Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Sexual Health Reports
Published in: Current Sexual Health Reports 4/2017

01-12-2017 | Male and Female Surgical Interventions (A Burnett and C Carson, Section Editors)

Prosthetic Considerations in Neophallic Reconstruction

Authors: Geolani W. Dy, Aaron Weinberg, Lee C. Zhao

Published in: Current Sexual Health Reports | Issue 4/2017

Login to get access

Abstract

Purpose of Review

Phalloplasty may be performed in patients with acquired or congenital penile insufficiency or transgender individuals who desire phallic construction. Demand for neophallus creation and prosthesis placement has increased in recent years with growing coverage for gender affirming surgery among transgender patients. This report describes consideration of prosthetic implantation in neophallic reconstruction.

Recent Findings

Prosthesis implantation in a neophallus requires special consideration regarding avoidance of critical structures, proximal prosthesis anchoring, and distal cushioning in patients without native corpora cavernosa. Neophallus prostheses are associated with increased risk of infection, extrusion, erosion, and device migration relative to standard prostheses, with a high revision rate.

Summary

Implanters should have a thorough understanding of neophallic reconstructive technique prior to proceeding with device placement. Current literature on this subject consists predominantly of retrospective reviews and case reports with variable outcome measures. The creation of validated assessment tools will provide more meaningful data to inform provider counseling and patient expectations.
Literature
1.
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.CrossRefPubMed
2.
Amukele SA, Lee GW, Stock JA, Hanna MK. 20-year experience with iatrogenic penile injury. J Urol. 2003;170(4 Pt 2):1691–4.CrossRefPubMed
3.
Callens N, Hoebeke P. Phalloplasty: a panacea for 46, XY disorder of sex development conditions with penile deficiency? Endocr Dev. 2014;27:222–33.CrossRefPubMed
4.
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.CrossRefPubMed
5.
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.CrossRefPubMed
6.
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 6–7CrossRefPubMed
7.
Garaffa G, Raheem AA, Christopher NA, Ralph DJ. Total phallic reconstruction after penile amputation for carcinoma. BJU Int. 2009;104(6):852–6.CrossRefPubMed
8.
9.
Flores AR, Herman JL, Gates GJ, Brown TNT. How many adults identify as transgender in the United States? The Williams Institute: Los Angeles; 2016.
10.
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.
11.
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.CrossRefPubMed
12.
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.CrossRefPubMed
13.
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.CrossRefPubMed
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.CrossRefPubMed
15.
Chang TS, Hwang WY. Forearm flap in one-stage reconstruction of the penis. Plast Reconstr Surg. 1984;74(2):251–8.CrossRefPubMed
16.
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.CrossRefPubMed
17.
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.CrossRefPubMed
18.
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: JPRAS. 2009;62(3):e45–9.CrossRefPubMed
19.
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.CrossRefPubMed
20.
Bettocchi C, Ralph DJ, Pryor JP. Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int. 2005;95(1):120–4.CrossRefPubMed
21.
Selvaggi G, Bellringer J. Gender reassignment surgery: an overview. Nat Rev Urol. 2011;8(5):274–82.CrossRefPubMed
22.
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.CrossRefPubMed
23.
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.CrossRefPubMed
24.
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.CrossRefPubMed
25.
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.CrossRefPubMed
26.
Borgoras N. Uber die volle plastische wie-derhersteuung eines zum koitus fahigen penis (peniplastica totalis). Zentralbl Chir. 1936;63:1271–6.
27.
Biemer E. Penile construction by the radial arm flap. Clin Plast Surg. 1988;15(3):425–30.PubMed
28.
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: JPRAS. 2009;62(3):309–17.CrossRefPubMed
29.
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.CrossRefPubMedPubMedCentral
30.
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.CrossRefPubMed
31.
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.CrossRefPubMed
32.
Selvaggi G, Elander A, Branemark R. Penile epithesis: preliminary study. Plast Reconstr Surg. 2010;126(5):265e–6e.CrossRefPubMed
33.
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.CrossRefPubMed
34.
Scott FB, Bradley WE, Timm GW. Management of erectile impotence use of implantable inflatable prosthesis. Urology. 1973;2(1):80–2.CrossRefPubMed
35.
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.CrossRefPubMed
36.
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.CrossRefPubMed
37.
Levine LA, Zachary LS, Gottlieb LJ. Prosthesis placement after total phallic reconstruction. J Urol. 1993;149(3):593–8.CrossRefPubMed
38.
• 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. This study describes a bone anchoring technique alternative to the commonly accepted suturing method. CrossRefPubMed
39.
40.
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.CrossRefPubMed
41.
• 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. This is among the larger recent series describing penile prosthesis surgical techniques and outcomes among patients with phalloplasty. CrossRefPubMed
42.
• 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. This is the largest series of erectile implants in neophallus to date. CrossRefPubMed
43.
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.CrossRefPubMed
44.
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.CrossRefPubMed
45.
• 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. This is among the larger recent series describing penile prosthesis surgical techniques and outcomes among patients with phalloplasty. CrossRefPubMed
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.CrossRefPubMed
47.
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.CrossRefPubMed
48.
• 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. This study highlights patient quality of life following phalloplasty. CrossRefPubMed
49.
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. 2011;185(2):614–8.CrossRefPubMed
50.
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.CrossRefPubMed
51.
Perovic SV. Editorial comment on: erectile implants in female-to-male transsexuals: our experience in 129 patients. Eur Urol. 2010;57(2):340.CrossRefPubMed
52.
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.CrossRefPubMed
Metadata
Title
Prosthetic Considerations in Neophallic Reconstruction
Authors
Geolani W. Dy
Aaron Weinberg
Lee C. Zhao
Publication date
01-12-2017
Publisher
Springer US
Published in
Current Sexual Health Reports / Issue 4/2017
Print ISSN: 1548-3584
Electronic ISSN: 1548-3592
DOI
https://doi.org/10.1007/s11930-017-0126-1

Other articles of this Issue 4/2017

Current Sexual Health Reports 4/2017 Go to the issue

Medical Comorbidities (M Miner, S Parish and A Goldstein, Section Editors)

The Testosterone Trials: What the Results Mean for Healthcare Providers and for Science

Medical Comorbidities (M Miner, S Parish and A Goldstein, Section Editors)

Testosterone and Cardiovascular Diseases: Causes or Consequences: The Lesson from the Last 5 Years

Medical Comorbidities (M Miner, S Parish and A Goldstein, Section Editors)

Testosterone and Physical Function

Preclinical and Psychophysiology (F Guarraci and L Marson, Section Editors)

Sexual Transmission of Cyst-Forming Coccidian Parasites with Complex Life Cycles

Female Sexual Dysfunction and Disorders (M Chivers and C Pukall, Section Editors)

Recent Developments in Psychopharmaceutical Approaches to Treating Female Sexual Interest and Arousal Disorder

Preclinical and Psychophysiology (F Guarraci and L Marson, Section Editors)

Neural and Endocrine Factors Contribute to the Comorbidity of Urinary and Sexual Dysfunctions