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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Article info
Publication history
Published online: January 17, 2023
Accepted:
January 2,
2023
Received:
September 6,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
