The aim of this study is to share our preliminary outcomes of the pedicled Antero Lateral Thigh flap (ALTf) phalloplasty technique, which we presume to be the first reported case series of a single center from Turkey. A cross-sectional study, comprising all cases who underwent pedicled ALTf phalloplasty in our clinic, between January 2015 and December 2019, was designed. Demographic data, case characteristics and surgical details including complications were recorded. The mean age of our 26 cases was 30 (28-34) years. The mean penile length and diameter were 15.07 ± 0.98 cm and 3.9 ± 0.34 cm, respectively. Tactile sensation was evaluated by touching the radix, corpus and tip of the neo-phallus showing response in 17 (65.4%), 7 (26.9%) and 2 (7.7%) of the cases, respectively. In 14 (53.8%) of all our cases no complication was reported at all. However, in 12 (46.1%) cases, although no intraoperative complication occurred; postoperative complications were observed as Clavien-2 (3.8%), Clavien-3a (3.8%) and Clavien-3b (71%). Postoperative satisfaction rates were found 77.14% (38-94). Although relevant studies are limited, in addition to low complication rates and high satisfactory outcomes, by leading to a concealable donor site, the pedicled ALTf can be used as a preferred phalloplasty technique, especially in transmen with religious or cultural sensibility.

UNASSIGNED: Genital lymphedema is a severe, disabling condition associated with a malfunction of the lymphatic system. Primary lymphedema of the scrotum is a variant of congenital dysplasia of lymphatic vessels. Secondary genital lymphedema is much more common and can be caused by parasitic invasion (filariasis) or damage to the lymphatic system during the treatment of cancer (radiation therapy, lymphadenectomy). Healthcare providers are frequently unable to detect and treat this illness successfully in ordinary clinical practice. This paper uses the case of a patient with stage 3 secondary lymphedema (unknown genesis) of both lower extremities and lymphedema of the scrotum, complicated by recurrent erysipelas, a history of lymphorrhoea, impaired skin trophic and multiple papillomatosis, to demonstrate the efficacy of a combination of conservative and surgical methods in the treatment of giant lymphedema of the scrotum.
UNASSIGNED: In the treatment, the combination of decongestant physical therapy (CDPT, CDT) according to M. Földi was used at pre-surgery and post-surgery stages, combined with a reconstructive operation, including the removal of the affected tissues of the urogenital region, phalloplasty, and scrotoplasty with rotational skin flaps.
UNASSIGNED: A decrease in the circumference of the lowest extremities in the lower leg area by 68 cm on the right and by 69 cm on the left was achieved by conservative treatment. Due to the combination of conservative and surgical treatment, the patient\'s body weight decreased by 69.4 kg, and the scrotum decreased by 63 cm. Subsequently, the patient fully recovered his sexual function.
UNASSIGNED: A combination of complex decongestive physical therapy and surgery is necessary for patients with advanced genital edema. The isolated use of surgical or conservative treatment does not provide a sufficient improvement in the patient\'s quality of life. Modern plastic surgery technologies enable patients to achieve complete functional and cosmetic recovery, while proper selection and usage of compression hosiery help preserve and improve the outcomes acquired following treatment.

We present the first case of a patient born with congenital fusiform megalourethra who underwent the successful placement of an inflatable penile prosthesis (IPP) and mesh phalloplasty due to primary erectile dysfunction (ED). After an extensive psychosexual assessment and a preoperative MRI scan, an IPP was successfully implanted. The procedure was carried out through a penoscrotal approach, which offered excellent exposure to the crura and the proximal ends of the corpora cavernosa. Following the incision and the dilatation of both corpora cavernosa, the penile cylinders were inserted and a mesh phalloplasty was performed, to replace the erectile tissues lacking in the distal corpora cavernosa. After reservoir and pump placement, the device was tested, and no mechanical issues were recorded. The postoperative course was uneventful, and, at the 2-year follow-up, the patient reported highly satisfactory results, with valid functional erections.

UNASSIGNED: Surgery to reduce the size of the reconstructed penis is uncommon. Patients who have undergone total penis reconstruction may want to reduce the size of their reconstructed penis due to convenience issues. To reduce reconstructed penis size, surgical treatment is essential. However, no research has thus far reported on this methodology.
UNASSIGNED: A 50-year-old Asian man experienced a nearly total loss of his penis due to trauma 30 years ago. He underwent nearly total penis reconstruction using a tubed abdominal flap. The patient\'s reconstructed penis showed hypospadias, which caused discomfort during urination. The length of the penis was 17 cm. The patient felt that the reconstructed penis was too large, and a reduction surgery was planned for corrective action. Y-shape incision lines were applied on both lateral sides of the reconstructed penis to reduce the circumference, and curved incision lines were applied on the front and back of the penis to construct the neomeatus and glans of the penis. The incision was made, and the remnant tissue was dissected, with attention paid to avoid damage to the neourethra. After the tissue resection, the neourethra was isolated and resected to fit the height of the penis to construct the neomeatus and correct the hypospadias. An approximation was performed after the reconstructed penis reduction.
UNASSIGNED: Two years after the surgery, there were no complications, such as urethral stricture or fistula, and the patient was satisfied with the shape and size of the reduced penis (9 cm). The surgical reconstructed penis reduction procedure introduced in this case report achieved satisfactory aesthetic and functional results.

BACKGROUND: In phalloplasty, there is a lack of standardized follow-up examinations of motor function and strength after harvesting oversized radial forearm free flaps (RFFF).
METHODS: We evaluated the donor site of 20 transmen after phalloplasty, using a multimodal, standardized approach, assessing the following parameters: opposition of the thumb, composite range of motion of the finger joints, grip strength, mobility of the wrist, lesion of the superficial branch of the radial nerve, the dorsal branch of the ulnar nerve, the sensation of pain, and cold intolerance. The contralateral, nonoperated forearm was used as a control.
RESULTS: No impairment of the mobility of the thumb (Kapandji score median 10, range 5-10) or fingers (all fingers at both sides pulp-to-palm 0 cm, nail-to-table 0 cm) were detected. Grip strength (median 36,3kg, p=0.629) and wrist extension (62.5°vs.70°, p=0.357), flexion (70°vs.70°, p=0.535), pronation (90°vs.90°), supination (90°vs.90°), radial (30°vs.30°, p=0.195), and ulnar deviation (40°vs.50°, p=0.125) did not statistically differ between donor and control hand. Injury of the dorsal branch of the ulnar nerve was uncommon (0% hypoesthesia, 10% positive Tinel\'s sign). We did not observe any persistent pain of the donor forearm (NRS median 0, range 0-9). We did observe irritation of the superficial branch of the radial nerve (hypoesthesia 40%, neuroma 45%).
CONCLUSIONS: The harvest of an oversized RFFF for phalloplasty does not cause any significant difference in motor function or strength between the donor and nonoperated hand. A potential risk of injuring the radial nerve branch is to be avoided. An aesthetic impairment could be addressed in future studies.

Penile amputation is a rare deformity mostly resulting from self-mutilation, felonious assault, or accidental trauma, and penile reconstruction or phalloplasty is necessary when microreplantation cannot be performed. Here we report a rare case of a 42-year-old man with traumatic penile amputation and describe surgical techniques for partial penile reconstruction by using a novel innervated and vascularized radial thenar flap free grafting method. Excellent cosmetic and functional results were reported with no severe complications of dysuria, urethral stricture, and urinary fistula were observed during the 23 months of postoperative follow-up time. It is believed that innervated and vascularized radial thenar flap free grafting is an acceptable treatment option for patients with traumatic penile amputation.

Circumcision is regarded as one of the most common procedures in pediatrics. We present a case of a newborn, who has undergone circumcision using monopolar electrocautery. He admitted to the hospital with glans necrosis and was treated with antibiotics and surgical debridement. Four months later, phalloplasty was performed for the newborn using scrotal flap. The result is satisfactory, and the penis is esthetically acceptable with effective urination. Our case suggests the use of scrotal flap for penile reconstruction due to feasibility of procedure and anatomic privilege. It would also support usage of bipolar electrocautery for circumcision to avoid possible unwanted complications of monopolar electrocautery.

Some transgender men express the wish to undergo genital gender-affirming surgery. Metoidioplasty and phalloplasty are procedures that are performed to construct a neophallus. Genital gender-affirming surgery contributes to physical well-being, but dissatisfaction with the surgical results may occur. Disadvantages of metoidioplasty are the relatively small neophallus, the inability to have penetrative sex, and often difficulty with voiding while standing. Therefore, some transgender men opt to undergo a secondary phalloplasty after metoidioplasty. Literature on secondary phalloplasty is scarce.
Explore the reasons for secondary phalloplasty, describe the surgical techniques, and report on the clinical outcomes.
Transgender men who underwent secondary phalloplasty after metoidioplasty were retrospectively identified in 8 gender surgery clinics (Amsterdam, Belgrade, Bordeaux, Austin, Ghent, Helsinki, Miami, and Montreal). Preoperative consultation, patient motivation for secondary phalloplasty, surgical technique, perioperative characteristics, complications, and clinical outcomes were recorded.
The main outcome measures were surgical techniques, patient motivation, and outcomes of secondary phalloplasty after metoidioplasty in transgender men.
Eighty-three patients were identified. The median follow-up was 7.5 years (range 0.8-39). Indicated reasons to undergo secondary phalloplasty were to have a larger phallus (n = 32; 38.6%), to be able to have penetrative sexual intercourse (n = 25; 30.1%), have had metoidioplasty performed as a first step toward phalloplasty (n = 17; 20.5%), and to void while standing (n = 15; 18.1%). Each center had preferential techniques for phalloplasty. A wide variety of surgical techniques were used to perform secondary phalloplasty. Intraoperative complications (revision of microvascular anastomosis) occurred in 3 patients (5.5%) undergoing free flap phalloplasty. Total flap failure occurred in 1 patient (1.2%). Urethral fistulas occurred in 23 patients (30.3%) and strictures in 27 patients (35.6%).
A secondary phalloplasty is a suitable option for patients who previously underwent metoidioplasty.
This is the first study to report on secondary phalloplasty in collaboration with 8 specialized gender clinics. The main limitation was the retrospective design.
In high-volume centers specialized in gender affirming surgery, a secondary phalloplasty in transgender men can be performed after metoidioplasty with complication rates similar to primary phalloplasty. Al-Tamimi M, Pigot GL, van der Sluis WB, et al. The Surgical Techniques and Outcomes of Secondary Phalloplasty After Metoidioplasty in Transgender Men: An International, Multi-Center Case Series. J Sex Med 2019;16:1849-1859.

Plastic surgery continues to maintain a prominent presence in the evolution of male genital reconstruction. In this case report, we are presenting a case of post-electric burn with a total loss of penis. Sustaining other major injuries following an electric burn with loss of right upper limb and extensive tissue damage to left upper limb, abdomen and both thighs, this young male patient was initially managed from life-threatening problems. With many options closed following a major electric burn and its acute management, penile and urethral reconstruction was a unique and a great challenge in this patient. Heeding to the patient\'s wish of male pattern micturition, we had performed a successful reconstruction of urethra and entire phallus with groin flap.