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Surgical Outcomes at a Single Institution of Infrapubic Insertion of Malleable Penile Prosthesis in Transmen

Published:January 17, 2023DOI:https://doi.org/10.1016/j.urology.2023.01.001

      OBJECTIVE

      To describe our technique for the infrapubic approach for malleable penile prosthesis (MPP) insertion after phalloplasty in transgender men and review surgical outcomes.

      METHODS

      The infrapubic prosthesis insertion technique involves a horizontal incision anterior to the pubic symphysis, allowing dissection of the neophallus tract and anchor site on the pubic symphysis. Surgical outcomes by a single surgeon using a Spectra or Genesis MPP between October 2017 and May 2022 were retrospectively reviewed. Complications were categorized into erosions, infections, device detachment, device malposition, pain or activity limitation, urethral injury, and flap loss. Implant survival kinetics were assessed by evaluating time to surgical revision.

      RESULTS

      Forty patients underwent infrapubic MPP insertion; 35 patients had a prior radial forearm free flap (RFFF) and 5 had a prior anterolateral thigh flap (ALT) phalloplasty. Of 30 patients who maintained follow-up, mean follow-up was 34.9 months. Complications were not mutually exclusive, with 7 implant detachments from the anchor site, 3 malpositions, 2 with pain/activity limitation, and 1 infection. Surgical revision was required in 12/30 patients (40%). There were no neophallus erosions, flap loss, nor urethral injuries. More complications occurred with the Spectra (9/17 or 53%) than the Genesis MPP (3/13 or 23%), but this was not statistically significant (P = .10).

      CONCLUSION

      Infrapubic insertion in transmen after phalloplasty using commercially available MPPs is safe compared with other post-phalloplasty penile prosthesis insertion techniques, with similarly high surgical revision rates. Further study of techniques is needed to improve outcomes after penile prosthesis insertion in transmen.
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      References

        • Bettocchi C
        • Ralph DJ
        • Pryor JP
        Pedicled pubic phalloplasty in females with gender dysphoria.
        BJU Int. 2005; 95: 120-124https://doi.org/10.1111/j.1464-410X.2004.05262.x
        • Djordjevic ML
        • Bencic M
        • Kojovic V
        • et al.
        Musculocutaneous latissimus dorsi flap for phalloplasty in female to male gender affirmation surgery.
        World J Urol. 2019; 37: 631-637https://doi.org/10.1007/s00345-019-02641-w
        • Falcone M
        • Garaffa G
        • Gillo A
        • Dente D
        • Christopher AN
        • Ralph DJ
        Outcomes of inflatable penile prosthesis insertion in 247 patients completing female to male gender reassignment surgery.
        BJU Int. 2018; 121: 139-144https://doi.org/10.1111/bju.14027
        • Hoebeke PB
        • Decaestecker K
        • Beysens M
        • Opdenakker Y
        • Lumen N
        • Monstrey SM
        Erectile implants in female-to-male transsexuals: our experience in 129 patients.
        Eur Urol. 2010; 57: 334-341https://doi.org/10.1016/j.eururo.2009.03.013
        • van der Sluis WB
        • Pigot GLS
        • Al-Tamimi M
        • et al.
        A retrospective cohort study on surgical outcomes of penile prosthesis implantation surgery in transgender men after phalloplasty.
        Urology. 2019; 132: 195-201https://doi.org/10.1016/j.urology.2019.06.010
        • Mirheydar H
        • Zhou T
        • Chang DC
        • Hsieh TC
        Reoperation rates for penile prosthetic surgery.
        J Sex Med. 2016; 13: 129-133https://doi.org/10.1016/j.jsxm.2015.11.013
        • Rooker SA
        • Vyas KS
        • DiFilippo EC
        • Nolan IT
        • Morrison SD
        • Santucci RA
        The rise of the neophallus: a systematic review of penile prosthetic outcomes and complications in gender-affirming surgery.
        J Sex Med. 2019; 16: 661-672https://doi.org/10.1016/j.jsxm.2019.03.009
        • Miller LE
        • Khera M
        • Bhattacharyya S
        • Patel M
        • Nitschelm K
        • Burnett AL
        Long-term survival rates of inflatable penile prostheses: systematic review and meta-analysis.
        Urology. 2022; 166: 6-10https://doi.org/10.1016/j.urology.2022.03.026
        • Grewal S
        • Vetter J
        • Brandes SB
        • Strope SA
        A Population-based analysis of contemporary rates of reoperation for penile prosthesis procedures.
        Urology. 2014; 84: 112-116https://doi.org/10.1016/j.urology.2014.02.028
        • Zuckerman JM
        • Smentkowski K
        • Gilbert D
        • et al.
        Penile prosthesis implantation in patients with a history of total phallic construction.
        J Sex Med. 2015; 12: 2485-2491https://doi.org/10.1111/jsm.13067
        • Briles BL
        • Middleton RY
        • Celtik KE
        • Crane CN
        • Safir M
        • Santucci RA
        Penile prosthesis placement by a dedicated transgender surgery unit: a retrospective analysis of complications.
        J Sex Med. 2022; 19: 641-649https://doi.org/10.1016/j.jsxm.2022.01.518
        • Chen ML
        • Patel DP
        • Moses RA
        • et al.
        Infrapubic insertion of penile implants in transmen after phalloplasty.
        Urology. 2021; 152: 79-83https://doi.org/10.1016/j.urology.2021.01.026
        • Krueger M
        • Yekani SAH
        • Hundt G v.
        • Daverio PJ
        Use of erectile prostheses in patients with free forearm flap phalloplasty.
        Int J Transgenderism. 2007; 10: 19-22https://doi.org/10.1300/J485v10n01_04
        • Levine LA
        • Becher E
        • Bella A
        • et al.
        Penile prosthesis surgery: current recommendations from the International Consultation on Sexual Medicine.
        J Sex Med. 2016; 13: 489-518https://doi.org/10.1016/j.jsxm.2016.01.017
        • Neuville P
        • Morel-Journel N
        • Maucourt-Boulch D
        • Ruffion A
        • Paparel P
        • Terrier JE
        Surgical outcomes of erectile implants after phalloplasty: retrospective analysis of 95 procedures.
        J Sex Med. 2016; 13: 1758-1764https://doi.org/10.1016/j.jsxm.2016.09.013
        • Segal RL
        • Massanyi EZ
        • Gupta AD
        • et al.
        Inflatable penile prosthesis technique and outcomes after radial forearm free flap neophalloplasty.
        Int J Impot Res. 2015; 27: 49-53https://doi.org/10.1038/ijir.2014.30
        • Neuville P
        • Morel-Journel N
        • Cabelguenne D
        • Ruffion A
        • Paparel P
        • Terrier JE
        First outcomes of the ZSI 475 FtM, a specific prosthesis designed for phalloplasty.
        J Sex Med. 2019; 16: 316-322https://doi.org/10.1016/j.jsxm.2018.11.013
        • Cohen AJ
        • Bhanvadia RR
        • Pariser JJ
        • Hatcher DM
        • Gottlieb LJ
        • Bales GT
        Novel technique for proximal bone anchoring of penile prosthesis after radial forearm free flap neophallus.
        Urology. 2017; 105: 2-5https://doi.org/10.1016/j.urology.2017.01.016
        • Jordan GH
        • Alter GJ
        • Gilbert DA
        • Horton CE
        • Devine CJ
        Penile prosthesis implantation in total phalloplasty.
        J Urol. 1994; 152: 410-414https://doi.org/10.1016/S0022-5347(17)32751-9
        • Verla W
        • Goedertier W
        • Lumen N
        • et al.
        Implantation of the ZSI 475 FTM erectile device after phalloplasty: a prospective analysis of surgical outcomes.
        J Sex Med. 2021; 18: 615-622https://doi.org/10.1016/j.jsxm.2020.11.008
        • Pigot GLS
        • Sigurjónsson H
        • Ronkes B
        • Al-Tamimi M
        • van der Sluis WB
        Surgical experience and outcomes of implantation of the ZSI 100 FtM malleable penile implant in transgender men after phalloplasty.
        J Sex Med. 2020; 17: 152-158https://doi.org/10.1016/j.jsxm.2019.09.019
        • Barrett DM
        • Furlow WL
        Penile Prosthesis Implantation.
        in: Segraves RT Schoenberg HW Diagnosis and Treatment of Erectile Disturbances: A Guide for Clinicians. Springer US, Boston, MA1985: 219-240https://doi.org/10.1007/978-1-4615-9409-3_10
        • Palmisano F
        • Boeri L
        • Cristini C
        • et al.
        Comparison of infrapubic vs penoscrotal approaches for 3-piece inflatable penile prosthesis placement: do we have a winner?.
        Sex Med Rev. 2018; 6: 631-639https://doi.org/10.1016/j.sxmr.2018.03.007
        • Vollstedt A
        • Gross MS
        • Antonini G
        • Perito PE
        The infrapubic surgical approach for inflatable penile prosthesis placement.
        Transl Androl Urol. 2017; 6: 620-627https://doi.org/10.21037/tau.2017.07.14