Penile Reconstruction Surgery Has High Success Rate and Outcomes

British plastic surgeon Sir Harold Gillies, left, a pioneer in phalloplasty, speaks to Dr. E. Barton at Foyle Art Gallery in London on January 14, 1948. AP

Reconstructive surgery is one of the miracles of modern medicine, especially when it's used to improve a person's quality of life and their body's functions. Phalloplasty, which is surgery to reconstruct or completely build a penis, is a way for patients to regain both urinary and sexual abilities and another step in gender reassignment for biological females wishing to transition to male.

Men who suffer severe trauma or a loss of their penis through an accident, or medical affliction such as cancer, are usually candidates for complete phallic reconstruction. Some accidents, particularly in military combat, can result in the amputation of the penis, and surgeons to do the procedures are in high demand. According to a study published January 2014 in the Journal of Men's Health, rates of genital injuries in combat have increased by nearly 350 percent since the early 2000s.

But the medical community is only beginning to answer the question of just how well the reconstructed organs actually perform. Because the surgery is currently used for two very distinct patient groups—biological men and transgendered—the outcomes aren't always the same. New research presented at the Annual Meeting of the American Urological Association on May 7 suggests the success rate of these surgeries is high, as is patients' satisfaction with its outcome.

The study involved 100 patients who underwent the procedure. Of those, 47 were transgender and 53 were non-transgender and undergoing phalloplasty due to injury, congenital defects or penile cancer. Nearly all of the phalloplasties used a standard technique called radial artery-based forearm phalloplasty (RAP). In the procedure, a surgeon removes a flap of skin on the inner forearm, along with at least one artery and one large nerve and the layer of soft tissue that protects the bones. The flap is then rolled into a tube. This is then stitched to the groin vessel to form the penile replacement. Additionally, in most instances, a patient opts to have an internal penile pump inserted to facilitate sexual function and maintain erection.

Forty-eight percent of non-transgendered patients and 38.6 percent of transgendered patients reported improved outcomes in terms of urinary function. About 70 percent of both groups experienced increased sensation, and a quarter of each group reported being more sexually active after the operation than before. Transgendered patients were more likely to experience urinary complications than the non-transgender group, specifically the narrowing of the urethra. But the transgender group was overall less likely to experience complications—45 percent versus 63 percent.

Dr. Nim Christopher, a urological surgeon at the University College London Hospitals and researcher on the study, says while the surgery doesn't result in something exactly like the real thing it can significantly change a person's life. "I always tell patients in a dark room most things look the same," he says. "The skin may be kind of hairy, the skin will be a different color, the glans are never going to be pink but the shape—the ridge, the head and the shaft— is pretty much the same as a regular penis."

Phalloplasty has been around in some form for 80 years. In 1936, Nikolaj A. Bogoraz, a Russian urological and plastic surgeon, constructed the first ever neophallus (a surgically constructed penis) for the purpose of reversing erectile dysfunction. He created an implant from a portion of the patient's rib cartilage, in order to facilitate an erection and essentially wrapped it up in skin from the patient's abdomen and shaped it as best he could so it (almost) resembled the real thing. The first female-to-male gender reassignment procedure was performed by British physician Sir Harold Gillies in 1946.

Today's neophalluses are much more advanced, and a skilled surgeon can make one that functions nearly as well as a God-given appendage. Through a number of experimental techniques, men can do away with catheter bags, experience sensation and regain complete sexual function. As long as a man still has his testes he will be able to father a child.

Hospitals are also developing other procedures, including penis transplants; Johns Hopkins University plans to perform the first one this year . In the more distant future, scientists also say they'll have the ability to create lab-grown penises .