A normal anterior urethral on retrograde urethrography nearly ensures an anastomotic repair of a PFUI is feasible.
PFUIs most commonly occur between the prostate and membranous urethra.
Pelvic fractures are associated with urethral injuries in about 10% of cases.
In the prepubescent male, PFUI's are more likely to involve the prostatic urethra.
The appearance of the bladder neck on preoperative contrast studies does not accurately predict continence outcomes following anastomotic repair of PFUIs.
rerouting of the spongiosum above the crura of the corpora cavernosa.
mobilizing the corpus spongiosum off the corpora cavernosa up to the corona of the glans.
excision of Buck fascia from the corpus spongiosum.
periosteal elevation and infrapubectomy.
dissection of the intracrural space down to the pubis.
Men with arteriogenic ED following PFUI who demonstrate bilateral occlusion of the internal pudendal arteries without reconstitution
Men with normal erectile function following PFUI
Men with arteriogenic ED following PFUI who demonstrate unilateral occlusion of the internal pudendal artery
Men with erectile dysfunction (ED) following PFUI, but normal hemodynamics on penile duplex sonography
Men following PFUI with ED and hemodynamics on penile duplex sonography suggesting venous leak
Urinary fistulae, although a common complication following phallic construction, are often resolved with conservative measures and do not routinely require operative repair.
Current techniques are accomplished with a variety of flap designs, which use microvascular free flap transfer.
Penile tactile and erogenous sensation can be achieved following total phallic construction via coaptation of the flap cutaneous nerves to the dorsal penile/clitoral nerve, the pudendal nerve, or the ilioinguinal nerve.
Phallic rigidity may be achieved in the neophallus by placement of a penile prosthesis before the return of tactile sensation of the phallus.
Complications following prosthesis placement into patients following total phallic construction are higher than those following placement into men with normal corporal anatomy.
idiopathic proximal 1-cm bulbar urethral stricture in a patient with a history of a prior hypospadias repair.
pelvic fracture urethral injury with a 3-cm gap demonstrated on preoperative urethrography.
iatrogenic urethral trauma during a transurethral resection resulting in a 1- cm bulbar urethral stricture.
perineal trauma resulting in a 2-cm proximal bulbar urethral stricture.
straddle injury resulting in a 1-cm bulbar urethral stricture.
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