Surgical Outcomes at a Single Institution of Infrapubic Insertion of Malleable Penile Prosthesis in Transmen

Abstract

To describe our technique for the infrapubic approach for malleable penile prosthesis (MPP) insertion after phalloplasty in transgender men and review surgical outcomes. The infrapubic prosthesis insertion technique involves a horizontal incision anterior to the pubic symphysis, allowing dissection of the neophallus tract and anchor site on the pubic symphysis. Surgical outcomes by a single surgeon using a Spectra or Genesis MPP between October 2017 and May 2022 were retrospectively reviewed. Complications were categorized into erosions, infections, device detachment, device malposition, pain or activity limitation, urethral injury, and flap loss. Implant survival kinetics were assessed by evaluating time to surgical revision. Forty patients underwent infrapubic MPP insertion; 35 patients had a prior radial forearm free flap (RFFF) and 5 had a prior anterolateral thigh flap (ALT) phalloplasty. Of 30 patients who maintained follow-up, mean follow-up was 34.9 months. Complications were not mutually exclusive, with 7 implant detachments from the anchor site, 3 malpositions, 2 with pain/activity limitation, and 1 infection. Surgical revision was required in 12/30 patients (40%). There were no neophallus erosions, flap loss, nor urethral injuries. More complications occurred with the Spectra (9/17 or 53%) than the Genesis MPP (3/13 or 23%), but this was not statistically significant (P = .10). Infrapubic insertion in transmen after phalloplasty using commercially available MPPs is safe compared with other post-phalloplasty penile prosthesis insertion techniques, with similarly high surgical revision rates. Further study of techniques is needed to improve outcomes after penile prosthesis insertion in transmen.