OBJECTIVE To report our experience of total phallic reconstruction (TPR) with the use of the radial-artery free flap (RAFF) in patients who have had a subtotal penectomy for penile or urethral cancer, as the goal of TPR is the creation of a sensate and cosmetically acceptable phallus with an incorporated neourethra that allows the patient to void while standing, and with the insertion of a penile implant to resume sexual activities, improving quality of life. METHODS The notes of the 15 patients who had undergone RAFF TPR between January 1998 and May 2008 were reviewed retrospectively. The surgical outcome, cosmesis of the phallus, complications, eventual need for revision surgery and patient satisfaction were recorded during the follow-up. RESULTS This technique allowed the reconstruction of a cosmetically acceptable phallus in all patients. After a median (range) follow-up of 20 (1-68) months all patients were satisfied with the cosmesis and size of the phallus, and 14 were able to void while standing. Among the seven patients who have subsequently had insertion of a penile prosthesis, five can now engage in sexual intercourse. Urethral strictures and fistulae were the commonest complications in, respectively, three and four cases, and one patient had his penile prosthesis explanted because of infection. CONCLUSIONS RAFF phalloplasty is an excellent technique for TPR, giving excellent cosmetic and functional results.