Total urethral construction with the radial artery-based forearm free flap in the transsexual

Giulio Garaffa, David J Ralph, Nim Christopher
BJU International 2010, 106 (8): 1206-10

OBJECTIVE: to report our experience of using a radial artery-based forearm free flap urethroplasty (RAFFFU) inside a pre-fashioned pedicled pubic phalloplasty for female-to-male gender reassignment.

PATIENTS AND METHODS: a neourethra based on the RAFFF was incorporated into a previously constructed phalloplasty in 27 patients. Surgical outcome, patients' satisfaction and voiding sensation of the neourethra were subjectively and prospectively assessed by direct questioning during the follow-up.

RESULTS: after a median follow-up of 9.2 months, all patients who completed the two stages of the procedure were able to void from the tip of the phallus while standing. Donor-site morbidity was minimal, with all patients reporting a complete recovery of forearm sensation and mobility. The overall satisfaction rate was 92%.

CONCLUSIONS: the RAFFFU is the best technique of total urethral construction in female-to-male transsexuals who opt not to undergo a RAFFF phalloplasty.

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