FtM Penis Urethroplasty
Enhancements and Upgrades of FtM Phalloplasty
Conjoined Bilateral Pedicled Groin Flap FtM Phalloplasty can include urethroplasty and a penile prosthesis implant for sex.
Dr Kim can also upgrade, revise and/or correct the surgical results of other FtM phalloplasty surgeons such as Dr Toby R Meltzer or Dr Sherman Leis so your penis can be used to urinate standing and have sexual intercourse with a partner.
Yes. Dr Kim provides upgrades and enhancements to his own Conjoined Bilateral Pedicled Groin Flap procedure as well as a Leis or Meltzer FtM penis so it can accommodate a penile prosthesis implant and enable FtM erection and sex.
In recent years, Dr Kim's surgical technique for “penile urethra prefabrications" has evolved from folding of the unilateral side flap to using vaginal mucosa which gained from the patient's vaginectomy.
He has been using it for his mucosal graft method.
The reasons for the evolution of Dr Kim's surgical tricks were to:
- Increase the body surface area of the neo-phallus because patients want a bigger neo-phallus size.
- Avoid creating an additional skin graft donor site by re-engineering the vaginal mucosa resulting from a vaginectomy to create the neo-urethra. No need for buccal mucosa urethroplasty.
- Minimize shortening of the penile urethra during healing process, after folding of the flaps. During the healing period of one month, the distal part of the sutures sometimes break down and the skin tube is apt to be widened and flattened. That is the reason for a proximally located urethral meatus, although Dr Kim's initial design was more distally located at the tips of neo-phallus.
- Reduce chances of fistula development. When sutures break down in the middle or proximal part of prefabricated penile urethra, that results in a fistula. When the mucosal graft method is used, the possibility of fistulas is very rare, except for the openings of the proximal and distal ends.
- Reduce risks of vascular stress on the folded donor tissue flap.
- Reduce the potential for urethral stricture at the site of urethral realignment resulting from he difference in dermal thickness between the skin flap and genital skin.
Dr Kim says:
There is no perfect solution for neo-urethra creation in a neophallus. It takes lots of time and energy for the patient's convenience and good quality of life.
Patients hoping to upgrade the phalloplasty they got from Dr Meltzer or Dr Leis have asked Dr Kim numerous questions regarding the upgrades they want: urethroplasty to pee standing using their penis and penile prosthesis implantation.
Here are Dr Kim's responses.
Do you charge to treat fistula resulting from the urethroplasty?
I charge nothing for fistula surgery. But the patient pays for anesthesia, oral medicines, hospital stay and various other expenses — if it is needed.
For fistula repair under local anesthesia, a patient pays only for oral medications.
Can the neo-urethra extend to the tip and the center of the neo-phallus?
Yes, when vaginal mucosal grafting method is applied for penile urethra prefabrications.
Does the neophallus ever develop tactile sensation? To the tip? Are any nerves moved and reconnected with the flap?
About 80% of my patients experience full recovery of sensation within two years after surgery. I do not perform any special procedure, except for flap harvesting and rotation. The rest is done by nature.
How many people at your hospital can speak English to patients besides you?
Everybody understands basic English, because they graduated from college. There would be no big communication difficulties for medical purposes.
One of my assistants, Mr. Lim, served as KATUSA (Korean Augmentation Troops to the United States Army) and as an MP (military police) for three years. So he can speak military English also.
Can Dr. Kim do glansoplasty or at least make the tip look more like a glans?
I make the tip of the neophallus bigger and round-shaped by placing hemispherical silicone elastomers at the distal ends of the malleable penile prosthesis.
Shaping or grooving of the coronal sulcus is the final step, maybe under local anesthesia, if the patient wants and requests it.
Will the scrotum be in front or way below where the labia is now?
What is the minimum period that is recommended for me to be off testosterone injection totally?
I don't tell patients to stop testosterone, because the procedures are done under spinal and epidural anesthesia.
The risk of DVT (deep venous thrombosis) is very rare when the anesthesia is not a general one.
Also, oriental people have relatively short extremities which reduces the risk of DVT.
Any nutritional diet/vitamins advice in preparation for the surgery?
Vitamin overdosage helps fast recovery. Sometimes, Vitamin C mega-dose therapy is be done by doctors when the wound condition is not good.
Has Dr. Kim done any phalloplasty for patients from Singapore/Malaysia?
One ethnic Chinese Malaysian, who is now staying Singapore, received TVH & BSO last summer.
One Japanese patient visited me for metoidioplasty after a consultation with a Japanese doctor.
Three American citizens received Mastectomy and TVH & BSO.
I got a total hysterectomy in 2001 and have a scar along my abdomen. Would there be a problem?
The reason I developed bilateral conjoined groin flap is because of previous hysterectomy scars of transverse directions, which are called Pfannensteal incisions. In those cases, lower abdominal flaps for phalloplasty (also called Pryor's methods) is impossible.
The reason is that the main blood supply for the flap, which should come from the hypogastric vessel systems, are already destroyed.
So I must find the blood supply more laterally, not from lower centrally, inferior epigastric vessel systems, as well as circumflex iliac vessel systems.