Penile implants after phalloplasty in transgender individuals: a consensus-based surgical clinical protocol
Maya Levy1,2, Marco Falcone3, Julia Bohr4
1Department of Urology, Amsterdam University Medical Centre, 1081 HV Amsterdam, the Netherlands.
Background:
Individuals undergoing phalloplasty as part of their gender-affirming medical transition are subsequently able to undergo insertion of a penile implant to achieve rigidity in the neophallus for penetrative intercourse. These procedures require specific knowledge and surgical skills, as the anatomy of the neophallus differs from that of the native penis. Currently, there is no universally accepted guideline for preoperative assessment, surgical technique, or postoperative care.
Aim:
To address this gap, we developed consensus-based protocol informed by expert opinions to standardize peri-surgical care delivery and facilitate valid scientific evaluation.
Methods:
A Delphi approach was used to develop and reach a consensus on a clinical protocol for pre-, peri-, and postoperative care related to penile prosthesis implantation surgery after phalloplasty. Surgeons who perform this procedure regularly were recruited to participate in the expert panel. The process included two rounds of voting by the expert panel to achieve maximum level of consensus on the protocol items.
Outcomes:
Consensus ratings were obtained for each recommendation, culminating in a final set of items to be included in the final version of the clinical protocol.
Results:
Twenty-one experts agreed to participate in the study, with 17/21 (81%) partaking in the first voting round and 16/21 (76%) in the second. In the first voting round, 65 items were presented to the expert panel, and consensus was reached on the inclusion of 27 (42%) of them. In the second round, 29 items were presented, and consensus was reached on 26 (90%) of them.
Clinical Implications:
This protocol can be used by physicians worldwide to enhance global clinical outcomes and facilitate scientific research by promoting consistency.
Strengths And Limitations:
Strengths of this protocol include its consolidation of expert opinions in a niche surgical field to create consensus-backed recommendations for care in this clinical context. However, limitations stem from the overrepresentation of certain geographical areas, which may hinder its applicability in regions with differing resources and care protocols.
Conclusion:
Consensus was successfully reached on recommended practices for penile implant insertion in transgender and gender diverse individuals with phalloplasty.
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