Innovative Technique for Single-Stage Phalloplasty with Complete Urethral Reconstruction for Micropenis and Perineal Hypospadias

Abstract In a 20-year-old male patient born with micropenis and urethral opening in the perineal region, total phallus and bulbar portions of the urethra were reconstructed in a single stage using the radial artery forearm flap. The penile reconstruction followed a tube-in-tube design, and for the bulbar urethral reconstruction, an additional length of radial artery forearm flap was designed and reinforced with deep fascia of the forearm. Gracilis muscle was harvested from the opposite thigh and used to reinforce the urethral anastomotic site. The descending branch of the lateral circumflex femoral artery was chosen to vascularize the reconstructed urethra and penis, using this vessel as the recipient, giving a distinct advantage over the deep inferior epigastric or femoral vessels. To the best of our knowledge, this technique of total penile and urethral reconstruction in a single stage has not been described in the literature, and this would be a useful technique in the armamentarium of penile reconstruction.