Goel
authors.forename: John P
authors.initials: JP
authors.lastname: Gearhart
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Burnett
authors.forename: Trinity J
authors.initials: TJ
authors.lastname: Bivalacqua
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Redett
mesh_terms: D000015:Abnormalities, Multiple; D001746:Bladder Exstrophy / Q000601:surgery*; D005500:Follow-Up Studies; D005542:Forearm / Q000601:surgery*; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D017060:Patient Satisfaction; D010409:Penile Diseases / Q000151:congenital / Q000601:surgery*; D010413:Penis / Q000002:abnormalities* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D055815:Young Adult