Penile Prosthesis Placement by a Dedicated Transgender Surgery Unit: A Retrospective Analysis of Complications

Abstract

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.

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

“…There is substantial interest in alternatives to internal erectile prostheses for individuals who have undergone phalloplasty and are interested in using the neophallus for sexual penetration. 4 This reflects, in part, the fact that current internal devices have high failure rates and may require multiple surgeries for implantation and removal, 10,20,21 as well as pose a risk of causing damage to the neophallus. 22,23 As phalloplasty is, inherently, a complex surgery with a high risk of complications, 24 the idea of undergoing additional surgeries to attain sufficient rigidity for penetration may be untenable for some individuals.…”

Insertion of inflatable penile prosthesis in the neophallus of assigned female at birth individuals: a systematic review of surgical techniques, complications and outcomes

“…One hundred and eighty-five articles were identified using the search strategy above, and 15 studies [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] were included for analysis following abstract and full-text screening (Figure 1). Fourteen studies were retrospective and one study was prospective in nature.…”

“…The most used flap for phalloplasty was the radial artery forearm free flap (RFFF), with only one study reporting the insertion of IPP following musculocutaneous latissimus dorsi free flap phalloplasty. 13 Five studies 6,7,12,13,17 reported outcomes on both IPP and malleable implants so only data relevant to IPP insertion were extracted and synthesised.…”

“…18 The IPP insertion approach was commonly infrapubic or parascrotal based on the reporting centre's preference (Table 1). Four studies used the infrapubic approach, 6,7,15,16 five studies used the parascrotal approach 9,11,14,17,20 and two studies used both approaches. 10,13 Due to the absence of the corpus cavernosa in the neophallus, the rear tips of the IPPs are usually anchored to the pubic bone to prevent migration (Table 1).…”

“…10,13 Due to the absence of the corpus cavernosa in the neophallus, the rear tips of the IPPs are usually anchored to the pubic bone to prevent migration (Table 1). Some studies use additional grafts such as polyethylene terephthalate (Dacron™) 7,10 or other autologous tissue or acellular matrix 6 to help anchor the implant to the pubis. The material can be fashioned into a sock, cap and sock or a full sheath around each cylinder.…”