Phalloplasty with Urethral Lengthening Surgery

Introduction

Phalloplasty with urethral lengthening surgery is a complex and life-changing surgical procedure for transgender. This surgery provides an opportunity to align their gender identity with their physical appearance. This surgery involves constructing a phallus (a surgically created penis) and extending the urethra to allow for micturition through the newly built organ. This surgery is a significant step in the gender-affirming process for many transgender who seek a more authentic representation of their identity.

What Is a Phalloplasty?

Phalloplasty is a series of complex reconstructive surgical procedures done for patients who want to change their sex by surgically constructed penis. This surgery involves multiple steps and a series of surgeries and may take a few years to create a penis with tissue from elsewhere on the body. The first phalloplasty surgery was in 1936 by Dr. Wassilieff; he used rib cartilage and skin grafts to create a phallus. Since then, various surgical techniques have been developed to enhance phalloplasty's outcome. At present, different types of phalloplasty surgery are available, but they all aim to create phallus for patients undergoing gender confirmation surgery.

A phalloplasty may include a few or all of these procedures: •

• Creating a shaft.

• Urethra within the shaft creation (urethral lengthening).

• Creating a segment of the urethra called a perineal urethra.

• Creating a scrotum (scrotoplasty).

• Removal of the vagina (Vaginectomy).

• Burial of clitoral tissue.

• Glansplasty.

• Erectile device implant.

• Testicular implants.

What Are the Steps Involved in Phalloplasty With Urethral Lengthening Surgery?

The type of surgical technique may vary depending on the patient's needs and doctor's recommendations, but there are some common steps involved in the surgical process:

Before Surgery - Before undergoing the surgery, patients undergo a comprehensive evaluation, which may include medical history, discussions about their goals and expectations, and psychological assessment. Also, a patient needs to have realistic expectations and stable mental health before the surgery.

Donor Site Selection - The donor site for the neophallus is a crucial step in phalloplasty. The choice of donor site is based on factors such as tissue quality, the patient's anatomy, and the desired size of the neophallus. The most common donor sites include the forearm, the thigh, and the abdomen.

Reconstruction of the Donor Site - After removing the donor tissue from the donor site, it is covered with a skin graft to help it heal. The tissue is carefully shaped and connected to form the penis. Then, a fine shaver takes a thin layer of tissue, called a split-thickness skin graft, from the thigh to attach it to the donor site wound, which makes healing faster and looks like a layer of skin. The surgeon may also incorporate erectile implants or prosthetic devices to enable erections.

Hair Removal for Urethral Lengthening - Electrolysis or laser to permanently remove hair on the donor site used to make the urethra is necessary for phalloplasty with urethral lengthening surgery. The skin has many hair follicles that need removal before the skin is transferred to construct the urethra, or it can cause complications like urethral stones and recurrent infections.

Urethral Lengthening - The surgeon extends the patient's urethra to the tip of the new phallus, which will work as a natural urinary function. This is a delicate and complex part of the procedure and may require advanced surgical techniques.

Other Surgical Procedures - Many patients may also choose to have scrotoplasty performed along with phalloplasty. Scrotoplasty involves the creation of a scrotum, using labia majora tissue or tissue graft, and placing testicular implants. This glansplasty (construction of the glans) is also done, another essential step in phalloplasty. The surgeon will shape the tissue to create a natural appearance.

What to Expect During the Recovery Process?

After phalloplasty with urethral lengthening surgery, the recovery process is an important phase in a patient's journey. The recovery duration can vary depending on the patient’s health and surgical techniques.

• After the surgery, the patients typically spend several days in the hospital for monitoring and wound care. This period is essential to check for immediate postoperative complications.

• Following urethral lengthening, a catheter aids urine drainage while the surgical site heals. The catheter will have been inserted while the patient is under general anesthesia. The catheter is removed after a few weeks.

• Pain and discomfort are common during the recovery period. So pain medications are prescribed to manage discomfort, and they are encouraged to follow a pain management plan.

• The patient is expected to take at least six weeks off work and avoid exercise and heavy lifting during recovery.

• Patients will have several follow-up appointments with their healthcare professionals to monitor their progress and address any complaints or concerns that may arise.

• The recovery process is lengthy, and patients should continue with wound care and hygiene routines for a long duration.

The recovery process can be emotionally challenging, as patients may experience a range of emotions, including frustration, excitement, and anxiety. Support from medical professionals, friends, and family is invaluable during this time.

What Are the Complications of Phalloplasty With Urethral Lengthening Surgery?

Phalloplasty with urethral lengthening surgery carries certain risks and potential complications. It is important for patients to be well-informed about these complications and to have realistic expectations about the outcomes.

• Infection at the surgical sites requires prompt treatment.

• The surgical incisions may reopen, causing complications like delayed wound healing.

• Urinary leakage due to abnormal connections between the phallus and the urinary or reproductive systems.

• Urethral strictures (narrowing of the urethra) can obstruct urine flow and require additional surgical procedures.

• Nerve damage can occur during the surgery, affecting the neophallus sensation.

• Scarring.

• Patients may experience psychological and emotional challenges during recovery, including anxiety, depression, and body image concerns.

Conclusion

Phalloplasty with urethral lengthening surgery is a complex procedure that can have a profound impact on a transgender person’s life. With advancements in surgical techniques, the outcomes of these surgeries have improved significantly. The potential benefits of the surgery are body confidence, improved quality of life, and emotional well-being are compelling. However, the surgery does not come without risks and complications, so the patient should be well-informed and have realistic expectations about the outcomes.