Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Inflatable penile prosthesis implantation after gender affirming phalloplasty with radial forearm free flap

International Journal of Impotence Research volume 32, pages 99–106 (2020)Cite this article

Subjects

Abstract

We aimed to review all information on penile prosthetic surgery in patients with prior phalloplasty and give a detailed description of the authors’s preferred technique. A nonsytematic review of the articles that were published in English and indexed on Pubmed, Google Scholar, and Embase databases was conducted. The relevant literature reports mainly on the outcomes of penile prosthesis (PP) implantation following gender affirming phalloplasty with the radial forearm free flap technique. Three-piece inflatable penile prostheses (IPP) have been the most commonly utilized hardware in this setting. PP implantation in a neophallus is a complex procedure and contains some technical nuances. Creation of spaces within the neophallus for the cylinder(s), wrapping the cylinder(s) with synthetic materials or allografts, and fixation of the prosthesis to the pubic bony structures can be considered as the most important steps of this procedure. Five-year IPP retention rates in flap phalloplasty range between 42 and 78% which is lower than the rate observed in anatomic phallus. In addition, complication and mechanical failure rates are higher in flap phalloplasty. However, satisfaction rates after PP implantations in anatomic penis versus neophallus seem to be similarly high. Infection, migration, and mechanical failure are the most frequent complications.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Rashid M, Tamimy MS. Phalloplasty: the dream and the reality. Indian J Plast Surg. 2013;46:283–93.

    Article  Google Scholar 

  2. Gilbert DA, Horton CE, Terzis JK, Devine CJ Jr, Winslow BH, Devine PC. New concepts in phallic reconstruction. Ann Plast Surg. 1987;18:128–36.

    Article  CAS  Google Scholar 

  3. Monstrey S, Ceulemans P, Hoebeke P. Sex reassignment surgery in the female-to-male transsexual. Semin Plast Surg. 2011;25:229–44.

    Article  Google Scholar 

  4. Falcone M, Garaffa G, Gillo A, Dente D, Christopher AN, Ralph DJ. Outcomes of inflatable penile prosthesis insertion in 247 patients completing female to male gender reassignment surgery. BJU Int. 2018;121:139–44.

    Article  CAS  Google Scholar 

  5. Young EE, Friedlander D, Lue K, Anele UA, Khurgin JL, Bivalacqua TJ, et al. Sexual function and quality of life before and after penile prosthesis implantation following radial forearm flap phalloplasty. Urology. 2017;104:204–8.

    Article  Google Scholar 

  6. Callens N, De Cuypere G, T’Sjoen G, Monstrey S, Lumen N, Van Laecke E, et al. Sexual quality of life after total phalloplasty in men with penile deficiency: an exploratory study. World J Urol. 2015;33:137–43.

    Article  Google Scholar 

  7. Schultheiss D, Gabouev AI, Jonas U. Nikolaj A. Bogoraz (1874-952): pioneer of phalloplasty and penile implant surgery. J Sex Med. 2005;2:139–46.

    Article  Google Scholar 

  8. Dy GW, Sun J, Granieri MA, Zhao LC. Reconstructive management pearls for the transgender patient. Curr Urol Rep. 2018;19:36.

    Article  Google Scholar 

  9. Scott FB, Bradley WE, Timm GW. Management of erectile impotence. Use of implantable inflatable prosthesis. Urology. 1973;2:80–2.

    Article  CAS  Google Scholar 

  10. Puckett CL, Montie JE. Construction of male genitalia in the transsexual, using a tubed groin flap for the penis and a hydraulic inflation device. Plast Reconstr Surg. 1978;61:523–30.

    Article  CAS  Google Scholar 

  11. Hoebeke PB, Decaestecker K, Beysens M, Opdenakker Y, Lumen N, Monstrey SM. Erectile implants in female-to-male transsexuals: our experience in 129 patients. Eur Urol. 2010;57:334–40.

    Article  Google Scholar 

  12. Kocjancic E, Lacovelli V. Penile Prostheses. Clin Plast Surg. 2018;45:407–14.

    Article  Google Scholar 

  13. Levine LA, Becher EF, Bella AJ, Brant WO, Kohler TS, Martinez-Salamanca JI, et al. Penile prosthesis surgery: current recommendations from the international consultation on sexual medicine. J Sex Med. 2016;13:489–518.

    Article  Google Scholar 

  14. Vesely J, Hyza P, Ranno R, Cigna E, Monni N, Stupka I, et al. New technique of total phalloplasty with reinnervated latissimus dorsi myocutaneous free flap in female-to-male transsexuals. Ann Plast Surg. 2007;58:544–50.

    Article  CAS  Google Scholar 

  15. Schechter LS, Safa B. Introduction to phalloplasty. Clin Plast Surg. 2018;45:387–9.

    Article  Google Scholar 

  16. Remington AC, Morrison SD, Massie JP, Crowe CS, Shakir A, Wilson SC, et al. Outcomes after phalloplasty: do transgender patients and multiple urethral procedures carry a higher rate of complication? Plast Reconstr Surg. 2018;141:220e–9e.

    CAS  PubMed  Google Scholar 

  17. Levine LA, Zachary LS, Gottlieb LJ. Prosthesis placement after total phallic reconstruction. J Urol. 1993;149:593–8.

    Article  CAS  Google Scholar 

  18. Garaffa G, Christopher NA, Ralph DJ. Total phallic reconstruction in female-to-male transsexuals. Eur Urol. 2010;57:715–22.

    Article  Google Scholar 

  19. Garaffa G, Ralph DJ. Penile prosthesis implantation in phalloplasty in female-to-male transsexuals. In Trombetta C, Liguori G, Bertolotto M, editors. Management of Gender Dysphoria, Springer; 2015. p. 311–6.

  20. Segal RL, Massanyi EZ, Gupta AD, Gearhart JP, Redett RJ, Bivalacqua TJ, et al. Inflatable penile prosthesis technique and outcomes after radial forearm free flap neophalloplasty. Int J Impot Res. 2015;27:49–53.

    Article  CAS  Google Scholar 

  21. Zuckerman JM, Smentkowski K, Gilbert D, Storme O, Jordan G, Virasoro R, et al. Penile prosthesis implantation in patients with a history of total phallic construction. J Sex Med. 2015;12:2485–91.

    Article  Google Scholar 

  22. Neuville P, Morel-Journel N, Maucourt-Boulch D, Ruffion A, Paparel P, Terrier J-E. Surgical outcomes of erectile implants after phalloplasty: retrospective analysis of 95 procedures. J Sex Med. 2016;13:1758–64.

    Article  Google Scholar 

  23. Kocjancic E, Jaunarena J, Sofer L, Morgantini L, Schechter L. V11-04 inflatable penile prosthesis implantation post phalloplasty. J Urol. 2018;199:e1162–3.

    Google Scholar 

  24. Cohen AJ, Bhanvadia RR, Pariser JJ, Hatcher DM, Gottlieb LJ, Bales GT. Novel technique for proximal bone anchoring of penile prosthesis after radial forearm free flap neophallus. Urology. 2017;105:2–5.

    Article  Google Scholar 

  25. Leriche A, Timsit M-O, Morel-Journel N, Bouillot A, Dembele D, Ruffion A. Long-term outcome of forearm flee-flap phalloplasty in the treatment of transsexualism. BJU Int. 2008;101:1297–300.

    Article  Google Scholar 

  26. Garcia MM, Christopher NA, De Luca F, Spilotros M, Ralph DJ. Overall satisfaction, sexual function, and the durability of neophallus dimensions following staged female to male genital gender confirming surgery: the Institute of Urology, London U.K. experience. Transl Androl Urol. 2014;3:156–62.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA

    Ervin Kocjancic & Ömer Acar

  2. Department of Urology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Jorge H. Jaunarena

  3. Center for Gender Confirmation Surgery, Weiss Memorial Hospital, Chicago, IL, USA

    Loren Schechter

Authors
  1. Ervin Kocjancic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jorge H. Jaunarena
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Loren Schechter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ömer Acar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ömer Acar.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kocjancic, E., Jaunarena, J.H., Schechter, L. et al. Inflatable penile prosthesis implantation after gender affirming phalloplasty with radial forearm free flap. Int J Impot Res 32, 99–106 (2020). https://doi.org/10.1038/s41443-019-0153-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-019-0153-8

This article is cited by

Search

Advanced search

Quick links