XV Harry Benjamin International Gender Dysphoria Association Symposium

The State of Our Art and the State of Our Science

Dynaflex prosthesis in total phalloplasty: Experience in 9 patients

By P Hoebeke MD, G De Cuypere MD, S Monstrey MD,
Dept. of Urology, Psychiatry, Endocrinology, and Plastic Surgery, University Hospital, De Pintelaan 185, B 9000 Gent , Belgium
Abstract

• Results
• Conclusion

Although voiding while standing is a priority for most female-to-male transsexuals, most patients want to go on for the sexual experience once they are used to their new voiding abilities. Being faced with patients asking to treat their impotence and being aware of the high rate of complications and failures reported in literature, we started the procedure from August 1996.

Patients and methods: From March 1996 until March 1997, a Dynaflex® rigidity prosthesis was implanted in the neophallus of 9 female-to-male transsexuals. Implantation of the rigidity device was done as a secondary or tertiary procedure in all patients. Free sensate radial forearm flap phalloplasty was part of a one stage procedure for gender reassignment surgery (mastectomy, hysterectomy, culpectomy, phalloplasty) as a primary procedure. A time lap of at least 6 months between primary and secondary procedure is necessary in order to let the phallus heal and become sensate and reduce the risk for urinary complications as urethral fistula and urethral stenosis. Seven out of 9 patients had testicular implants as a secondary procedure. Although neoscrotal approach is used the testicular implants do not complicate the penile prosthesis implant. The implantation technique used is the one described by Hage in which the prosthesis is covered by a Dacron vascular prosthesis.

Results

Nine patients underwent prosthesis implantation. Seven patients had undergone phalloplasty in our center. Before implantation normal bladder function was controlled by history taking, uroflowmetry and urine-analysis. The phallus has to be sensate at the top. Immediately after surgery there was some decrease in blood flow as seen by a slower refill in 4 patients. The phallus was never in danger. Edema of the phallus was seen in all patients but recovered from within one week. All implants were successful with only one complication due to mechanical failure of the device. This was easily replaced by opening the Dacron and reinserting a new prosthesis. Six out of 9 patients are sexually active with high satisfaction. One patient is sexually inactive through lack of partner. One patient is sexually active but suffers problems of difficult penetration and prosthesis deflation during intercourse. Although all patients encounter this problem the majority can deal with it by adapting sexual technique. One patient is only recently implanted and the prosthesis is not yet activated.

Conclusion

A good experience is reported on penile prosthesis implant in female-to-male transsexual patients.