Novel penile prostheses for transmen: surgical outcomes of ZSI FTM penile implants after musculocutaneous latissimus dorsi neophalloplasty

Abstract

Aim: One of the main goals of neophalloplasty is to provide the possibility of penetrative sexual intercourse. For individuals undergoing neophalloplasty, the implantation of malleable or inflatable penile prostheses is currently the main option for achieving reliable erectile function. The aim of this study was to assess surgical outcomes after the implantation of specially designed malleable and inflatable penile implants for transgender men, following musculocutaneous latissimus dorsi free flap neophalloplasty.

Methods: Between January 2022 and January 2025, 20 transgender men underwent ZSI FTM 475 or ZSI FTM 100 penile prostheses insertion following musculocutaneous latissimus dorsi free flap neophalloplasty. The dorsal approach was used in all cases for prostheses insertion and plate fixation to the pubic periosteum. The space for the prosthesis was created in the neophallus, behind the muscle. For inflatable prostheses, the pump was placed into the left hemiscrotum and connected to the reservoir in the left inguinal region. Patient satisfaction was evaluated using the International Index of Erectile Function (IIEF).

Results: The mean follow-up period was 21 months (range 4-36 months), and the mean interval between neophalloplasty and prosthesis implantation was 44 months (range 6-120 months). No intraoperative complications occurred. The most significant complication observed was fracture of the penile implant (n = 2, 10%). All patients who engaged in penetrative sexual intercourse reported satisfactory penetration, with a mean IIEF score of 21.1.

Conclusion: These novel penile prostheses for transgender men demonstrate favorable surgical outcomes after latissimus dorsi neophalloplasty, with a high rate of patient satisfaction.

Keywords

Gender dysphoria / musculocutaneous latissimus dorsi / transmen / neophalloplasty / penile prostheses

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