Preconstruction of the pars pendulans urethrae for phalloplasty in female-to-male transsexuals.

One of the goals of phallic construction in female-to-male transsexuals should be the creation of a competent neourethra that allows patients to void while standing. Apart from constructing the perineal fixed part of the neourethra, it is therefore necessary to create a phallus with a pendulant part of the neourethra to be connected to the pars fixa urethrae. In patients in whom we apply microsurgical free-flap techniques for phalloplasty, the pars pendulans is usually created the Chinese way (n = 8). If, on the other hand, pedicled abdominal or inguinal skin flaps are used, a skin-lined urethral tube to be incorporated in the phallus should already be extant in the donor area of the flap (n = 25). In the 20-year period 1971-1991, such a preconstruction of the pars pendulans urethrae has been attempted in 25 female-to-male transsexuals employing Snyder's technique. This has been successful in all and uneventful in 17 patients. If malelike micturition while standing is the goal and the use of microsurgical free-flap techniques is not indicated, this procedure seems to be the method of choice.