Complex penile reconstruction continues to pose a significant challenge to surgeons and patients alike. The ideal phalloplasty is one that can be reproducibly performed in a single stage, creates a neourethra that allows for voiding while standing, produces a phallus with tactile and erogenous sensation, allows for penetrative sexual intercourse, and offers satisfactory aesthetic results. With recent advances in microsurgery and perforator flap dissection, several techniques and modifications thereof have been described that aim to achieve these reconstructive goals. All of these now conventional techniques, however, fall short in one way or another - often with regards to urinary transport, the ability to achieve an erection, and the need for multiple surgical stages and revision operations. These limitations of conventional reconstruction have led some surgeons to explore new avenues for complex penis reconstruction, giving birth to the novel field of penile transplantation. In this article, we discuss the complexities of male genitourinary reconstruction in the context of conventional methods for reconstruction as well as the burgeoning field of penile transplantation.