Neourethra Creation in Gender Phalloplasty: Differences in Techniques and Staging

Jens U. Berli, Stan Monstrey, Bauback Safa, Mang Chen

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Summary: The creation of a sensate, aesthetic, and functional phallus for transmasculine individuals has high reported complication rates. Neourethra reconstruction is the most challenging aspect of this surgery, with widely varying techniques and staging between providers. In an operation of this complexity, surgeons should not be expected to offer all the options, but rather the specific variation that works in their given setting. For some, it is single-stage phalloplasty with full-length urethroplasty. For others, staged phalloplasty with separation of perineal masculinization from phallus reconstruction works better. In this expert opinion article, the authors strive to give an overview of the principles behind, and a detailed explanation of, the technical details of creating the penile and bulbar urethra during phalloplasty. The authors focus on the three most common strategies: single-stage phalloplasty; two-stage phalloplasty with a metoidioplasty-first approach; and two-stage phalloplasty with a phalloplasty-first (Big Ben method) approach. It is not the authors' intent to establish the "best" or "only" way, but rather to compile different options with their respective pros and cons.

Original languageEnglish (US)
Pages (from-to)801E-811E
JournalPlastic and reconstructive surgery
StateAccepted/In press - 2021

ASJC Scopus subject areas

  • Surgery


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