Dynamic Penile Corpora Cavernosa Reconstruction Using Bilateral Innervated Gracilis Muscles: A Preclinical Investigation

Yin, Zhuming; Liu, Liqiang; Xue, Boxin; Fan, Jincai; Chen, Wenlin; Liu, Zheng

doi:10.1016/j.esxm.2018.01.002

Cited by 2 publications

(3 citation statements)

References 30 publications

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“…Negative: Hopeful about sex (7) Hopeful about confidence (1) Hopeful about avoiding surgery/internal device (5) Worried about discomfort (1) After learning about the device, but not yet having seen it. .…”

Section: Positivementioning

confidence: 99%

“…Negative: Less interference with sex (7) Increased Confidence (8) Easier to use than current method (4) More sensation than current method (4) Excited about sex with the device (5) Worries about measurement/sizing (10) Worries about device slipping/failure (6) Worries about safety (1) Worries about discomfort (9) After seeing the device, but not yet having used it. .…”

Section: Positivementioning

confidence: 99%

“…1 Transgender men may be justifiably concerned about device failure and the possible need for additional surgery with existing options for internal erectile prostheses, particularly given the higher complication rates seen for these devices in transgender men when compared to cisgender men experiencing erectile dysfunction in a natal phallus. 2−4 As such, there is a need to develop alternative methods for helping transgender men achieve penetrative function after phalloplastythrough both surgical options 5 as well as non-surgical alternatives to assist with erectile function. 6,7 One such option may be the use of external erectile prostheses.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of an External Erectile Prosthesis for Transgender Men Who have Undergone Phalloplasty

et al. 2022

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Introduction Transgender men interested in achieving penetration after phalloplasty are currently limited to internal devices and makeshift supports. More options are needed to support sexual penetration after phalloplasty. Aim This study was designed to assess the feasibility of an external erectile prosthesis (the Elator) for transgender men who have undergone phalloplasty and wish to use their neophallus for sexual penetration, assess how the device affected the sexual experiences of men and their partners, and identify any side effects and concerns. Methods Transgender men and their partners were provided with an erectile device to use for one month. They were surveyed at 4 time points: enrollment, measurement, receipt, and after using the device, using a combination of pre-existing and device-specific measures. Main Outcome Measure The primary outcome was whether men found it feasible to use an external penile prosthesis for sexual penetration after phalloplasty – defined as interest in, and willingness to, use the device more than once over the study period; intention to continue using the device on the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS); and no decrease in relationship satisfaction on the Gay and Lesbian Relationship Satisfaction Scale (GLRSS). The secondary outcome was an increase in sexual or relationship satisfaction with use of the device, defined as a statistically significant increase on either the Quality of Sexual Experience Scale (QSE) or the GLRSS. Results Fifteen couples enrolled in the pilot study. Of the 10 who completed the study, only 3 found device use feasible and endorsed strongly positive experiences, while the remaining 7 found it unusable. There were no changes in QSE or GLRSS scores. Most device issues were related to proper fit. Conclusion There is a great deal of interest in non-surgical options for achieving penetration after phalloplasty. The tested external erectile device can work well, but its utility is limited to individuals with very specific post-phalloplasty anatomy. Most individuals and couples found the device unsuitable for the neophallus and/or that it could not be used comfortably.

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Section: Positivementioning

confidence: 99%

Section: Positivementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility of an External Erectile Prosthesis for Transgender Men Who have Undergone Phalloplasty

et al. 2022

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The pedicled gracilis muscle combined with the fascia lata: a preliminary clinical study of a new biomimetic dynamic phalloplasty method

Cao

Liu

Yang

et al. 2023

The Journal of Sexual Medicine

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Background Phalloplasty is a challenging procedure in the field of repair and reconstruction. Traditional skin flap methods with prostheses or autologous tissue implantation are still common; however, with this method the reconstructed phallus is static and has a high risk of complications. Aim We aimed to use novel methods for phalloplasty to mimic the normal structure of the phallus while maintaining the patient’s ability to obtain sufficient hardness and subjective controllability. Methods The neophallus comprised the bilateral pedicled neurovascular gracilis muscle, which provided neophallus volitional control; the pedicled fascia lata, which mimicked the tunica albuginea; the pedicled anterolateral thigh flap, which was used to reconstruct the neourethra and neoglans; and the thin split-thickness skin grafted on the surface of the fascia lata. The urethral anastomosis was performed simultaneously. The appearance and function of the neophallus, as well as patient satisfaction, were evaluated postoperatively. Outcomes The biomimetic dynamic phalloplasty using the bilateral pedicled gracilis muscle combined with the fascia lata was successfully performed in 4 patients. Results During follow-up at 10-21 months after the procedure, all 4 patients could complete sexual intercourse and were satisfied with the appearance and self-controllability of the neophallus. The size of the neophallus stabilized within 6 months. The tactile, deep touch sensation, and pain sensations of the neophallus partially recovered. All of the patients could stand to urinate. Clinical Implications We used the gracilis muscle combined with the fascia lata to mimic the basic structure of the corpus cavernosum and tunica albuginea and successfully reconstructed the biomimetic dynamic neophallus. Strengths and Limitations This is to our knowledge the first report of biomimetic dynamic phalloplasty using the bilateral pedicled gracilis muscle combined with the fascia lata to mimic the complex structure of the phallus and enable the achievement of erection. However, due to the small number of patients included in this study, the data have no statistical significance. More cases are needed to obtain conclusive data and examine the long-term clinical effects of this procedure. Conclusion Using novel methods for phalloplasty, we successfully maintained the patient’s ability to obtain sufficient hardness and subjective controllability without the use of implants, and the preliminary clinical results are encouraging.

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Dynamic Penile Corpora Cavernosa Reconstruction Using Bilateral Innervated Gracilis Muscles: A Preclinical Investigation

Cited by 2 publications

References 30 publications

Feasibility of an External Erectile Prosthesis for Transgender Men Who have Undergone Phalloplasty

Feasibility of an External Erectile Prosthesis for Transgender Men Who have Undergone Phalloplasty

The pedicled gracilis muscle combined with the fascia lata: a preliminary clinical study of a new biomimetic dynamic phalloplasty method

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