Neophallus penile prosthesis placement-anatomic and post-surgical challenges, device selection criteria, and proposed surgical technique
1: Cedars-Sinai Medical Center, United States
Objectives: Challenges to penile prosthesis placement after phalloplasty include the absence of a natural tunical space into which to place the prosthetic device to prevent distal and proximal migration of the device, and, specifically for inflatable penile prosthetics, the angle of the cylinder (relative to where it is secured to the patient’s body) when it is inflated. Other challenges include factors associated with the phallo-urethroplasty technique used before prosthesis placement.
We describe our surgical technique for penile prosthesis placement, and, the pros and cons of malleable penile prosthetics. We also reflect on specific pitfalls that can result from specific phallo-urethroplasty techniques.
Materials and Methods: We describe our surgical technique for malleable and inflatable penile prosthesis placement, and factors that drive recommendation of malleable versus inflatable devices, and factors that affect our decision to place one versus two cylinders. We also review our clinical experience placing penile prostheses into neophalluses made at outside centers for our series of 72 patients, and specific techniques that may predispose to surgery failure (infection, chronic pain, and device malfunction). We discussed advantages and disadvantages of AMS and Coloplast products.
Results: We describe our surgical technique. The majority of penile prostheses we place are inflatable (>96%), and single-cylinder (88%). The location of the phallus on the pubic symphysis, and use of pre-laminated neourethra predisposed to adverse outcomes. We review alternative placement techniques and discuss associated pros and cons.
Conclusions: Penile prosthesis placement into a neophallus for transgender men undergoing genital gender affirming surgery is challenging and associated with high risk of complications, and, choice of device manufacturer. It is useful to understand how post-surgery changes to neophallus anatomy and location can contribute to adverse outcomes. We strongly favor use of inflatable devices and use of Dacron to secure the device to the Obturator ramus. All necessary neophallus revision surgery should be performed before penile prosthesis placement to minimize risk of adverse outcomes.
Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.Go Back