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Prosthetics: Erectile Implant, Testicular Implants

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Urological Care for the Transgender Patient

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Abstract

Erectile ability is a common goal for transgender men seeking phalloplasty, which necessitates prosthesis placement in most phalloplasty techniques. In the absence of preexisting corpora, implant placement is associated with increased risk of poor proximal fixation, device migration, distal erosion, and neurovascular compromise, infection, and malfunction. Modifications to conventional surgical technique, such as avoidance of critical structures, proximal prosthesis anchoring, and distal cushioning with vascular or synthetic grafts, are common techniques to address anatomic challenges.

Further training for urologic surgeons, technical optimization of procedures, and development of standardized outcome measures are important future developments in prosthesis surgery for transgender men. This chapter describes the current state of penile and testicular implant surgery for transmasculine patients.

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References

  1. Flores AR, Herman JL, Gates GJ, Brown TNT. How many adults identify as transgender in the United States? The Williams Institute: Los Angeles; 2016.

    Google Scholar 

  2. Grant JMML, Tanis J, Herman JL, Harrison J, Keisling M. National transgender discrimination survey report on health and health care. Washington, DC: National Center for Transgender Equality and the National Gay and Lesbian Task Force; 2010.

    Google Scholar 

  3. Falcone M, Garaffa G, Raheem A, Christopher NA, Ralph DJ. Total phallic reconstruction using the radial artery based forearm free flap after traumatic penile amputation. J Sex Med. 2016;13(7):1119–24.

    Article  PubMed  Google Scholar 

  4. Amukele SA, Lee GW, Stock JA, Hanna MK. 20-year experience with iatrogenic penile injury. J Urol. 2003;170(4 Pt 2):1691–4.

    Article  PubMed  Google Scholar 

  5. Callens N, Hoebeke P. Phalloplasty: a panacea for 46, XY disorder of sex development conditions with penile deficiency? Endocr Dev. 2014;27:222–33.

    Article  PubMed  Google Scholar 

  6. Garaffa G, Spilotros M, Christopher NA, Ralph DJ. Total phallic reconstruction using radial artery based forearm free flap phalloplasty in patients with epispadias-exstrophy complex. J Urol. 2014;192(3):814–20.

    Article  PubMed  Google Scholar 

  7. Kayes O, Shabbir M, Ralph D, Minhas S. Therapeutic strategies for patients with micropenis or penile dysmorphic disorder. Nat Rev Urol. 2012;9(9):499–507.

    Article  PubMed  Google Scholar 

  8. 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(2):272–6. discussion 6-7

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  10. Bluebond-Langner R, Redett RJ. Phalloplasty in complete aphallia and ambiguous genitalia. Semin Plast Surg. 2011;25(3):196–205.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hage JJ, Bout CA, Bloem JJ, Megens JA. Phalloplasty in female-to-male transsexuals: what do our patients ask for? Ann Plast Surg. 1993;30(4):323–6.

    Article  CAS  PubMed  Google Scholar 

  12. Jacobsson J, Andreasson M, Kolby L, Elander A, Selvaggi G. Patients’ priorities regarding female-to-male gender affirmation surgery of the genitalia – a pilot study of 47 patients in Sweden. J Sex Med. 2017;14(6):857–64.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  14. Frey JD, Poudrier G, Chiodo MV, Hazen A. An update on genital reconstruction options for the female-to-male transgender patient: a review of the literature. Plast Reconstr Surg. 2017;139(3):728–37.

    Article  CAS  PubMed  Google Scholar 

  15. Selvaggi G, Bellringer J. Gender reassignment surgery: an overview. Nat Rev Urol. 2011;8(5):274–82.

    Article  PubMed  Google Scholar 

  16. Chang TS, Hwang WY. Forearm flap in one-stage reconstruction of the penis. Plast Reconstr Surg. 1984;74(2):251–8.

    Article  CAS  PubMed  Google Scholar 

  17. Monstrey S, Hoebeke P, Selvaggi G, Ceulemans P, Van Landuyt K, Blondeel P, et al. Penile reconstruction: is the radial forearm flap really the standard technique? Plast Reconstr Surg. 2009;124(2):510–8.

    Article  CAS  PubMed  Google Scholar 

  18. Lee GK, Lim AF, Bird ET. A novel single-flap technique for total penile reconstruction: the pedicled anterolateral thigh flap. Plast Reconstr Surg. 2009;124(1):163–6.

    Article  CAS  PubMed  Google Scholar 

  19. Rubino C, Figus A, Dessy LA, Alei G, Mazzocchi M, Trignano E, et al. Innervated island pedicled anterolateral thigh flap for neo-phallic reconstruction in female-to-male transsexuals. J Plast Reconstr Aesthet Surg. 2009;62(3):e45–9.

    Article  CAS  PubMed  Google Scholar 

  20. Morrison SD, Son J, Song J, Berger A, Kirby J, Ahdoot M, et al. Modification of the tube-in-tube pedicled anterolateral thigh flap for total phalloplasty: the mushroom flap. Ann Plast Surg. 2014;72(Suppl 1):S22–6.

    Article  CAS  PubMed  Google Scholar 

  21. Bettocchi C, Ralph DJ, Pryor JP. Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int. 2005;95(1):120–4.

    Article  PubMed  Google Scholar 

  22. 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(1):139–44. https://doi.org/10.1111/bju.14027. Epub 2017 Oct 20. PMID: 28940910.

  23. Selvaggi G, Monstrey S, Ceulemans P, T’Sjoen G, De Cuypere G, Hoebeke P. Genital sensitivity after sex reassignment surgery in transsexual patients. Ann Plast Surg. 2007;58(4):427–33.

    Article  CAS  PubMed  Google Scholar 

  24. Hoebeke P, Selvaggi G, Ceulemans P, De Cuypere G, T’Sjoen G, Weyers S, et al. Impact of sex reassignment surgery on lower urinary tract function. Eur Urol. 2005;47(3):398–402.

    Article  PubMed  Google Scholar 

  25. Van Caenegem E, Verhaeghe E, Taes Y, Wierckx K, Toye K, Goemaere S, et al. Long-term evaluation of donor-site morbidity after radial forearm flap phalloplasty for transsexual men. J Sex Med. 2013;10(6):1644–51.

    Article  PubMed  Google Scholar 

  26. Rohrmann D, Jakse G. Urethroplasty in female-to-male transsexuals. Eur Urol. 2003;44(5):611–4.

    Article  PubMed  Google Scholar 

  27. Ascha M, Massie JP, Morrison SD, Crane CN, Chen ML. Outcomes of single stage phalloplasty by pedicled anterolateral thigh flap versus radial forearm free flap in gender confirming surgery. J Urol. 2018;199(1):206–14. https://doi.org/10.1016/j.juro.2017.07.084. Epub 2017 Jul 29. PMID: 28765066.

  28. Lumen N, Monstrey S, Goessaert AS, Oosterlinck W, Hoebeke P. Urethroplasty for strictures after phallic reconstruction: a single-institution experience. Eur Urol. 2011;60(1):150–8.

    Article  PubMed  Google Scholar 

  29. Levine LA, Elterman L. Urethroplasty following total phallic reconstruction. J Urol. 1998;160(2):378–82.

    Article  CAS  PubMed  Google Scholar 

  30. Leriche A, Timsit MO, 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(10):1297–300.

    Article  PubMed  Google Scholar 

  31. Noe JM, Birdsell D, Laub DR. The surgical construction of male genitalia for the female-to-male transsexual. Plast Reconstr Surg. 1974;53(5):511–6.

    Article  CAS  PubMed  Google Scholar 

  32. Borgoras N. Uber die volle plastische wie-derhersteuung eines zum koitus fahigen penis (peniplastica totalis). Zentralbl Chirurg. 1936;63:1271–6.

    Google Scholar 

  33. Biemer E. Penile construction by the radial arm flap. Clin Plast Surg. 1988;15(3):425–30.

    Article  CAS  PubMed  Google Scholar 

  34. Kim SK, Lee KC, Kwon YS, Cha BH. Phalloplasty using radial forearm osteocutaneous free flaps in female-to-male transsexuals. J Plast Reconstr Aesthet Surg. 2009;62(3):309–17.

    Article  PubMed  Google Scholar 

  35. Kim SK, Kim TH, Yang JI, Kim MH, Kim MS, Lee KC. The etiology and treatment of the softened phallus after the radial forearm osteocutaneous free flap phalloplasty. Arch Plast Surg. 2012;39(4):390–6.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Schaff J, Papadopulos NA. A new protocol for complete phalloplasty with free sensate and prelaminated osteofasciocutaneous flaps: experience in 37 patients. Microsurgery. 2009;29(5):413–9.

    Article  PubMed  Google Scholar 

  37. Papadopulos NA, Schaff J, Biemer E. The use of free prelaminated and sensate osteofasciocutaneous fibular flap in phalloplasty. Injury. 2008;39(Suppl 3):S62–7.

    Article  PubMed  Google Scholar 

  38. Selvaggi G, Elander A, Branemark R. Penile epithesis: preliminary study. Plast Reconstr Surg. 2010;126(5):265e–6e.

    Article  PubMed  Google Scholar 

  39. Selvaggi G, Branemark R, Elander A, Liden M, Stalfors J. Titanium-bone-anchored penile epithesis: preoperative planning and immediate postoperative results. J Plast Surg Hand Surg. 2015;49(1):40–4.

    Article  PubMed  Google Scholar 

  40. Scott FB, Bradley WE, Timm GW. Management of erectile impotence. Use of implantable inflatable prosthesis. Urology. 1973;2(1):80–2.

    Article  CAS  PubMed  Google Scholar 

  41. 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(4):523–30.

    Article  CAS  PubMed  Google Scholar 

  42. Levine LA, Zachary LS, Gottlieb LJ. Prosthesis placement after total phallic reconstruction. J Urol. 1993;149(3):593–8.

    Article  CAS  PubMed  Google Scholar 

  43. Hage JJ, Bloem JJ, Bouman FG. Obtaining rigidity in the neophallus of female-to-male transsexuals: a review of the literature. Ann Plast Surg. 1993;30(4):327–33.

    Article  CAS  PubMed  Google Scholar 

  44. 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(2):49–53.

    Article  CAS  PubMed  Google Scholar 

  45. Hoebeke P, de Cuypere G, Ceulemans P, Monstrey S. Obtaining rigidity in total phalloplasty: experience with 35 patients. J Urol. 2003;169(1):221–3.

    Article  CAS  PubMed  Google Scholar 

  46. Neuville P, Morel-Journel N, Maucourt-Boulch D, Ruffion A, Paparel P, Terrier JE. Surgical outcomes of erectile implants after Phalloplasty: retrospective analysis of 95 procedures. J Sex Med. 2016;13(11):1758–64.

    Article  PubMed  Google Scholar 

  47. 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  PubMed  Google Scholar 

  48. Hage JJ. Dynaflex prosthesis in total phalloplasty. Plast Reconstr Surg. 1997;99(2):479–85.

    Article  CAS  PubMed  Google Scholar 

  49. 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(12):2485–91.

    Article  PubMed  Google Scholar 

  50. Jordan GH, Alter GJ, Gilbert DA, Horton CE, Devine CJ Jr. Penile prosthesis implantation in total phalloplasty. J Urol. 1994;152(2 Pt 1):410–4.

    Article  CAS  PubMed  Google Scholar 

  51. 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(2):334–40.

    Article  PubMed  Google Scholar 

  52. Large MC, Gottlieb LJ, Wille MA, DeWolfe M, Bales GT. Novel technique for proximal anchoring of penile prostheses in female-to-male transsexual. Urology. 2009;74(2):419–21.

    Article  PubMed  Google Scholar 

  53. 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(1):137–43.

    Article  PubMed  Google Scholar 

  54. Neuville P, Morel-Journel N, Cabelguenne D, Ruffion A, Paparel P, Terrier JE. First outcomes of the ZSI 475 FtM, a specific prosthesis designed for Phalloplasty. J Sex Med. 2019;16(2):316–22. https://doi.org/10.1016/j.jsxm.2018.11.013. Epub 2019 Jan 9.

  55. Carson CC III, Mulcahy JJ, Harsch MR. Long-term infection outcomes after original antibiotic impregnated inflatable penile prosthesis implants: up to 7.7 years of followup. J Urol. 185(2):614–8.

    Google Scholar 

  56. Carson CC, Mulcahy JJ, Govier FE. Efficacy, safety and patient satisfaction outcomes of the AMS 700CX inflatable penile prosthesis: results of a long-term multicenter study. AMS 700CX study group. J Urol. 2000;164(2):376–80.

    Article  CAS  PubMed  Google Scholar 

  57. Perovic SV. Editorial comment on: erectile implants in female-to-male transsexuals: our experience in 129 patients. Eur Urol. 57(2):340.

    Google Scholar 

  58. De Cuypere G, T’Sjoen G, Beerten R, Selvaggi G, De Sutter P, Hoebeke P, et al. Sexual and physical health after sex reassignment surgery. Arch Sex Behav. 2005;34(6):679–90.

    Article  PubMed  Google Scholar 

  59. Selvaggi G, Hoebeke P, Ceulemans P, Hamdi M, Van Landuyt K, Blondeel P, et al. Scrotal reconstruction in female-to-male transsexuals: a novel scrotoplasty. Plast Reconstr Surg. 2009;123(6):1710–8.

    Article  CAS  PubMed  Google Scholar 

  60. Stojanovic B, Bizic M, Bencic M, Kojovic V, Majstorovic M, Jeftovic M, et al. One-stage gender-confirmation surgery as a viable surgical procedure for female-to-male transsexuals. J Sex Med. 2017;14(5):741–6.

    Article  PubMed  Google Scholar 

  61. Turek PJ, Master VA. Testicular prosthesis study G. safety and effectiveness of a new saline filled testicular prosthesis. J Urol. 2004;172(4 Pt 1):1427–30.

    Article  CAS  PubMed  Google Scholar 

  62. Kogan S. The clinical utility of testicular prosthesis placement in children with genital and testicular disorders. Transl Androl Urol. 2014;3(4):391–7.

    PubMed  PubMed Central  Google Scholar 

  63. Lucas JW, Lester KM, Chen A, Simhan J. Scrotal reconstruction and testicular prosthetics. Transl Androl Urol. 2017;6(4):710–21.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Bodiwala D, Summerton DJ, Terry TR. Testicular prostheses: development and modern usage. Ann R Coll Surg Engl. 2007;89(4):349–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Dy GW, Sun J, Granieri MA, Zhao LC. Reconstructive management pearls for the transgender patient. Curr Urol Rep. 2018;19(6):36.

    Article  PubMed  Google Scholar 

  66. Dieckmann KP, Anheuser P, Schmidt S, Soyka-Hundt B, Pichlmeier U, Schriefer P, et al. Testicular prostheses in patients with testicular cancer – acceptance rate and patient satisfaction. BMC Urol. 2015;15:16.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, New York University, New York, NY, USA

    Geolani W. Dy & Lee C. Zhao

  2. New York University School of Medicine, New York, NY, USA

    Ian T. Nolan

  3. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Nabeel A. Shakir

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  1. Geolani W. Dy
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  2. Ian T. Nolan
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  3. Nabeel A. Shakir
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  4. Lee C. Zhao
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Correspondence to Lee C. Zhao .

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Editors and Affiliations

  1. Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA

    Dmitriy Nikolavsky

  2. Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA

    Stephen A. Blakely

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Dy, G.W., Nolan, I.T., Shakir, N.A., Zhao, L.C. (2021). Prosthetics: Erectile Implant, Testicular Implants. In: Nikolavsky, D., Blakely, S.A. (eds) Urological Care for the Transgender Patient. Springer, Cham. https://doi.org/10.1007/978-3-030-18533-6_12

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  • DOI: https://doi.org/10.1007/978-3-030-18533-6_12

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