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Current Sexual Health Reports

Erschienen in:

23.02.2022 | Male Sexual Dysfunction and Disorders (N Thirumavalavan, Section Editor)

Review of Phalloplasty Techniques and Prosthetics in Transgender Male Patients

verfasst von: Randall Li, Laura Bukavina, Shubham Gupta, Aram Loeb, Kyle Scarberry, Lee C. Zhao, Kirtishri Mishra

Erschienen in: Current Sexual Health Reports | Ausgabe 2/2022

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Abstract

Purpose of Review

Techniques for phalloplasty and penile prosthesis implantation have been associated with a high rate of complications, but recent advances in surgical options and penile implant technology may mark a paradigm shift in the approach to female-to-male genital gender-affirming surgery. This review aims to highlight the current state of research on phalloplasty and penile prosthesis implantation and explores the newest innovations for improving outcomes.

Recent Findings

Multiple techniques for phalloplasty have been described with variable outcomes, complications, and strengths. In addition, the majority of penile prosthesis implants have been designed for cis-male anatomy, and rates of complications have been markedly higher in neophallus implantation. The introduction of two new models specifically designed for the neophallus by Zephyr Surgical Implants in recent years may signal a new horizon for penile prostheses tailored for the neophallus.

Summary

The steady rise in the number of transgender individuals seeking surgical treatment options for female-to-male genital gender-affirming surgery has driven the evolution of techniques for phalloplasty and penile prosthesis implantation. Complications remain stubbornly elevated when compared to cis-male outcomes, but the first penile prosthesis designed for the neophallus offers hope that additional breakthroughs may be forthcoming. Additional studies with standardized outcomes are needed to further evaluate superiority between different techniques and penile prostheses.

Stroumsa D, Kirkland AR. Health coverage and care for transgender people - threats and opportunities. N Engl J Med. 2020;383(25):2397–9.PubMedCrossRef

Canner JK, Harfouch O, Kodadek LM, Pelaez D, Coon D, Offodile AC 2nd, et al. Temporal trends in gender-affirming surgery among transgender patients in the United States. JAMA Surg. 2018;153(7):609–16.PubMedPubMedCentralCrossRef

Blecher GA, Christopher N, Ralph DJ. Prosthetic placement after phalloplasty. Urol Clin North Am. 2019;46(4):591–603.PubMedCrossRef

Nair R, Sriprasad S. 1129 Sir Harold Gillies: pioneer of phalloplastyand the birth of uroplastic surgery. J Urol. 2010;183(4S):e437.

Heston AL, Esmonde NO, Dugi DD 3rd, Berli JU. Phalloplasty: techniques and outcomes. Transl Androl Urol. 2019;8(3):254–65.PubMedPubMedCentralCrossRef

• Rooker SA, Vyas KS, DiFilippo EC, Nolan IT, Morrison SD, Santucci RA. The rise of the neophallus: a systematic review of penile prosthetic outcomes and complications in gender-affirming surgery. J Sex Med. 2019;16(5):661–72. An extensive literature review and aggregation of characteristics and outcomes of penile prosthesis implantation in transgender patients.PubMedCrossRef

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

•• Falcone M, Preto M, Timpano M, Ciclamini D, Crosio A, Giacalone F, et al. The surgical outcomes of radial artery forearm free-flap phalloplasty in transgender men: single-centre experience and systematic review of the current literature. Int J Impot Res. 2021;33(7):737–45. A comprehensive review of vascular complications related to radial artery forearm free-flap phalloplasty.

Cheng C, Zhang Y, Liu Y. Technical description and microsurgical outcomes in phalloplasty using the deep inferior epigastric artery and locoregional veins. Plast Reconstr Surg. 2021;147(4):713e-e714.PubMedCrossRef

10.

Felici N, Felici A. A new phalloplasty technique: the free anterolateral thigh flap phalloplasty. J Plast Reconstr Aesthet Surg. 2006;59(2):153–7.PubMedCrossRef

11.

Garaffa G, Christopher NA, Ralph DJ. Total phallic reconstruction in female-to-male transsexuals. Eur Urol. 2010;57(4):715–22.PubMedCrossRef

12.

Wirthmann AE, Majenka P, Kaufmann MC, Wellenbrock SV, Kasper L, Huttinger S, et al. Phalloplasty in female-to-male transsexuals by gottlieb and levine’s free radial forearm flap technique-a long-term single-center experience over more than two decades. J Reconstr Microsurg. 2018;34(4):235–41.PubMedCrossRef

13.

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.PubMedCrossRef

14.

Doornaert M, Hoebeke P, Ceulemans P, T’Sjoen G, Heylens G, Monstrey S. Penile reconstruction with the radial forearm flap: an update. Handchir Mikrochir Plast Chir. 2011;43(4):208–14.PubMedCrossRef

15.

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.PubMedCrossRef

16.

Song C, Wong M, Wong CH, Ong YS. Modifications of the radial forearm flap phalloplasty for female-to-male gender reassignment. J Reconstr Microsurg. 2011;27(2):115–20.PubMedCrossRef

17.

De Wolf E, Claes K, Sommeling CE, Opsomer D, Cherubino M, Vieni S, et al. Free bipedicled radial forearm and posterior interosseous artery perforator flap phalloplasty. J Sex Med. 2019;16(7):1111–7.PubMedCrossRef

18.

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

19.

Terrier M, Morel-Journel N, Carnicelli D, Ruffion A, Terrier JE, Maucort-Boulch D, et al. Suprapubic phalloplasty in transmen: surgical results and critical review. Int J Impot Res. 2021;33(7):754–61.CrossRef

20.

Falcone M, Timpano M, Oderda M, Cocci A, Morelli G, Preto M, et al. Suprapubic pedicled phalloplasty in transgender men: a multicentric retrospective cohort analysis. Int J Impot Res. 2020;33(8):808–14.

21.

Djordjevic ML, Bencic M, Kojovic V, Stojanovic B, Bizic M, Kojic S, et al. Musculocutaneous latissimus dorsi flap for phalloplasty in female to male gender affirmation surgery. World J Urol. 2019;37(4):631–7.PubMedCrossRef

22.

Jun MS, Pusica S, Kojovic V, Bizic M, Stojanovic B, Krstic Z, et al. Total phalloplasty with latissimus dorsi musculocutaneous flap in female-to-male transgender surgery. Urology. 2018;120:269–70.PubMedCrossRef

23.

Kojovic V, Marjanovic M, Radenkovic A, Ilic P, Simic R, Bojovic B. Latissimus dorsi free flap phalloplasty: a systematic review. Int J Impot Res. 2021;33(7):746–53.CrossRef

24.

Terrell M, Roberts W, Price CW, Slater M, Loukas M, Schober J. Anatomy of the pedicled anterolateral thigh flap for phalloplasty in transitioning-males. Clin Anat. 2018;31(2):160–8.PubMedCrossRef

25.

Koshima I, Fukuda H, Utunomiya R, Soeda S. The anterolateral thigh flap; variations in its vascular pedicle. Br J Plast Surg. 1989;42(3):260–2.PubMedCrossRef

26.

Nikolavsky D, Hughes M, Zhao LC. Urologic complications after phalloplasty or metoidioplasty. Clin Plast Surg. 2018;45(3):425–35.PubMedCrossRef

27.

Jun MS, Santucci RA. Urethral stricture after phalloplasty. Transl Androl Urol. 2019;8(3):266–72.PubMedPubMedCentralCrossRef

28.

Kim SK, Moon JB, Heo J, Kwon YS, Lee KC. A new method of urethroplasty for prevention of fistula in female-to-male gender reassignment surgery. Ann Plast Surg. 2010;64(6):759–64.PubMedCrossRef

29.

Rashid M, Sarwar SU. Avulsion injuries of the male external genitalia: classification and reconstruction with the customised radial forearm free flap. Br J Plast Surg. 2005;58(5):585–92.PubMedCrossRef

30.

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

31.

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

32.

Monstrey SJ, Ceulemans P, Hoebeke P. Sex reassignment surgery in the female-to-male transsexual. Semin Plast Surg. 2011;25(3):229–44.PubMedPubMedCentralCrossRef

33.

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.PubMedCrossRef

34.

Lumen N, Oosterlinck W, Decaestecker K, Monstrey S, Hoebeke P. Endoscopic incision of short (<3 cm) urethral strictures after phallic reconstruction. J Endourol. 2009;23(8):1329–32.PubMedCrossRef

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.PubMedCrossRef

36.

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.PubMedCrossRef

37.

Barnard JT, Cakir OO, Ralph D, Yafi FA. Technological advances in penile implant surgery. J Sex Med. 2021;18(7):1158–66.PubMedCrossRef

38.

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.PubMedCrossRef

39.

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.PubMedCrossRef

40.

Atri E, Wong V, Barengo NC, Nieder AM, Polackwich AS. A comparison between AMS 700 and Coloplast titan: a systematic literature review. Cureus. 2020;12(11):e11350.PubMedPubMedCentral

41.

Chen ML, Patel DP, Moses RA, Goodwin IA, Safa B, Watt AJ, et al. Infrapubic insertion of penile implants in transmen after phalloplasty. Urology. 2021;152:79–83.PubMedCrossRef

42.

•• 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. This is the first study to report data on the ZSI 475 FtM. Preliminary results were encouraging and demonstrated high patient satisfaction.PubMedCrossRef

43.

•• Erla W, Goedertier W, Lumen N, Spinoit AF, Waterloos M, Waterschoot M, et al. Implantation of the ZSI 475 FTM erectile device after phalloplasty: a prospective analysis of surgical outcomes. J Sex Med. 2021;18(3):615–22. This is the first prospective study of the ZSI 475 FtM. It is also the largest observational study to date on the ZSI 475 FtMCrossRef

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.PubMedCrossRef

45.

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.PubMedCrossRef

46.

Carson CC 3rd, Mulcahy JJ, Harsch MR. Long-term infection outcomes after original antibiotic impregnated inflatable penile prosthesis implants: up to 77 years of followup. J Urol. 2011;185(2):614–8.PubMedCrossRef

47.

Krueger M, Yekani SAH, Hundt GV, Daverio PJ. Use of erectile prostheses in patients with free forearm flap phalloplasty. Int J Transgender. 2007;10(1):19–22.CrossRef

48.

Ji YS, Ko YH, Song PH, Moon KH. Long-term survival and patient satisfaction with inflatable penile prosthesis for the treatment of erectile dysfunction. Korean J Urol. 2015;56(6):461–5.PubMedPubMedCentralCrossRef

49.

• Pigot GLS, Sigurjonsson H, Ronkes B, Al-Tamimi M, van der Sluis WB. Surgical experience and outcomes of implantation of the ZSI 100 FtM malleable penile implant in transgender men after phalloplasty. J Sex Med. 2020;17(1):152–8. This is the first study reviewing the ZSI 100 FtM. Key advantages and disadvantages were highlighted.PubMedCrossRef

Titel: Review of Phalloplasty Techniques and Prosthetics in Transgender Male Patients
verfasst von: Randall Li
Laura Bukavina
Shubham Gupta
Aram Loeb
Kyle Scarberry
Lee C. Zhao
Kirtishri Mishra
Publikationsdatum: 23.02.2022
Verlag: Springer US
Erschienen in: Current Sexual Health Reports / Ausgabe 2/2022
Print ISSN: 1548-3584
Elektronische ISSN: 1548-3592
DOI: https://doi.org/10.1007/s11930-022-00326-x

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Review of Phalloplasty Techniques and Prosthetics in Transgender Male Patients