V12-05: A Bone-Anchored Technique for Penile Prosthesis Insertion After Radial Forearm Free Flap Neophallus
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.
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.
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.
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.