Surgical Outcomes of Erectile Implants After Phalloplasty: Retrospective Analysis of 95 Procedures

Abstract

Introduction The creation of a neophallus is a complex surgery that must meet functional and esthetic requirements. It is a long and demanding surgical process whose final stage consists of the implantation of a rigid or inflatable material that can be used to reproduce an erection. Data in the literature are scarce, with only the pioneering series present, which includes the use of the first devices and techniques. Aim To report the outcome of patients with phalloplasty after implantation of erectile implants using standardized surgical techniques and the use of recent prosthesis types with or without a vascular graft. Methods This is a retrospective hospital-based analysis of all patients with phalloplasty who underwent implantation of an erectile prosthesis from March 2007 to May 2015. Factors associated with complications were investigated by multivariate logistic regression analysis. Main Outcome Measures Early-onset (during the first month after surgery) and late-onset complications, including erosion, infections, malpositioning, and dysfunction. Results Sixty-nine patients were included in the study and 95 procedures were analyzed. After a median follow-up of 4 years (minimum = 169 days, maximum = 6.1 years), the original prosthesis was still in place in 43 patients (62.3%). Patients underwent phalloplasty after female-to-male transsexualism (n = 62, 89.9%), malformation (n = 4, 5.8%), or trauma (n = 3, 4.3%). The proportions for the different types of phalloplasty were 58% for forearm free flap phalloplasty (n = 40), 33.3% for suprapubic phalloplasty (n = 23), and 7% for other (n = 6). The erectile prostheses used were the two-piece AMS Ambicor (n = 71, 74.7%), the Ambicor with a vascular graft (n = 19, 20.0%), and the AMS 700CXR, AMS 700CX, or AMS600-650 (n = 5, 5.2%). There were no early-onset complications in 89 procedures (93.7%) and, when present, they were always related to infection (n = 4, 4.2%). Late-onset complications were erosion (n = 4, 4.2%), infection (n = 4, 4.2%), dysfunction (n = 10, 10.5%), and malpositioning (n = 12, 12.6%). No significant difference was observed for malpositioning (12.7% vs 10.5%, P = .87) and dysfunction (7.0% vs 10.5%, P = .78) between the AMS Ambicor prosthesis and the Ambicor prosthesis with a vascular graft. Conclusion This study provides updated data on complications after the implantation of erectile implants. Multicenter studies, including the evaluation of patient satisfaction, are needed to increase our understanding of factors associated with the outcomes.

Outcomes of inflatable penile prosthesis insertion in 247 patients completing female to male gender reassignment surgery

“…Penile implantation in phalloplasty for gender dysphoria has rarely been addressed in the scientific literature. Following the first scientific report in 1978 by Puckett and Montie [20], other authors have described the successful implantation of a PP in small series [11,14,15,17,21]. Table 2 compares the largest series, all of which were retrospective, observational and from single centres.…”

The anatomy of the musculocutaneous latissimus dorsi flap for neophalloplasty

“…The large size and musculature incorporated into the graft could make a prosthesis implantation more likely to be successful. There are challenges when penile prosthesis implantation in phalloplasties from any origin is considered because patients have typically undergone multiple procedures and the neophallus lacks a tunica albuginea (Neuville et al ). A retrospective analysis regarding erectile implants in female‐to‐male transsexual patients found that despite the high complication rates prosthesis implantation is currently the best option for transgender men to achieve sexual intercourse (Hoebeke et al ).…”

“…Another recent retrospective study by Neuville et al () reviewed 95 female‐to‐male transgender patients with erectile implants. This study included patients who had received both radial forearm flap phalloplasties and suprapubic phalloplasties.…”

“…After a median follow‐up of four years, 62.3% of the patients still had their original prosthesis in place. Early‐onset complications occurred in 4.2% and were related to infection, while the most common late‐onset complications included malpositioning (12.6%) and dysfunction (10.5%) (Neuville et al ). However, neither of these studies specifically assessed the effectiveness of implantable penile prostheses in patients with the MLD phalloplasty.…”

Military genitourinary injuries: past, present, and future

“…Either radial artery forearm free flap ( 18 ) or anterolateral thigh flap ( 19 ) are appropriate for phallic reconstruction, depending on what concomitant extremity injury(-ies) may be present. Flap-based genital reconstruction is commonly performed for gender confirmation among the transgender population ( 18 , 20 ) with good results. However, patients who have sustained polytraumatic blast injuries to the upper and/or lower extremities may not be candidates for such complex flap-based genital reconstructive procedures.…”