Penile reconstruction requires separate plans for coverage, urination, sensation and rigidity. The remaining anatomy and the patient's goals determine which components are needed.

In this episode of Plastics in Practice, we review reconstruction after penile tissue loss and gender-affirming options, connecting native tissue preservation, flap selection, urethral design and staged functional goals.

Key takeaways:

• Define the remaining skin, urethra, erectile tissue and neurovascular structures before selecting reconstruction.

• Preserve viable native tissue when possible; suitable acute amputations need urgent assessment for replantation, while selected skin defects may be managed with grafted coverage.

• Distinguish metoidioplasty using native erectile tissue from flap phalloplasty, and balance donor-site thickness, blood supply, sensation and morbidity.

• Make urethral lengthening an explicit decision. A new urinary channel can develop fistula or stricture even when the outer shaft is viable.

• Nerve coaptation can support sensory recovery, but sensation varies and is not guaranteed.

• Plan rigidity separately: a soft tissue flap does not recreate native erectile bodies, and later erectile devices add implant risks and possible revision.

This content is for educational purposes only and is not medical advice.

The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience.

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Free study guide: https://docs.google.com/document/d/1lhgYYGTSqDcHL7FzUAqFH0gfbreyWovZ/edit

#PenileReconstruction #Phalloplasty #Metoidioplasty #ReconstructiveUrology #PlasticSurgeryEducation

References:

1. European Association of Urology. EAU Guidelines on Urological Trauma. https://uroweb.org/guidelines/urological-trauma/chapter/urogenital-trauma-guidelines

2. Oregon Health and Science University. Phalloplasty and Metoidioplasty. https://www.ohsu.edu/transgender-health/phalloplasty-and-metoidioplasty

3. Johns Hopkins Medicine. Phalloplasty for Gender Affirmation. https://www.hopkinsmedicine.org/health/expert-qa/phalloplasty-for-gender-affirmation

4. European Association of Urology. EAU Guidelines on Urethral Strictures: Disease Management in Transgender Patients. https://uroweb.org/guidelines/urethral-strictures/chapter/disease-management-in-transgender-patients