Fundamentals of Complex Male Genitourinary Reconstruction and Transplantation

Genital reconstruction is performed for a spectrum of conditions, predominantly of the penis, that are congenital or acquired in origin. Congenital penile deformities include genital insufficiency which are reconstructed using skin grafts or tissue expansion-assisted penile lengthening or phalloplasty, as well as those relating to urethral anomalies. Hypospadias and epispadias are typically reconstructed by urologists, however, techniques from plastic surgery such as skin grafting, and tissue expansion can be used to provide new penile skin which can subsequently be used for the urethral plate in primary reconstruction or management of complications. Acquired penile deformities include a buried penis, lymphedema, and corporal and/or glans loss. A buried penis and penile lymphedema are reconstructed with penile resurfacing or shaft skin excision, respectively, with subsequent skin graft placement. Patients who experience corporal and/or glans loss may require penile replantation, if suitable, phalloplasty or penile transplantation.