Presentation Authors: Borko Stojanovic, Marta Bizic, Vladimir Kojovic, Slavica Pusica, Marko Bencic, Miroslav Djordjevic*, Belgrade, Serbia
Introduction: Insertion of penile prostheses after previously performed phalloplasty in female to male (FTM) transsexuals is essential in all patients whose main goal is to obtain rigidity and erection. The objective of our study was to evaluate the outcomes of penile prosthesis insertion after total musculocutaneous latissimus dorsi (MLD) phalloplasty in female to male transsexuals.
Methods: Between January 2009 and May 2017, 61 FTM transsexuals underwent implantation of penile prosthesis, as a second stage of gender affirmation surgery. All patients in our series had previously undergone total MLD phalloplasty. Period between phalloplasty and prosthesis insertion ranged from 9 and 23 months (mean 13 months). Malleable penile prostheses are inserted into the neophallus using dorsal and/or penoscrotal approach. The proximal end of the prosthesis was fixed to the pubic symphysis preventing dislocation of cylinders. When a three-component inflatable prosthesis was used, cylinders were inserted using dorsal approach. Pump was positioned in the opposite scrotum from microvascular anastomosis side, while the reservoir was placed retrovesically using the inguinal approach.
Results: Mean follow-up was 37 months (range 17-117 months). Inflatable and malleable prostheses were implanted in 22 and 39 patients, respectively. Good functioning with full rigidity was reported in 15 and 37 patients. Rejection of inflatable penile prosthesis due to an infection was noted in two patients and in one patient after malleable penile prosthesis implantation. In two patients, inflatable penile prosthesis was replaced by a malleable due to migration of cylinders with rigidity of only proximal part of the neophallus. Three patients reported no using of the inflatable implants. Broken malleable penile prosthesis was noted in two patients after sexual intercourse and thus had to be replaced. All other patients who were having sexual intercourse reported satisfying prosthesis functioning.
Conclusions: Penile prosthesis plays a main role for FTM transsexuals who have undergone phalloplasty and wish to have penetrative sexual intercourse. Insertion of penile prosthesis represents complex procedure with risks of complications, like rejection and malfunctioning. Musculocutaneous latissimus dorsi flap results in good volume and dimensions of the neophallus offering simple and safe insertion of penile prosthesis. Our survey proved lower complication rate when compared to penile prosthesis insertion after other phalloplasty techniques.