Sexual Health Outcomes Following Penile Lengthening and Phalloplasty For Adult Male Bladder Exstrophy Patients
Thomas Harris, MBChB, Preeya Khandge, MD, Wayland Wu, MD, Angelo Leto Barone, MD, Roni Manyevitch, BS, Trinity Bivalacqua, MD, Arthur Burnett, MD, Richard Redett III, MD, John Gearhart, MD.
Johns Hopkins, Baltimore, MD, USA.
BACKGROUND: The penis in exstrophy-epispadias complex (EEC) males is demure and patients are often dissatisfied with penile appearance. There is an increased risk of psychosexual dysfunction and so patients desire penile reconstruction. Reconstructive techniques include penile lengthening with a full thickness skin graft (SG) or tissue expansion (TE) subsequently used to provide cutaneous coverage of the gained corporal length, or phalloplasty using a radial forearm free flap or pedicled anterolateral thigh flap. The aim of this study was to assess long-term patient reported sexual health outcomes following SG or TE assisted penile lengthening and phalloplasty.
METHODS: An institutionally approved database of 1389 EEC patients was retrospectively reviewed for male patients who received SG or TE assisted penile lengthening and phalloplasty. Patient perception of penile appearance, sexual function and their frequency of sexual intercourse and satisfaction were assessed using a survey consisting of validated and non-validated questions.
RESULTS: Eighty-three patients previously received penile reconstruction, of which 68 met our inclusion criteria and 28 responded to the survey (41.2%). This included 6 patients reconstructed using TE, 14 with a SG, and 8 who underwent phalloplasty. Prior to reconstruction almost all patients were dissatisfied or very dissatisfied with both penile length and appearance Overall, median penile perception score (range 0 to 12) after reconstruction demonstrated statistically significant improvement from 4.5 to 7.5 (p=0.0034). The majority of patients (70.3%) masturbated at least once per week before surgery and postoperatively, a fairly similar proportion (66.6%) maintained the same frequency. Nine patients engaged in sexual intercourse prior to reconstruction which increased to 17 afterwards. Using a five-
point Likert scale median intercourse satisfaction scores before and after surgery were 3 and 4, respectively.
CONCLUSIONS: Reconstruction of EEC males with a congenitally demure penis is a challenging problem. TE or SG assisted penile lengthening and phalloplasty all improved patient perception of penile appearance and length as well as sexual function and satisfaction. Patients who previously had not engaged in intercourse are now able to do so and those who had are now doing so more frequently. These novel results are encouraging and can provide vital information in the management of dissatisfied EEC patients considering reconstruction.
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