Giovanni Alei

Innervated island pedicled anterolateral thigh flap for neo-phallic reconstruction in female-to-male transsexuals

Many techniques have been described to create an aesthetic and functional neo-phallus after penile amputation or in female-to-male transsexuals. Microsurgical free-flap phalloplasty seems to be the preferred method of penile reconstruction. For many years the radial forearm free flap has been considered the best procedure, but other flaps have been attempted to minimize donor site morbidity and optimize outcome. Pedicled flaps are considered to be reliable and to decrease the risk of total failure. Recently, a one-stage non-microsurgical technique was described for phallic reconstruction in a young male patient. We report successful total phallic reconstruction in a female-to-male transsexual patient using an island pedicled anterolateral thigh (ALT) flap. Urethral reconstruction was left as a possible further procedure due to patients preference. A malleable soft silicone penile prosthesis was inserted within the flap and the lateral cutaneous femoral nerve stump was sutured to the dorsal clitoris branch from the pudendal nerve for flap sensation. After 6 months, the patient demonstrated successful aesthetic and functional reconstruction referring to satisfactory sexual activity. To our knowledge, this is the first report of an innervated island pedicled ALT flap used for female-to-male penile reconstruction in a transsexual patient. The pedicled ALT flap may be a reliable option to avoid visible scarring at the donor site on exposed parts of the body, and reduce the risk of total flap failure from microsurgical procedures for reconstruction of a neo-phallus in this increasing population of patients.

Original Technique for Penile Girth Augmentation Through Porcine Dermal Acellular Grafts: Results in a 69‐Patient Series

INTRODUCTION Although different techniques for augmentation phalloplasty have been reported in the medical literature, this issue is still highly controversial, and none of the proposed procedures has been unanimously approved. AIMS The aim of this study is to describe an innovative surgical technique for penile girth augmentation with porcine dermal acellular grafts, through a small transverse incision at the penile base, along the penopubic junction. METHODS Between 2000 and 2009, 104 patients were referred to our institution for penile enhancement. After a preoperative psychosexual consultation and a general medical assessment, 69 patients were deemed suitable good candidates for surgery. The average penis circumference was measured at the mid-length of the penis and was 8.1 cm (5.4-10.7 cm) and 10.8 cm (6.5-15.8 cm) during flaccidity and erection, respectively. All patients received penile augmentation with porcine dermal acellular grafts. MAIN OUTCOME MEASURES Results evaluation of an innovative technique for penile girth augmentation through exogenous porcine grafts and small penobubic incision. RESULTS Postoperative measurements were performed at 6 and 12 months. At the 1-year follow-up, the average penis circumference was 11.3 cm (8.2-13.2 cm, 3.1 cm mean increase) during flaccidity and 13.2 cm (8.8-14.5 cm, 2.4 cm mean increase) during erection. No major complications occurred in the series. Minor complications were resolved with conservative treatment within 3 weeks. Sexual activity was resumed from 1 to 2 months after surgery. The psychosexual impact of the operation was beneficial in the majority of cases. CONCLUSION Penile girth enlargement with acellular dermal matrix grafts has several advantages over augmentation with autogenous dermis-fat grafts: the elimination of donor site morbidity and a significantly shorter operation time. With this approach, through a short dorsal incision at the base of the penis, the scar is concealed in a crease covered by pubic hair and thus hardly visible.

New surgical technique for ventral penile curvature without circumcision

To describe and report on our variant of penile corporoplasty, the ‘double‐breasted’ corporoplasty, with penoscrotal and infrapubic access not requiring circumcision. The medicolegal aspects of treatment are also discussed.

PPTLBA-01 QUALITY OF LIFE AFTER PENILE PROSTHESIS IMPLANTATION – 1 YEAR FOLLOW-UP DATA OF THE ITALIAN PROSPECTIVE REGISTRY INSIST-ED

Paolo Capogrosso*, Giovanni Alei, Gabriele Antonini, Antonio Avolio, Antonio Barbieri, Carlo Bettocchi, Marco Bitelli, Francesco Boezio, Masssomo Capone, Enrico Caraceni, Maurizio Carrino, Carlo Ceruti, Sandro Ciampalini, Fulvio Colombo, Enrico Conti, Antonio Corvasce, Giuseppe Dachille, Diego Pozza, Stefano Fiordelise, Alessandro Franceschelli, Giulio Garaffa, Nicola Ghidini, FrancoGiorgio, Emilio Italiano, Giuseppe La Pera, Antonino Lagan a, Giovanni Liguori, Lilia Utizi, Matteo Matera, Nicola Mondaini, Alessandro Natali, Carlo Negro, Fabrizio Palumbo, Matteo Paradiso, Edoardo Pescatori, MassimoPolito,GaiaPolloni, AndreaSalonia,MauroSilvani, AldoTamai, Massimiliano Timpano, Francesco Varvello, Patrizio Vicini, Antonio Vitarelli, Antonio Palmieri, Federico Deh o, Milan, Italy

Male Genital Aesthetic Surgery

Since antiquity, doctors and surgeons have made countless attempts to modify the shape and size of the penis, but the first scientifically validated technique to correct curved penis was defined only in 1965. In the following years the evolution of the surgery of the cavernous bodies has become remarkable, expanding to include different new techniques related to the correction of both the shape and size (especially in the most recent years) of the cavernous bodies. In this chapter we analyze the most successful techniques related to penis and testicular aesthetics. With regard to cavernous bodies surgery, we must point out that when pursuing an aesthetic result, the postoperative outcome needs to preserve the function. This concept must be stressed not only because of its semantic aspect but also because of its legal importance.

Advanced Techniques of Plication Surgery with Basal Approach: When and Why

We describe and report on our variant of penile corporoplasty, the ‘double-breasted’ and ‘track’ corporoplasty, with penoscrotal and infrapubic access not requiring circumcision in penile curvature due to Peyronie’s disease. Preoperative evaluation included prostaglandin E1 injection with photographic documentation and measurement of penile angulation and administration of the International Index of Erectile Function-5 (IIEF-5). Scrotal access was used in patients with dorsal curvature and infrapubic access in patients with ventral curvature. After preparation and incision of Colles’ fascia, the penis is degloved and double-breasted, or track corporoplasty is performed at the site established at preoperative assessment. Complete correction of penile curvature was achieved in 96 % of patients; recurrence occurred in 4 %. No major complications were reported, nor were there neurovascular lesions or change in erectile function. There was no change in the appearance of the penis as circumcision was not performed and the residual scar was barely noticeable as it was hidden in the infrapubic fold. This original technique is associated with low morbidity, a low recurrence rate and excellent aesthetic results.

Future Perspectives in Peyronie’s Disease

This chapter provides the reader with information about future perspectives of medical treatment of Peyronie’s disease (PD).

Penile Subcutaneous Fibrolipoma Postaugmentative Phalloplasty

Fibrolipomas are a rare subtype of lipomas. We describe a case of a man suffering from subcutaneous penile fibrolipoma, who three months earlier has been submitted to an augmentative phalloplasty due to aesthetic dysmorphophobia. After six months from the excision of the mass, the penile elongation and penile enlargement were stable, and the patient was satisfied with his sexual intercourse and sexual life. To our knowledge, this is the first reported penile subcutaneous fibrolipoma case in the literature. The diagnostics and surgical features of this case are discussed.