Surgical Outcomes of Erectile Implants After Phalloplasty: Retrospective Analysis of 95 Procedures.
BACKGROUND
The creation of a neophallus is a complex surgery that must meet functional and esthetic requirements. It is a long and demanding surgical process whose final stage consists of the implantation of a rigid or inflatable material that can be used to reproduce an erection. Data in the literature are scarce, with only the pioneering series present, which includes the use of the first devices and techniques.


OBJECTIVE
To report the outcome of patients with phalloplasty after implantation of erectile implants using standardized surgical techniques and the use of recent prosthesis types with or without a vascular graft.


METHODS
This is a retrospective hospital-based analysis of all patients with phalloplasty who underwent implantation of an erectile prosthesis from March 2007 to May 2015. Factors associated with complications were investigated by multivariate logistic regression analysis.


METHODS
Early-onset (during the first month after surgery) and late-onset complications, including erosion, infections, malpositioning, and dysfunction.


RESULTS
Sixty-nine patients were included in the study and 95 procedures were analyzed. After a median follow-up of 4 years (minimum = 169 days, maximum = 6.1 years), the original prosthesis was still in place in 43 patients (62.3%). Patients underwent phalloplasty after female-to-male transsexualism (n = 62, 89.9%), malformation (n = 4, 5.8%), or trauma (n = 3, 4.3%). The proportions for the different types of phalloplasty were 58% for forearm free flap phalloplasty (n = 40), 33.3% for suprapubic phalloplasty (n = 23), and 7% for other (n = 6). The erectile prostheses used were the two-piece AMS Ambicor (n = 71, 74.7%), the Ambicor with a vascular graft (n = 19, 20.0%), and the AMS 700CXR, AMS 700CX, or AMS600-650 (n = 5, 5.2%). There were no early-onset complications in 89 procedures (93.7%) and, when present, they were always related to infection (n = 4, 4.2%). Late-onset complications were erosion (n = 4, 4.2%), infection (n = 4, 4.2%), dysfunction (n = 10, 10.5%), and malpositioning (n = 12, 12.6%). No significant difference was observed for malpositioning (12.7% vs 10.5%, P = .87) and dysfunction (7.0% vs 10.5%, P = .78) between the AMS Ambicor prosthesis and the Ambicor prosthesis with a vascular graft.


CONCLUSIONS
This study provides updated data on complications after the implantation of erectile implants. Multicenter studies, including the evaluation of patient satisfaction, are needed to increase our understanding of factors associated with the outcomes.
Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France.
Paul
P
Neuville
Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France.
Nicolas
N
Morel-Journel
Department of Biostatistics, Hospices Civils de Lyon, Lyon, France.
Delphine
D
Maucourt-Boulch
Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France.
Alain
A
Ruffion
Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France.
Philippe
P
Paparel
Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Université Lyon 1 Claude Bernard, Faculté de Médecine Lyon-Sud, Oullins Cedex, France. Electronic address: jean-etienne.terrier01@chu-lyon.fr.
Jean-Etienne
JE
Terrier
D000328:Adult; D000368:Aged; D001187:Artificial Organs; D004954:Esthetics; D005260:Female; D005542:Forearm / Q000601:surgery; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010410:Penile Erection / Q000502:physiology; D015917:Penile Prosthesis; D011183:Postoperative Complications / Q000209:etiology; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods; D012189:Retrospective Studies; D057830:Gender-Affirming Surgery / Q000379:methods*; D014189:Transsexualism / Q000601:surgery*; D055815:Young Adult
Erectile Device; Female-to-Male Transsexualism; Neophallus; Penile Prosthesis; Phalloplasty; Transsexualism