Background Penile prostheses may be used as a component of genital gender affirmation surgery for the purpose of achieving penile rigidity after phalloplasty, and transgender individuals experience higher complication rates than cisgender individuals. Aim To observe complications with transmasculine penile prosthesis surgery over time and across surgical conditions. Methods Retrospective chart review of all transmasculine patients with phalloplasty undergoing penile prosthesis placement between 4/14/2017 and 2/11/2020 (80 patients). Outcomes Independent variables include implant type, previous genital surgeries, and simultaneous genital surgeries. Dependent variables include prosthesis infection and mechanical complication (device malfunction, dislodgement, erosion). Results There was an overall complication requiring surgery rate of 36% and infection rate of 20% (15/67 for inflatable prostheses and 1/13 for semirigid), with 14% (11/80) experiencing infection requiring removal. Differences in infection rates appeared insignificant across categories of previous surgery or with simultaneous surgery, but we did notice a markedly lower rate for semirigid prostheses compared to inflatable. There was a significant relationship between infection and case number, with the probability of infection decreasing over time. Device loss at 9 months was 21% overall. Preoperative conditions of the neophallus such as prior stricture correction and perioperative factors such as simultaneous clean and clean-contaminated procedures seemed to pose no additional increase in complication rates. Clinical Implications Type and number of prior and simultaneous non-prosthetic surgeries should not be considered as a risk factor for penile prosthesis after phalloplasty for transmasculine patients, even those that are clean-contaminated Strengths & Limitations Our cohort size is large compared to currently available studies, although not large enough to generate sufficient power for group comparisons. We have reported every genital surgical step between phalloplasty and penile prosthesis placement and recorded complications with subsequent devices after failure. Patient-reported outcomes were not collected. Conclusion We demonstrate that preoperative conditions of the neophallus, such as prior stricture correction, and perioperative factors, such as simultaneous clean and clean-contaminated procedures, seem to pose no additional increase in complication rates. Our data suggest that surgical experience may further decrease complications over time.

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complication, <1% had a rectal injury, 21% had urinary issues, 19% had a urethral stricture, 16% had loss of neovaginal depth and 15% had prolapse (Table 1). Smoking was the only factor that was found to have a statistically significant HR for both common and gender affirming complications (1.48 and 1.26, respectively; p<0.05).CONCLUSIONS: Post-vaginoplasty, the majority of patients have at least one complication based on claims data. All patients should be counseled on smoking cessation prior to surgery to potentially decrease the rate of complications.

INTRODUCTION AND OBJECTIVE:The impact of genderaffirming androgen deprivation hormone therapy (HT) on the prostate of transgender females (TF) has not been well described. The aim of our study is to understand prostate characteristics on ultrasound in TF.METHODS: We retrospectively evaluated the charts of TF on medical or surgical androgen deprivation (AD) as part of their gender transition who had transrectal ultrasound (US) imaging of the prostate. Ultrasounds were performed using a 10-5 MHz biplane probe for surgical planning. Variables evaluated included age, body mass index (BMI), prostate size, PSA values, if present, and duration of hormonal therapy. We performed age-matched comparisons between our cohort, published literature, and an internal data set of cisgender male patients. Pearson's R, Student's T test, and one-way ANOVA with Tukey's HSD were performed for hypothesis testing.RESULTS: Between 2020 and 2022, 60 TF patients underwent prostate US. Demographics and findings are summarized in Table 1. There was no correlation in prostate size with duration of HT (DHT) or BMI. Older current age was associated with increased prostate size (R [0.58, p<0.001). Starting AD at a later age of hormone transition (AHT) was also associated with larger prostate size (R[0.59, p<0.001). When stratifying by age at hormone transition and current age, patients over age 50 had significantly larger prostates, compared to age groups <26 and 26-50 (p<0.01, Figure 1). Linear regression modeling both AHT and DHT as predictors of prostate size showed that AHT was about twice as impactful as DHT (R[0.68, p<0.001). We also noted that our cohort's prostate volumes were significantly smaller than known population means for patients under age 51 (p<0.001), and were smaller than an age-matched cis male cohort from the same institution (Table 1).CONCLUSIONS: TF, primarily after 50, have larger prostates despite ongoing HT. Duration of HT and BMI were not independently correlated to prostate size, but older age at hormone transition and current age were associated with larger prostate size. [1]