Sexual Function and Quality of Life Before and After Penile Prosthesis Implantation Following Radial Forearm Flap Phalloplasty.
OBJECTIVE
To provide sexual function and quality of life outcomes in patients with severe penile deficiency who underwent radial forearm flap phalloplasty with and without penile prosthesis implantation.


METHODS
Patients with history of severe penile deficiency who underwent microsurgical radial forearm flap phalloplasty with and without penile prosthesis implantation between 2007 and 2014 were identified. They completed a set of web-based validated questionnaires including the International Index of Erectile Function, the Pediatric Penile Perception Score, the Sexual Quality of Life for Men, and several items addressing general quality of life. Outcomes were compared between groups.


RESULTS
Nine of the 12 identified patients who had prosthesis after phalloplasty and 4 out of the 7 phalloplasty-only patients completed the survey, resulting in an overall response rate of 68%. Among the phalloplasty-prosthesis patients, 66% reported current sexual activity and 78% reported regular masturbation, whereas 1 of the 4 phalloplasty-only patients reported both. Prosthesis patients scored notably higher in all domains of the International Index of Erectile Function except for sexual desire. In contrast, they demonstrated similar scores of penile perception, as well as general and sexual quality of life.


CONCLUSIONS
Among patients who have undergone flap phalloplasty, the subsequent placement of penile prosthesis appears to effectively allow for both intercourse and masturbation, resulting in measurable improvements in orgasmic function, intercourse satisfaction, and overall sexual satisfaction. Despite these important benefits, prosthesis placement does not appear to result in improvements in penile perception scores, or general or sexual quality of life.
Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY. Electronic address: ezekiel.young@stonybrookmedicine.edu.
Ezekiel E
EE
Young
The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
Daniel
D
Friedlander
The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
Kathy
K
Lue
The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
Uzoma A
UA
Anele
The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
Jacob L
JL
Khurgin
The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
Trinity J
TJ
Bivalacqua
The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
Arthur L
AL
Burnett
Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Richard J
RJ
Redett
The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
John P
JP
Gearhart
D000293:Adolescent; D000328:Adult; D003075:Coitus; D007172:Erectile Dysfunction / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery*; D005542:Forearm; D006801:Humans; D020407:Internet; D008297:Male; D009948:Orgasm; D017060:Patient Satisfaction; D019935:Penile Implantation; D015917:Penile Prosthesis; D010413:Penis / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012720:Severity of Illness Index; D012725:Sexual Behavior; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult