V12-05 A BONE-ANCHORED TECHNIQUE FOR PENILE PROSTHESIS INSERTION AFTER RADIAL FOREARM FREE FLAP NEOPHALLUS

Abstract

You have accessJournal of UrologyReconstruction1 Apr 2016V12-05 A BONE-ANCHORED TECHNIQUE FOR PENILE PROSTHESIS INSERTION AFTER RADIAL FOREARM FREE FLAP NEOPHALLUS Joseph J. Pariser, David M. Hatcher, and Gregory T. Bales Joseph J. PariserJoseph J. Pariser More articles by this author , David M. HatcherDavid M. Hatcher More articles by this author , and Gregory T. BalesGregory T. Bales More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2131AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients often undergo neophallus creation as a result of gender reassignment or loss of the penis. Our preferred method is a radial forearm free flap using microsurgical anastomoses. Patients often desire erectile function, and penile prosthesis offers the potential for adequate rigidity. We present our technique and experience of inflatable penis prosthesis insertion in patients with prior neophallus construction. METHODS Patients with a history of prior neophallus construction who underwent penile prosthesis insertion were identified. All patients underwent previous radial forearm free flaps at our institution as a separate procedure at least one year prior to prosthesis insertion. A single inflatable cylinder was used in almost all procedures. A bone drill was used to create a fixation chamber in the symphysis pubis to anchor the proximal rear tip. RESULTS Nine consecutive patients underwent inflatable penis prosthesis insertion in a neophallus. Mean age at neophallus construction was 41 years old. Neophallus was performed for gender reassignment in seven patients and for penile loss in two patients. Mean age at prosthesis insertion was 41 years old, and the mean time between neophallus and prosthesis insertion was 22 months. The mean cylinder size was 17 cm with mean rear tip size of 1.8 cm. Mean followup was 30.5 months. Four patients required reoperation. One patient who did not undergo bone drilling required additional proximal bony fixation, and two required replacement for mechanical malfunction. One infection occurred 3 months after surgery, which required device removal. CONCLUSIONS Inflatable penile prosthesis is safe and effective for achieving erectile function after neophallus construction. We favor anchoring the proximal cylinder into the symphysis pubis with a bone drill, which can maximize proximal fixation. Additionally, using a single inflatable cylinder and standard prosthetic infectious precautions may optimize surgical outcomes. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1067 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Joseph J. Pariser More articles by this author David M. Hatcher More articles by this author Gregory T. Bales More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...