V11-04: Inflatable Penile Prosthesis Implantation Post Phalloplasty
Female to male gender confirmation surgeries are more common every year. Once the neophallus has been constructed, the implantation of a penile prosthesis grants optimal functionality. Patients often choose the Inflatable Penile Prosthesis (IPP) over the malleable prosthesis, as the former allows for a more natural erection. In this video we present our technique for inflatable penile prosthesis implantation after gender confirmation surgery.
A 4 cm transverse incision was made just below the level of the pubic bone. Two grooves were created in the periosteum of the pubis to anchor the prosthesis and 0 polypropylene stay sutures were placed. Two cavities were created with sharp dissection in the tissue within the neophallus and serially dilated to #10 Hegar. The Furlow instrument was passed distally into the neophallus, and the length of the cylinder needed for the prosthesis was measured to be 16 cm. The space for the 65 cc reservoir was created by developing the retropubic space with the aid of a nasal speculum. For placement of the left testicular prosthesis, a transverse incision was made in the upper portion of the left hemiscrotum and a pouch for the prosthesis was created with blunt and sharp dissection. Dermis allograft was tubularized around a 10.5 Hegar, to create the corpora cavernosa. The Furlow device with the Keith needle was used to place the dermis allografts over the two prosthetic cylinders. The Furlow was used again to guide the cylinders into the dilated tissue within the neophallus. At this point, the stay sutures were threaded through 0.5 back tip extenders bilaterally to anchor the cylinders to the periosteum. The prosthesis pump was then placed in the right side of the scrotum, contralateral to the vascular pedicle of the neophallus.
The operative time was 120 minutes. EBL was minimal. Patient was discharged on postoperative day 1. There were no postoperative complications. After two months, the patient was able to have satisfactory intercourse. Out of ten female to male gender confirmation surgeries this year all of them had an IPP placement and there were no complications.
Inflatable penile prosthesis placement is the ultimate step in female to male gender confirmation surgery. Proper identification of the vascular pedicle of the neophallus, and pubic fixation of the prosthesis are essential elements of this procedure. A tubularized dermis allograft around the prosthesis cylinders prevents complications of erosion. This surgery provides patients with optimal functionality of their neophallus.