Inflatable penile implant for phalloplasty following major trauma

Authors: João P. Lima, Paulo Azinhais, Paulo Temido, Miguel Eliseu, Arnaldo Figueiredo

Key words: Neophallus; Phalloplasty, Penile Prosthesis; Erectile Device; Trauma; Penile Avulsion;

This video presents the first penile prosthesis implantation (PPI) following phalloplasty performed in the Portuguese National Health System, on a cis-gender patient who suffered penile avulsion following major trauma. The patient was a 27-year-old patient who suffered a major car accident with trauma to the pelvis, resulting in left hemipelvectomy and penile amputation. He was subsequently submitted to phalloplasty with latissimus dorsi flap. To our knowledge, this represents one of the very few PPI for phalloplasty on a cis-gender patient worldwide, with few reports on PPI for phalloplasty, which consider mostly transgender patients. This surgery faces multiples challenges, with the absence of penile crura and corpora cavernosa resulting in no anchor points and higher risk of erosion, a poorer vascularization of the neophallus, which increases risk for infection and erosion, and patients who are usually younger and therefore sexually more active, with higher risks of mechanical faults. These challenges result ultimately in a high rate of infection and need for implant removal, with device survival rates of 30-60%. For this purpose, we selected the ZSI 475FtM prosthesis, which consists on a three component, single cylinder inflatable implant, with a stainless pad at the proximal end that allows for pubic bone fixation. The video outlines the surgical steps to obtain the best results while attempting to minimize every factor that could lead to prosthesis explantation.

Acknowledgements: The ZSI 475 FtM Prosthesis was kindly provided by Zephyr Surgical Implants (ZSI).

Disclosures: The authors have nothing to disclose