Phalloplasty and Urethral (Re)construction: A Chronological Timeline

gender reassignment over the next 40 years.Various fasciocutaneous and extended pedicle island flaps were also developed during this time.Nonetheless, they continued to have suboptimal functional and aesthetic results due to their significant limitations in sensory recovery primarily [10,13,14].Throughout the 1970's other innovations were introduced in the field of penile reconstruction.In 1971, Kaplan et al. [15] developed a method that provided sensation to the neophallus.Their method involved using a pedicled medial thigh flap, based on the femoral branches of the genitofemoral nerve, to create the penile shaft and a turned-in flap from the median raphe of the scrotum to construct the urethra.This technique was initially used for patients who underwent penile amputation due to penile cancer.In 1972, Orticochea [16], a Colombian physician, first used a pedicled tube flap involving the gracilis muscle to provide an erection in patients who required reconstruction secondary to trauma and/or surgical ablation.In addition, the obturator nerve, which supplies sensation to the inner aspect of the thigh, was included and allowed the neophallus to experience erogenous, thermal, pain, and tactile sensations.A neourethra was also created.Patients reported satisfactory results in sexual performance and were even able to achieve orgasm.Despite these benefits, this technique consisted of five stages and included complications such as urethral fistulas and stenosis in addition to muscle-related problems with the gracilis muscle.Gregor et al. [17] developed the groin flap which was later adapted by Puckett, et al. [18] in 1976 for penile reconstruction, including a Scott penile inflation device to produce an erection.Previously, silicone rubber rods, bone, or cartilage were used to provide penile rigidity, but were found to erode through the soft tissue, as the neophallus takes some time to become sensate (9-12 months).Moreover, the constant rigidity served as a source of embarrassment to the patient [19] and led to the creation of the Scott prosthesis.