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Inflatable penile prosthesis technique and outcomes after radial forearm free flap neophalloplasty

International Journal of Impotence Research volume 27, pages 49–53 (2015)Cite this article

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Abstract

The aim of this study was to describe the technical aspects and short-term outcomes of inflatable penile prosthesis (IPP) implantation after neophallus reconstruction at a single institution. Nine men with previously constructed radial forearm neophalli underwent IPP implantation. The etiologies of their penile anomaly were bladder exstrophy complex in five, disorder of sexual differentiation in two and genital obliteration secondary to ballistic trauma in two. Median follow-up was 9.6 months (range 1.5–139.7). The records for these patients were retrospectively reviewed and outcomes recorded. Mean age was 23.6 (range 18–31) years, and mean time interval from neophalloplasty to IPP implantation was 22.1 months (range 3–48). In all cases, 3-piece IPPs were employed, with eight of patients having one cylinder implanted in the native corporal body and extending into the neophallus. Mean surgical time was 222 min (range 142–409). Median length of implanted device was 22 cm. No intraoperative complications were observed. At the most recent follow-up, six patients (66.7%) had functional devices, with acceptable surgical outcomes. Three patients (33.3%) sustained device infections, and three (33.3%) sustained cylinder erosion. In three patients in whom neo-tunica albuginea were fashioned by ensheathing the cylinder with allograft human dermal tissue matrix, no erosions occurred. One patient underwent two revisions, the first for the associated erosion and infection and the second for genital pain, and was left with a semi-rigid prosthesis. IPP implantation affords the best opportunity for functionality for patients with a radial forearm free flap neophallus. Caution must be taken to ensure viability of the neophallus intraoperatively, and protocols to minimize the risk of infection should be followed. Fashioning neo-tunica albuginea using graft material may reduce risk of erosion.

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References

  1. Bluebond-Langner R, Redett RJ . Phalloplasty in complete aphallia and ambiguous genitalia. Semin Plast Surg 2011; 25: 196–205.

    Article  Google Scholar 

  2. Bettocchi C, Ralph DJ, Pryor JP . Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int 2005; 95: 120–124.

    Article  Google Scholar 

  3. Hoebeke P, de Cuypere G, Ceulemans P, Monstrey S . Obtaining rigidity in total phalloplasty: experience with 35 patients. J Urol 2003; 169: 221–223.

    Article  CAS  Google Scholar 

  4. Hoebeke PB, Decaestecker K, Beysend M, Opdenakker Y, Lumen N, Monstrey SM . Erectile implants in female-to-male transsexuals: our experience in 129 patients. Eur Urol 2010; 57: 334–341.

    Article  Google Scholar 

  5. Lumen N, Monstrey S, Selvaggi G, Ceulemans P, De Cuypere G, Van Laecke E et al. Phalloplasty: a valuable treatment for males with penile insufficiency. Urology 2008; 71: 272–276.

    Article  Google Scholar 

  6. Garaffa G, Raheem AA, Christopher NA, Ralph DJ . Total phallic reconstruction after penile amputation for carcinoma. BJU Int 2009; 104: 852–856.

    Article  Google Scholar 

  7. Massanyi EZ, Gupta A, Goel S, Gearhart JP, Burnett AL, Bivalacqua TJ et al. Radial Forearm Free Flap Phalloplasty for Penile Inadequacy in Exstrophy Patients. J Urol 2012; 190 (4 Suppl): 1577–1582.

    PubMed  Google Scholar 

  8. Jordan GH, Alter GJ, Gilbert DA, Horton CE, Devine CJ . Penile prosthesis implantation in total phalloplasty. J Urol 1994; 152: 410–414.

    Article  CAS  Google Scholar 

  9. Ballaro A, Pryor JP, Ralph DJ . Prosthesis implantation after radial free flap phalloplasty in patient with bladder exstrophy. Int J Imp Res 1999; 11: 341–342.

    Article  CAS  Google Scholar 

  10. Levine LA, Zachary LS, Gottlieb LJ . Prosthesis placement after total phallic reconstruction. J Urol 1993; 149: 593–598.

    Article  CAS  Google Scholar 

  11. Hage JJ . Dynaflex prosthesis in total phalloplasty. Plast Reconstr Surg 1997; 99: 479–485.

    Article  CAS  Google Scholar 

  12. Katz DJ, Stember DS, Nelson CJ, Mulhall JP . Perioperative prevention of penile prosthesis infection: practice patterns among surgeons of SMSNA and ISSM. J Sex Med 2012; 9: 1705–1712.

    Article  Google Scholar 

  13. Fisch M, Wammack R, Ahlers J, Sennerich T, Müller SC, Hohenfellner R . Osseous fixation of a penile prosthesis after transsexual phalloplasty: a case report. J Urol 1993; 149: 122–125.

    Article  CAS  Google Scholar 

  14. Perovic SV, Djinovic R, Bumbasirevic M, Djordjevic M, Vukovic P . Total phalloplasty using a musculocutaneous latissimus dorsi flap. BJU Int 2007; 100: 899–905.

    Article  Google Scholar 

  15. Serefoglu EC, Mandava SH, Gokce A, Chouhan JD, Wilson SK, Hellstrom WJ . Long-Term Revision Rate due to infection in hydrophilic-coated inflatable penile prostheses: 11-year follow-up. J Sex Med 2012; 9: 2182–2186.

    Article  CAS  Google Scholar 

  16. Wilson SK, Zumbe J, Henry GD, Salem EA, Delk JR, Cleves MA . Infection reduction using antibiotic-coated inflatable penile prosthesis. Urol 2007; 70: 337–340.

    Article  Google Scholar 

  17. Silver RI, Yang A, Ben-Chaim J, Jeffs RD, Gearhart JP . Penile length in adulthood after exstrophy reconstruction. J Urol 1997; 157: 999–1003.

    Article  CAS  Google Scholar 

Download references

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Authors and Affiliations

  1. The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA

    R L Segal, E Z Massanyi, A D Gupta, J P Gearhart, T J Bivalacqua & A L Burnett

  2. Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA

    E Z Massanyi & J P Gearhart

  3. Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA

    R J Redett

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  1. R L Segal
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  2. E Z Massanyi
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  3. A D Gupta
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  4. J P Gearhart
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  5. R J Redett
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  6. T J Bivalacqua
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  7. A L Burnett
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Correspondence to A L Burnett.

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Segal, R., Massanyi, E., Gupta, A. et al. Inflatable penile prosthesis technique and outcomes after radial forearm free flap neophalloplasty. Int J Impot Res 27, 49–53 (2015). https://doi.org/10.1038/ijir.2014.30

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  • DOI: https://doi.org/10.1038/ijir.2014.30

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