Dr. Karl Coutinho is a fellowship-trained reconstructive urologist with advanced training in genitourinary trauma, urethral reconstruction, and prosthetic surgery. He is a founding member of the Society of Gender Surgeons and is part of the multidisciplinary Gender Affirming Medical and Microsurgical Associates (GAMMA) surgical team, where he works alongside gender-affirming plastic and reconstructive surgeons.
In many masculinizing genital procedures, Dr. Coutinho focuses on the urologic and urethral portions of reconstruction while the plastic surgery team performs complementary reconstructive portions. This collaborative model is particularly important because urethral reconstruction, soft-tissue coverage, flap blood supply, wound healing, and future prosthetic surgery all affect one another. Every patient’s anatomy, prior operations, and goals are different, so care is individualized and often staged.
Dr. Coutinho has specifically studied penile prosthesis implantation after phalloplasty. In 2026, he and his colleagues presented the SPACE (Surgical Protocol for Atraumatic Cylinder Entry) technique as a podium presentation at the American Society for Reconstructive Microsurgery annual meeting. The technique uses stepwise creation of an implant space within the flap, acellular dermal matrix coverage of the cylinder, and reinforced proximal fixation to protect reconstructed tissue and reduce erosion risk.
In the early 17-patient series described in the SPACE manuscript, no implant eroded through the flap; two patients developed infection and required implant removal. These early results come from a small series and do not eliminate the substantial risks of prosthetic surgery after phalloplasty. Dr. Coutinho generally approaches implantation in stages and often begins with one cylinder, tailoring subsequent reconstruction to the patient’s anatomy, healing, and goals.
His role as a founding member of the Society of Gender Surgeons and as a urologic member of the GAMMA team places this prosthetic work within a broader multidisciplinary gender-affirming practice, including management of the urethra before and after implant surgery.
