XVII Harry Benjamin International Gender Dysphoria Association Symposium
31 October - 4 November 2001, Galveston, Texas, U.S.A.

Obtaining Rigidity in ‘Total Phalloplasty’: Experience in 30 Patients

HOEBEKE, P. Belgium
Co-author: S. Monstrey (Belgium)

Introduction: The combination of a neourethra and an erection prosthesis in one neophallus in the female to male transsexual remains a challenge. The outcome reported in the literature is disappointing.

Material and Methods: Between August 1996 and March 2001, 30 patients underwent implantation surgery. The Dynaflex prosthesis was used in 10 patients, the CXM prosthesis in 9 and CX prosthesis in 11 patients. In the Dynaflex group the prosthesis is covered by a Dacron prosthesis in order to fix the prosthesis against the pubic bone. In the CXM and CX group only the proximal part of the prosthesis is covered with Dacron to fix the prosthesis to the pubic bone. The choice for CX or CXM depends on the space in the phallus. In some patients only one cylinder of the CX prosthesis was implanted.

Results: In the Dynaflex group (n=10), prosthesis implantation was uneventful in 8 patients. In 2 patients there was a technical failure due to breakage of the stiffener. In these 2 patients the prosthesis was replaced. In 1 of these patients the prosthesis had to be removed due to infection and was replaced by a CX prosthesis. At this time, with a mean follow up of 3.5 years, 9 patients have a Dynaflex prosthesis inserted. Eight of these are sexually active, with a satisfactory use of the prosthesis both to themselves and their partners.

In the CX-CXM group (n=20) prosthesis implantation was uneventful in 16 patients. In 1 patient infection and partial necrosis of the neophallus occurred. In one patient infection occurred, in 1 patient perforation of a cylinder through the tip of the phallus and in 1 patient technical failure doe to leakage of a cylinder. In the last 3 patients the prosthesis was replaced successfully in 2 patients; the other is on the waiting list. The patient with partial necrosis of the phallus is no longer a candidate for an erection prosthesis. At this time 18 patients have a CX/CXM prosthesis inserted. Fifteen of these patients are sexually active with high satisfaction for themselves and their partner.

Conclusion: Good results are reported with the implantation of the Dynaflex prosthesis in the total phalloplasty patient. Disadvantages of this prosthesis include deactivation during intercourse and the risk of breakage of the stiffener. Dynaflex is no longer available today. With the CX/CXM prosthesis the implantation results for this more complex type of prosthesis are as good as for the Dynaflex.