Novel Technique for Proximal Bone Anchoring of Penile Prosthesis After Radial Forearm Free Flap Neophallus.
OBJECTIVE
To describe outcomes of bone anchoring of penile implant in a neophallus with an accompanying video focusing on operative technique and salient tips for surgeons performing these procedures. Penile prosthesis insertion allows individuals with a neophallus to achieve erectile function. Lack of corporal bodies to accommodate cylinders makes anchoring of any prosthesis challenging. Anchoring the device to the pubic bone is one strategy to achieve proximal stabilization.


METHODS
A single-institution, retrospective chart review of 10 neophallus patients undergoing penile prosthesis placement from 2006 to 2015 was done. The pubic symphysis is exposed and corticotomy created for placement of the rear tip extender of the implant using a Stryker TPS bone drill. Anchoring sutures through the corticotomy defect, rear tip, and proximal cylinder seat the implant. The remainder of the implantation procedure mirrors that used in native tissue.


RESULTS
The overall perioperative complication rate was 20%, with a mean follow-up of 49 months. Seventy percent of the patients required reoperation, with a mean of 1.4 prosthesis revision surgeries per patient. Primary causes of revision included infection, poor fixation of the rear tip, and prosthesis failure. Despite high revision rates, 80% of the patients have fully functioning prosthesis as of last follow-up. Limitations include retrospective study design and the small patient cohort.


CONCLUSIONS
Penile prosthesis placement in the neophallus is feasible and effective. A bone-anchored rear tip is an option to provide proximal stabilization. Continued efforts to minimize the need for revisions are ongoing and necessary.
Section of Urology, Department of Surgery, University of Chicago, Chicago, IL. Electronic address: Andrew.Cohen@uchospitals.edu.
Andrew J
AJ
Cohen
Section of Urology, Department of Surgery, University of Chicago, Chicago, IL.
Raj R
RR
Bhanvadia
Section of Urology, Department of Surgery, University of Chicago, Chicago, IL.
Joseph J
JJ
Pariser
Section of Urology, Department of Surgery, University of Chicago, Chicago, IL.
David M
DM
Hatcher
Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago, Chicago, IL.
Lawrence J
LJ
Gottlieb
Section of Urology, Department of Surgery, University of Chicago, Chicago, IL.
Gregory T
GT
Bales
D000328:Adult; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D015917:Penile Prosthesis; D019919:Prosthesis Implantation / Q000379:methods*; D011630:Pubic Bone / Q000601:surgery*; D057830:Gender-Affirming Surgery / Q000379:methods*; D053441:Suture Anchors