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In the largest series to date almost patientsMonstrey et al 29 recently described the technical aspects of radial forearm phalloplasty and the extent to which this technique, in their hands approximates the criteria for ideal penile reconstruction. For the genitoperineal transformation vaginectomy, urethral reconstruction, scrotoplasty, phalloplastytwo surgical teams operate at the same time with the patient first placed in a gynecological lithotomy position. In the perineal area, a urologist may perform a vaginectomy, and lengthen the urethra with mucosa between the minor labiae.