Presentation Authors: David J Ralph*, London, United Kingdom, Marco Falcone, Mattia Anfosso, Paolo Gontero, Turin, Italy, Andrew Nim Christopher, Oliver Ralph, London, United Kingdom
Introduction: The aim of our study is to assess surgical and patientsâ€™ reported outcomes (PROâ€™s) after a TPR using a radial artery-based forearm free flap (RAFFF).
Methods: From September 2001 to August 2018 a consecutive series of 108 genetic male patients underwent a TPR using a RAFFF in a single tertiary referral centre secondary to a penile inadequacy. The TPR was conducted as a multiple staged procedure 1) TPR with RAFFF 2) glans sculpting 3) penile prosthesis implantation. A urethroplasty was performed in one or two stages depending on the quality of the previously reconstructive native urethra. A urethroplasty was performed in all patients even if they had had a urinary diversion (n=32) so as to enable ejaculation. The data was retrospectively extrapolated from the clinical records. The patientâ€™s baseline features and the incidence of postoperative complications are reported. PROâ€™s were assessed through a 4-items â€œad hocâ€ created questionnaire and a 5-point Likert item administered through a telephone interview.
Results: The aetiologies underlying the penile inadequacy were penile cancer (26%), bladder exstrophy and epispadias complex (30%), micropenis (26%) and traumatic amputation (18%). The median age at the time of the TPR was 32.5 years (IQR 24-46) and median follow-up was 78.5 mths (IQR 30-129). A primary anastamotic urethroplasty was performed in 87 patients (80.6%) and a staged urethroplasty in the remainder. A total of 77 patients (71%) completed all stages of the reconstruction including an inflatable penile prosthesis implantation.Forty one patients (38%) answered the telephone interview of which 80% of patients declared to be fully satisfied with the cosmetic appearance and size of the neo-phallus, 76% reported to successfully achieve an orgasm through masturbation or penetrative sex intercourses, 76% would have the operation again and 90% would recommend the operation to a friend.An acute arterial thrombosis occurred in 4 patients leading to a complete loss of the neo-phallus in 2 of them. A partial necrosis of the neo-phallus due to venous ischemia occurred in 21 patients (19%) which was managed successfully by early debridement and local flap reconstruction or grafting in all cases. The overall incidence of urethral complications was 60% (32% fistula and 28% stricture) with 2 patients ending up with a definitive perineal urostomy. The univariate logistic regression analysis showed a single statistically significant association (p = 0.041) between the staged urethral reconstruction and an increased incidence of urethral complications. No predictive factors were identified for vascular complications.
Conclusions: Despite the high incidence of postoperative complications and the possible need for multiple revisions, TPR in the genetic male with penile inadequacy using a RAFFF yields excellent aesthetic and functional.