026 Neophallus Penile Prosthesis Placement: Anatomic and Post-Surgical Challenges, Device Selection Criteria, and Proposed Surgical Technique

Abstract

Challenges to penile prosthesis placement after phalloplasty include the absence of a natural tunical space into which to place the prosthetic device to prevent distal and proximal migration of the device, and, specifically for inflatable penile prosthetics, the angle of the cylinder (relative to where it is secured to the patient's body) when it is inflated. Other challenges include factors associated with the phallo-urethroplasty technique used before prosthesis placement. We describe our surgical technique for penile prosthesis placement, and, the pros and cons of malleable penile prosthetics. We also reflect on specific pitfalls that can result from specific phallo-urethroplasty techniques. We describe our surgical technique for malleable and inflatable penile prosthesis placement, and factors that drive recommendation of malleable versus inflatable devices, and factors that affect our decision to place one versus two cylinders. We also review our clinical experience placing penile prostheses into neophalluses made at outside centers for our series of 72 patients, and specific techniques that may predispose to surgery failure (infection, chronic pain, and device malfunction). We discussed advantages and disadvantages of AMS and Coloplast products.