Prosthetics in Female to Male Transgender

Lee C. Zhao

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Challenges

•Avoid vasculature

•doppler

•No corporal tissue

•Absence of proximal fixation

•Migration/malposition

•Paucity of ”cushioning” tissue

distally

•erosion

•Migration within phallus

•Inadequate rigidity

Technique

•Fixation to inferior pubic ramus

•Suture

•Sheath

•Bone anchors

•Distal “neotunica” creation

•Gore-tex wrap

•Dacron

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Distal “cushioning”

•Delay between phalloplasty and penile

prosthesis

•Return of sensation

•Management of urethral complications

•Stable weight

• Inflatable implants less pressure than

malleable?

•Two cylinders

•More rigidity

•Cross-over

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Distal fixation

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•Early (30 days)

• Infection 4.2%

•Late

• Infection 4.2%

•Erosion 4.2%

•Malpositioning 12.6%

•Vascular graft material did not affect malpositioning

•At 4 years, 62.3% still had original implant

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• Infection 11.9%

•Erosion 9.1%

•Malposition 14.6%

•Leak 9.2%

•41% revision at mean

• follow up of 30 months

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New innovations in penile prosthesis

•Proximal fixation

•Rear-tip for fixation

•Distal cushioning

•Wide tip

•Single implant to provide rigidity and girth

•Wider cylinder

•Reduced risk for cross-over

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ZSI 100 FTM Malleable

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•Proximal fixation

•30mm x 25mm

•Distal cushioning

•25mm ”glans

stopper"

•Single cylinder

•22mm wide

cylinder

ZSI 475 FTM Hydraulic Penile Prosthesis

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Conclusions

•Penile prosthesis placement in FTM phalloplasty poses significant risk

•No standardized technique

•Variation in technique to solve major challenges of proximal fixation

and distal erosion

• Improvements to current devices are necessary

•Further research

•Device modifications

•Malleable vs inflatable

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Presentation Title Goes Here 23

Thank you!

lee.zhao@nyumc.org

Twitter: @lee_c_zhao

646-754-2419 (office)

312-493-1636 (cell)