Elsevier

Urology

Volume 132, October 2019, Pages 195-201
Urology

Reconstructive Urology
A Retrospective Cohort Study on Surgical Outcomes of Penile Prosthesis Implantation Surgery in Transgender Men After Phalloplasty

https://doi.org/10.1016/j.urology.2019.06.010Get rights and content

ABSTRACT

Objectives

To assess surgical outcomes of penile prosthesis implantation in transgender men who underwent phalloplasty.

Patients and Methods

Transgender men who underwent penile prosthesis implantation after phalloplasty between January 1989 and September 2018 were retrospectively identified. A chart study was performed recording patient demographics, perioperative complications, and reoperations.

Results

A total of 32 patients were identified: 22 underwent free radial forearm flap, 5 anterolateral thigh, 4 anterolateral thigh/free radial forearm flap, and 1 fibular flap phalloplasty. The median age at prosthesis implantation was 36 (range 21-59) years, the mean BMI 25.9 ± 4.0 kg/m2. At first implantation, 16 inflatable (AMS Dynaflex (n = 13), AMS Ambicor (n = 3)) and 16 malleable (Coloplast genesis (n = 14), AMS Spectra (n = 2)) prostheses were placed. Of these, 5 (16%) were removed/replaced because of infection, 2 (6%) because of leakage, 2 because of extrusion, 2 because of dislocation, 2 because of dysfunction, and 1 (3%) because of pain. The postoperative course was completely uneventful in 10 (31.3%) patients. Of all implanted prostheses, including revision procedures (n = 45), 21 (44%) were surgically replaced or removed.

Conclusion

Prosthesis explantation, replacement, or revision surgery occurs frequently after penile prosthesis implantation. Patients need to be well-informed preoperatively on these complication rates.

Section snippets

Retrospective Chart Study

In the period January 1988 to September 2017, a total of 170 patients underwent phalloplasty at our institution. All transgender men who underwent erectile prosthesis implantation after phalloplasty, from January 1989 until September 2018, were retrospectively identified from our hospital registry. A single-center retrospective chart review was performed, recording patient demographics (type of phalloplasty procedure performed, other medical and surgical history, comorbidity, age at surgery,

Patient Demographics

From January 1989 until September 2018, a total of 32 patients were retrospectively identified that underwent penile prosthesis implantation. Patient demographics are presented in Table 1. Twenty-two patients underwent FRFF (for an example, Fig. 1), 5 ALT, 4 ALT/FRFF, and 1 fibular flap phalloplasty. Two patients underwent penile prosthesis implantation in the same session as the phalloplasty procedure.

Retrospective Chart Study

A total of 45 prostheses were implanted in 32 transgender men. The median postoperative

DISCUSSION

Genital gender affirming surgery alters feelings of gender dysphoria. In phalloplasty surgery, implanting a penile prosthesis is often the last surgical step in the transition process. In this article, we reported on 32 transgender men who underwent penile prosthesis implantation between 1989 and September 2018. At last follow-up, 24 (75%) patients had a penile prosthesis in place. Revision surgery was performed in 21 (65.6%) patients. Of a total of 45 implanted prostheses, 8 were removed

CONCLUSION

Prosthesis explantation, replacement, or revision surgery occurs frequently after penile prosthesis implantation. Patients need to be informed preoperatively on these complication rates.

References (21)

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    Citation Excerpt :

    Phalloplasty patients reported satisfaction with function of PPI at a rate of 88–92%.90,97 A total of 57–61% of patients reported frequent orgasms after the insertion of the prosthesis90,97 and 77–85% were able to engage in penetrative intercourse.90,94,97 Of patients that had previously received the AMS Ambicor implant, 75% reported the ZSI 475 FtM to be “better” or “much better”.97

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Conflicts of Interest Statement: None to declare for all authors. Every author completed the ICMJE COI form without any conflicts of interest to declare.

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Both authors contributed equally to this manuscript.

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