Penile Prosthesis Implantation in Patients with a History of Total Phallic Construction

Abstract

Introduction Outcomes following penile prosthesis implantation in patients with a history of total phallic construction are not well described. Aim The aim of this study was to evaluate outcomes following neophallus penile prosthesis placement. Methods Retrospective review penile prosthesis placement in patients with prior total phallic construction. GORE-TEX® (Gore Medical, Flagstaff, AZ) sleeve neotunica construction was utilized in all patients. Main Outcome Measure Success defined as patient sexual activity with a functioning prosthesis. Results Thirty-one patients underwent neophallic prosthesis implantation at a mean 35.6 years of age. Prosthesis placement occurred at an average 56.3 months following phallic construction and follow-up was a mean of 59.7 months. Malleable prostheses were placed in 21 patients and inflatable in 10; implants were bilateral in 94%. Six percent experienced operative complications including a bladder injury (1) and phallic flap arterial injury (1). Postoperative complications occurred in 23% at a median 5.5 months following placement. Five prostheses were explanted secondary to infection or erosion and two additional required revisions. Of the explanted prosthesis two were later replaced without further complication. Eighty-one percent of patients were sexually active following prosthesis placement. Conclusions Penile prosthesis placement is possible in patients with prior penile reconstruction/phallic construction. Although complications rates appear to be elevated in this population compared with historic controls of normal anatomic men, the majority of patients in this series were sexually active following prosthesis placement. This demonstrates the utility of prosthesis implantation in these difficult patients.

Techniques and considerations of prosthetic surgery after phalloplasty in the transgender male

“…The authors assert that the neotunica aids in alignment of the neophallus and helps secure the proximal cylinder. They also claim that GORE-TEX ® provides adequate stretch for the cylinder when inflated (11). Other groups have reported that encasing the entire cylinder in graft material may result in higher rates of mechanical failure and cylinder aneurysm due to excess constraint on the cylinder during inflation (14,25).…”

“…Though this remains the most common technique of achieving rigidity in the neophallus, the ideal method of accomplishing this goal remains controversial. With reported modern complication rates ranging from 23-70%, there is clearly room for improvement in this realm (9)(10)(11)(12)(13)(14). With the growing population of patients who desire these procedures, ongoing development and refinement in techniques continues by leaders in the field.…”

“…Multi-component IPPs in cis-gender men are traditionally placed through either a penoscrotal or infrapubic incision (27). Similarly, in the neophallus, both parascrotal (along the lateral aspect of the neo-scrotum) and infrapubic (along the previous phalloplasty incision) incisions have been described (9)(10)(11)(12)(13)(14)25,26,28). We generally prefer an infrapubic approach.…”

“…Details of this will be discussed later. Alternatively, Zuckerman et al describe bilateral incisions over the ischial tuberosities to reach the inferior pubic rami for anchoring (11). In all approaches, special caution should be used to avoid compromising the vascular supply of the neophallus.…”

“…Zuckerman et al described a method in which they create a neotunica with polytetrafluoroethylene (GORE-TEX ® , Gore Medical, Flagstaff, AZ, USA), which covers the entire prosthesis. The proximal prosthesis is subsequently anchored to the inferior pubic ramus with 3-0 GORE-TEX ® suture (11). The authors assert that the neotunica aids in alignment of the neophallus and helps secure the proximal cylinder.…”