MP25-19 NEOPHALLUS PENILE PROSTHESIS PLACEMENT- ANATOMIC CHALLENGES, CONSIDERATIONS FOR DEVICE SELECTION, POTENTIAL PITFALLS, AND PROPOSED SURGICAL TECHNIQUE

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II1 Apr 2018MP25-19 NEOPHALLUS PENILE PROSTHESIS PLACEMENT- ANATOMIC CHALLENGES, CONSIDERATIONS FOR DEVICE SELECTION, POTENTIAL PITFALLS, AND PROPOSED SURGICAL TECHNIQUE Maurice Garcia Maurice GarciaMaurice Garcia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.856AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES 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. METHODS 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. RESULTS We describe our surgical technique. The majority of penile prostheses we place are inflatable (>96%), and single-cylinder (88%). The location of the phallus on the pubic symphysis, and use of pre-laminated neourethra predisposed to adverse outcomes. We review alternative placement techniques and discuss associated pros and cons. CONCLUSIONS Penile prosthesis placement into a neophallus for transgender men undergoing genital gender affirming surgery is challenging and associated with high risk of complications, and, choice of device manufacturer. It is useful to understand how post-surgery changes to neophallus anatomy and location can contribute to adverse outcomes. We strongly favor use of inflatable devices and use of Dacron to secure the device to the Obturator ramus. All necessary neophallus revision surgery should be performed before penile prosthesis placement, to minimize risk of device infection requiring explant. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e334 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Maurice Garcia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...