Currently, standardized surgical techniques or guidelines for genital gender affirmation surgery (GGAS) have not been established. However, a common goal of improving quality of life and relieving gender dysphoriashould stand, regardless. Important contributing factors include that a neophallus should provide the ability of standing micturition, offer tactile and erogenous sensation, exhibit penetrable rigidity and present satisfactory aesthetics.
Until now, phalloplasty and neourethra creation still remain the most challenging and complication prone aspects of GGAS. While tube within a tube (TWT) is most frequently utilized due to its one-stage nature, but many limitations remain. TWT is viable only if flap thickness is under 1 cm , limiting flap selection or necessitating a second flap. Neourethra hair growth within the tube also contribute to high obstruction rates. The prelaminated urethral method provided solutions to these issues. The staged surgery is recommended for the circulation of flaps to reconstruct the neophallus. I designed some techniques that the previous articles had not mentioned before, such as, dermofat testicle graft, extending prelaminated urethra, McDonald incision for pubic area and Calla lily preparation for the urethral connection.
I would like to share the personal experience about these techniques.