Total urethral construction with the radial artery‐based forearm free flap in the transsexual

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To report our experience of using a radial artery‐based forearm free flap urethroplasty (RAFFFU) inside a pre‐fashioned pedicled pubic phalloplasty for female‐to‐male gender reassignment. PATIENTS AND METHODS A neourethra based on the RAFFF was incorporated into a previously constructed phalloplasty in 27 patients. Surgical outcome, patients’ satisfaction and voiding sensation of the neourethra were subjectively and prospectively assessed by direct questioning during the follow‐up. RESULTS After a median follow‐up of 9.2 months, all patients who completed the two stages of the procedure were able to void from the tip of the phallus while standing. Donor‐site morbidity was minimal, with all patients reporting a complete recovery of forearm sensation and mobility. The overall satisfaction rate was 92%. CONCLUSIONS The RAFFFU is the best technique of total urethral construction in female‐to‐male transsexuals who opt not to undergo a RAFFF phalloplasty.