Obtaining rigidity in total phalloplasty: experience with 35 patients

Area of Science:

• Urology
• Gender Affirming Surgery
• Prosthetic Surgery

Background:

• Female-to-male (FtM) gender affirmation surgery often involves neophallus construction.
• Integrating a neourethra and erection prosthesis into a neophallus presents significant surgical challenges.
• Existing literature reports disappointing outcomes for neophallus prosthesis implantation.

Purpose of the Study:

• To report the surgical experience and outcomes of 35 female-to-male transsexual patients undergoing neophallus implantation.
• To evaluate the efficacy and complications associated with 1-piece and 3-piece hydraulic penile prostheses in neophallus construction.

Main Methods:

• A retrospective review of 35 patients who underwent neophallus implantation between August 1996 and December 2001.
• Implantation of a 1-piece hydraulic Dynaflex prosthesis in 10 patients and a 3-piece hydraulic CXM/CX prosthesis in 25 patients.
• The 1-piece model was discontinued, leading to a shift towards 3-piece prosthesis use.

Main Results:

• In the 1-piece group (n=10), 8 had uneventful implantation; 2 required replacement due to technical issues, with one later revised to a 3-piece prosthesis due to infection.
• In the 3-piece group (n=25), 20 had uneventful implantation; complications included infection (3), partial necrosis (1), cylinder perforation (1), and technical failure (1).
• Revision surgery was successful in 2 of the 4 complicated 3-piece cases; one patient with necrosis was no longer a candidate for prosthesis. Mean follow-up: 3.5 years for 1-piece, 1.8 years for 3-piece.

Conclusions:

• The Dynaflex (1-piece) prosthesis demonstrated good results in total phalloplasty patients, though it is no longer available.
• Outcomes with the more complex 3-piece CX and CXM prostheses are comparable to the 1-piece model.
• Penile prosthesis implantation in neophallus construction remains a complex procedure with potential for significant complications.