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Sexual quality of life after total phalloplasty in men with penile deficiency: an exploratory study

Nina Callens (UGent) , GRETA DE CUYPERE (UGent) , Guy T'Sjoen (UGent) , Stan Monstrey (UGent) , Nicolaas Lumen (UGent) , Erik Van Laecke (UGent) , Piet Hoebeke (UGent) and Martine Cools (UGent)
(2015) WORLD JOURNAL OF UROLOGY. 33(1). p.137-143
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Abstract
Total phalloplasty is rarely performed today in males with severe penile deficiency, despite its successful use in the transgender population. Can phalloplasty replicate the complexity of penile anatomy and function on the long term? Sexual quality of life (QoL) was assessed in 10 men (aged 20-43 years) at least 1 year after phalloplasty in a single institution (80 % radial forearm flap and 20 % anterolateral thigh flap). In all but one, an erectile prosthesis was implanted on average 1 year after phallic reconstruction. Sexual QoL outcomes were compared to those of men with hypospadias repair (n = 73) and control men (n = 50). After phalloplasty (mean 36.9 months, 14-92 months), all men were sexually active (80 % intercourse and 100 % masturbation with orgasm and ejaculation). However, 75 % indicated to be inhibited in seeking sexual contacts, compared to 40 % of hypospadias patients (p < 0.05) and 11 % of controls (p < 0.01). Although 90 % were satisfied with the final surgical result, dissatisfaction with some aspects of genital appearance was present in 50 %. Erogenous neophallus sensitivity was said to be less than previously hoped for. Six men developed urinary complications (urethral stricture and/or fistula), and one man underwent revision of the erectile implant because of dysfunction. Nevertheless, all indicated they would choose again for phalloplasty if necessary. Total phalloplasty opens new horizons for the treatment of men with penile deficiency, but limitations of the technique should be emphasized prior to surgery. An exploration of patient expectations and continued follow-up including psychological support is important for optimizing psychosexual comfort.
Keywords
Disorder of sex development (DSD), Reconstructive penile surgery, Psychosexual functioning, Phalloplasty, Micropenis, FOREARM FREE-FLAP, TERM-FOLLOW-UP, PSYCHOSEXUAL DEVELOPMENT, HYPOSPADIAS REPAIR, CLOACAL EXSTROPHY, MICROPENIS, RECONSTRUCTION, FEMALE, MALES, GENDER

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Chicago
Callens, Nina, GRETA DE CUYPERE, Guy T’Sjoen, Stan Monstrey, Nicolaas Lumen, Erik Van Laecke, Piet Hoebeke, and Martine Cools. 2015. “Sexual Quality of Life After Total Phalloplasty in Men with Penile Deficiency: An Exploratory Study.” World Journal of Urology 33 (1): 137–143.
APA
Callens, N., DE CUYPERE, G., T’Sjoen, G., Monstrey, S., Lumen, N., Van Laecke, E., Hoebeke, P., et al. (2015). Sexual quality of life after total phalloplasty in men with penile deficiency: an exploratory study. WORLD JOURNAL OF UROLOGY, 33(1), 137–143.
Vancouver
1.
Callens N, DE CUYPERE G, T’Sjoen G, Monstrey S, Lumen N, Van Laecke E, et al. Sexual quality of life after total phalloplasty in men with penile deficiency: an exploratory study. WORLD JOURNAL OF UROLOGY. 2015;33(1):137–43.
MLA
Callens, Nina, GRETA DE CUYPERE, Guy T’Sjoen, et al. “Sexual Quality of Life After Total Phalloplasty in Men with Penile Deficiency: An Exploratory Study.” WORLD JOURNAL OF UROLOGY 33.1 (2015): 137–143. Print.
@article{4382469,
  abstract     = {Total phalloplasty is rarely performed today in males with severe penile deficiency, despite its successful use in the transgender population. Can phalloplasty replicate the complexity of penile anatomy and function on the long term? 
Sexual quality of life (QoL) was assessed in 10 men (aged 20-43 years) at least 1 year after phalloplasty in a single institution (80 \% radial forearm flap and 20 \% anterolateral thigh flap). In all but one, an erectile prosthesis was implanted on average 1 year after phallic reconstruction. Sexual QoL outcomes were compared to those of men with hypospadias repair (n = 73) and control men (n = 50). 
After phalloplasty (mean 36.9 months, 14-92 months), all men were sexually active (80 \% intercourse and 100 \% masturbation with orgasm and ejaculation). However, 75 \% indicated to be inhibited in seeking sexual contacts, compared to 40 \% of hypospadias patients (p {\textlangle} 0.05) and 11 \% of controls (p {\textlangle} 0.01). Although 90 \% were satisfied with the final surgical result, dissatisfaction with some aspects of genital appearance was present in 50 \%. Erogenous neophallus sensitivity was said to be less than previously hoped for. Six men developed urinary complications (urethral stricture and/or fistula), and one man underwent revision of the erectile implant because of dysfunction. Nevertheless, all indicated they would choose again for phalloplasty if necessary. 
Total phalloplasty opens new horizons for the treatment of men with penile deficiency, but limitations of the technique should be emphasized prior to surgery. An exploration of patient expectations and continued follow-up including psychological support is important for optimizing psychosexual comfort.},
  author       = {Callens, Nina and DE CUYPERE, GRETA and T'Sjoen, Guy and Monstrey, Stan and Lumen, Nicolaas and Van Laecke, Erik and Hoebeke, Piet and Cools, Martine},
  issn         = {0724-4983},
  journal      = {WORLD JOURNAL OF UROLOGY},
  keyword      = {Disorder of sex development (DSD),Reconstructive penile surgery,Psychosexual functioning,Phalloplasty,Micropenis,FOREARM FREE-FLAP,TERM-FOLLOW-UP,PSYCHOSEXUAL DEVELOPMENT,HYPOSPADIAS REPAIR,CLOACAL EXSTROPHY,MICROPENIS,RECONSTRUCTION,FEMALE,MALES,GENDER},
  language     = {eng},
  number       = {1},
  pages        = {137--143},
  title        = {Sexual quality of life after total phalloplasty in men with penile deficiency: an exploratory study},
  url          = {http://dx.doi.org/10.1007/s00345-014-1283-8},
  volume       = {33},
  year         = {2015},
}

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