Erectile Implants in Female-to-Male Transsexuals: Our Experience in 129 Patients

Hoebeke, Piet; Decaestecker, Karel; Beysens, Matthias; Opdenakker, Yasmin; Lumen, Nicolaas; Monstrey, Stan

doi:10.1016/j.eururo.2009.03.013

Cited by 132 publications

(96 citation statements)

References 14 publications

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“…Penile prosthesis implantation represents the only solution to achieve the rigidity necessary for penetrative sexual intercourse, although complication rates are significantly higher than for virgin penile prosthesis implantation. 24,25 However, the 50% revision rate in this study is in line with those of other recent larger series. 5,8,9 …”

Section: Discussionsupporting

confidence: 93%

Total Phallic Reconstruction Using the Radial Artery Based Forearm Free Flap After Traumatic Penile Amputation

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Garaffa

Raheem

et al. 2016

The Journal of Sexual Medicine

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Introduction Although genital injuries in civilian centers are rare, the scenario is completely different in the battlefield. If the penile distal stump is not adequate for primary reimplantation or it cannot be found, then delayed penile reconstruction needs to be considered. Aim To report a single-center experience with total phallic reconstruction using radial artery based forearm free flap (RAFFF) after penile traumatic loss. Methods We retrospectively reviewed the clinical records of 10 patients who underwent total phallic reconstruction with the use of the RAFFF from September 2001 through August 2015 after traumatic amputation of the penis. Main Outcome Measures Patients' baseline features, surgical outcomes, complications, and satisfaction are reported. Results The average age at the time of penile reconstruction was 36 years (range = 27–52 years). The causes of penile loss were self-amputation owing to an acute schizophrenic episode (n = 2), road traffic accident (n = 3), blast injury (n = 3), donkey bite (n = 1), and Fournier gangrene (n = 1). The average time from the trauma to reconstruction with the RAFFF was 7 years (range = 2–15 years). The urethral stump was adequate for primary anastomosis, with phallic neourethra construction in six patients. The remaining patients had complete avulsion of the penis and were voiding though a perineal urethrostomy. In consequence, they required a two-stage urethroplasty. An acute arterial thrombosis of the microsurgical anastomosis occurred in two patients and was managed successfully with immediate exploration. A neourethra stricture and fistula occurred in one patient, which needed revision. All patients who underwent complete urethral reconstruction could void and ejaculate from the tip of the phallus. After a median follow-up of 51 months (range = 1–114 months), all patients were satisfied with the size, cosmetic appearance, and sensation of the phallus. Six patients underwent inflatable penile prosthesis implantation and could engage in penetrative sex. However, revision surgery was needed in three patients (infection, n = 2; mechanical failure, n = 1). Conclusion Despite the high incidence of postoperative complications and the possible need for multiple operations, in expert hands and in large-volume centers, penile reconstruction with the RAFFF after traumatic loss of the penis yields excellent results and allows patients to regain sexual and urinary functions.

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Section: Discussionsupporting

confidence: 93%

Total Phallic Reconstruction Using the Radial Artery Based Forearm Free Flap After Traumatic Penile Amputation

Falcone

Garaffa

Raheem

et al. 2016

The Journal of Sexual Medicine

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“…In a report with longer-term follow-up from the same group, with 120/129 gender reassignment patients receiving 3-piece IPPs, there was a 41.1% risk of surgical removal or revision of the prosthesis at a mean follow-up of 30.2 months for device infection, erosion or malfunction. 4 Of all IPPs used in this cohort, 108/185 (58.4%) still remained in place after initial implantation, with a total infection rate of 11.9%, erosion rate of 8.1%, prosthesis malfunction rate of 22.2% and malposition rate of 14.6%. Bettocchi et al 2 reported that among 17 patients with neophalli who underwent penile prosthesis surgery, 6 of 8 receiving semirigid prostheses sustained erosions.…”

Section: Discussionmentioning

confidence: 98%

“…Although it is reported that men with a neophallus alone are able to engage in penetrative intercourse successfully, 2 most reports of men with neophalli document the implantation of a penile prosthesis as the final step in the surgical reconstructive course. [3][4][5][6][7] Although neophalli have an impressively natural aesthetic appearance (Figure 1), they are comprised solely of soft tissue, and thus they typically cannot generate the rigidity needed for penetration.…”

Section: Introductionmentioning

confidence: 99%

Inflatable penile prosthesis technique and outcomes after radial forearm free flap neophalloplasty

Segal¹,

Massanyi

Gupta³

et al. 2014

Int J Impot Res

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The aim of this study was to describe the technical aspects and short-term outcomes of inflatable penile prosthesis (IPP) implantation after neophallus reconstruction at a single institution. Nine men with previously constructed radial forearm neophalli underwent IPP implantation. The etiologies of their penile anomaly were bladder exstrophy complex in five, disorder of sexual differentiation in two and genital obliteration secondary to ballistic trauma in two. Median follow-up was 9.6 months (range 1.5-139.7). The records for these patients were retrospectively reviewed and outcomes recorded. Mean age was 23.6 (range 18-31) years, and mean time interval from neophalloplasty to IPP implantation was 22.1 months (range 3-48). In all cases, 3-piece IPPs were employed, with eight of patients having one cylinder implanted in the native corporal body and extending into the neophallus. Mean surgical time was 222 min (range 142-409). Median length of implanted device was 22 cm. No intraoperative complications were observed. At the most recent follow-up, six patients (66.7%) had functional devices, with acceptable surgical outcomes. Three patients (33.3%) sustained device infections, and three (33.3%) sustained cylinder erosion. In three patients in whom neo-tunica albuginea were fashioned by ensheathing the cylinder with allograft human dermal tissue matrix, no erosions occurred. One patient underwent two revisions, the first for the associated erosion and infection and the second for genital pain, and was left with a semi-rigid prosthesis. IPP implantation affords the best opportunity for functionality for patients with a radial forearm free flap neophallus. Caution must be taken to ensure viability of the neophallus intraoperatively, and protocols to minimize the risk of infection should be followed. Fashioning neo-tunica albuginea using graft material may reduce risk of erosion.

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“…Overall, up to 60% of patients had a normally functioning penile prosthesis, were able to cycle the device and, potentially, to have penetrative sexual intercourse. 35 …”

Section: An Update On Penile Reconstruction G Garaffa Et Al 393mentioning

confidence: 99%

An update on penile reconstruction

Garaffa¹,

Raheem²,

Ralph³

2011

Asian J Androl

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Erectile Implants in Female-to-Male Transsexuals: Our Experience in 129 Patients

Cited by 132 publications

References 14 publications

Total Phallic Reconstruction Using the Radial Artery Based Forearm Free Flap After Traumatic Penile Amputation

Total Phallic Reconstruction Using the Radial Artery Based Forearm Free Flap After Traumatic Penile Amputation

Inflatable penile prosthesis technique and outcomes after radial forearm free flap neophalloplasty

An update on penile reconstruction

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