The bladder flap for urethral reconstruction in total phalloplasty.

At the University of Virginia Hospital we have developed a new technique of urethroplasty utilizing a full-thickness flap of bladder wall. Tubing and transfer of the flap may be completed in two stages. The bladder flap is approximately 28 X 4 cm in size. Strictures have not occurred with this technique, but special care is needed in placing the tube to avoid kinking of the new urethra at the angle where the penile urethra passes anterior to the pubic bone. In conjunction with modern methods of phalloplasty, a two-stage reconstruction of the entire phallus, including a functioning urethra, can be performed by combining the bladder wall flap with a modern (axial vessel) abdominal or groin skin flap. This will allow a patient to have satisfactory intercourse and permit orthostatic micturition with a minimum number of operative procedures.