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  • Friday, June 17, 2016
  • 0706-000462 PENILE PROSTHESIS IMPLANTATION IN FEMALE-TO-MALE TRANSSEXUALS WITH TOTAL PHALLOPLASTY

    June 19, 2016 3:54 PM - June 19, 2016 4:09 PM

    Neighbor venue 'Tolhuis'

    • Borko Stojanovic, MD ;
    • Marta Bizic, MD, PhD ;
    • Vladimir Kojovic, MD ;
    • Marko Majstorovic, MD ;
    • Gradimir Korac, MD ;
    • Svetlana Vujovic, MD, PhD ;
    • Dusica Markovic Zigic, MD, PhD, PsyD ;
    • Dragana Duisin, MD, PhD ;
    • Jasmina Barisic ;
    • Miroslav Djordjevic, MD, PhD

    Purpose

    Erectile function that enables sexual intercourse with penetration is an ultimate goal for many male transgenders with total phalloplasty. Penile prosthesis implantation presents a suitable option to achieve artificial erection in these patients, despite previously reported common complications and failure.

    Materials and Methods

    We report 43 female-to-male transsexuals who underwent penile prosthesis implantation between March 2009 and June 2015. Total phalloplasty had previously been performed at our center in all patients, using musculocutaneous latissimus dorsi flap, radial forearm flap, abdominal flap and anterolateral thigh flap in 36, 3, 3 and 1 patient, respectively. Second stage phalloplasty, including initial insertion of penile prosthesis and simultaneous reconstruction of the neoglans and/or neourethra, was done in 37 cases. Six patients underwent replacement of the prosthesis implanted elsewhere, due to its’ malposition and protrusion. Semirigid and three-piece inflatable penile implants are used in 28 and 15 cases, respectively. The infrapubic or penoscrotal approach is used to create the space for insertion of the prosthesis into the neophallus. After positioning, the prosthesis is fixed to the periostium of the inferior pubic rami and covered with vascular grafts imitating tunica albuginea, to provide stabilization and avoid cylinder protrusion through the neoglans. The pump of the inflatable prosthesis is placed into the scrotum.

    Results

    The mean follow-up was 48 months (ranged from 6 to 81 months). The procedure was uneventful in all cases, without injury of the neophallic vascular supply. In semirigid group, 26 patients (92.9%) still have the original implant, and good function is reported. There was one case of protrusion through the glans of the neophallus and in one patient mechanical failure occurred. Both patients underwent successful prosthesis replacement 6-9 months after rejection. Of 15 patients with inflatable implants, only one resulted in leakage and dysfunction after additional aesthetic correction of the neophallus performed elsewhere. Good erection and capability for penetration is reported in remaining 14 transsexuals.

    Conclusion

    Penile prostheses implantation presents the best option for obtaining sexual intercourse after phalloplasty in female-to-male transgenders. New and safe techniques for prosthesis insertion, performed by experienced surgeons, as well as improvement of the mechanical attributes of the implants, result in good outcome with low complication rates.


    Category: Surgery