INFLATABLE PENILE PROSTHESIS PLACEMENT IN TRANSGENDER NEOPHALLUS USING NOVEL HUMAN CADAVER PERICARDIUM (TUTOPLAST?) GRAFT SOCK TECHNIQUE

Introduction Placement of an inflatable penile prosthesis (IPP) in a transgender patient’s neophallus carries unique considerations versus cis-gender IPP in mitigating infection, erosion, and overall complication rates. Traditionally, the IPP implants used in cis-males are also employed in transmasculine patients. However, there are unique challenges in the transmasculine population, with one of the most significant being the lack of anatomical corpus cavernosum and crura for cylinder placement and anchoring. To account for this, multiple grafting approaches and materials have been utilized in IPP neophallus placement with the goal of facilitating cylinder anchoring and stability. Here we detail our experiences using a novel grafting approach with Tutoplast® pericardium graft in a “sock” and “cap” technique in IPP placement in a transgender neophallus. Objective Our objective is to evaluate postoperative satisfaction and device functionality in patients undergoing transgender neophallic IPP placement using our technique. Methods We describe our experience and surgical technique in IPP neophallus placement utilizing a single cylinder with novel distal and proximal cylinder human cadaver pericardium (Tutoplast®) graft. Results We performed neophallus IPP placement with this novel grafting technique, with operative images and graft details shown below. Patients had no complaints post-operatively, with cylinder and pump found to be in good position at first post-operative visit 6 weeks following surgery. There was no difficulty with urinating through the neophallus. All patients report continued satisfaction with device as well as ability to perform penetrative intercourse with device activated. All patients reported satisfaction and no complications at last follow-up (range: 3.5 months to 13 months), with all patients possessing continued satisfactory erectile function. One patient noted occasional mild pain in neophallus that self-resolves and does not cause any concern. Conclusions In neophallus IPP placement, the anatomical differences compared to cis-gender IPP operations require unique considerations such as cylinder grafting material selection for proximal cylinder fixation and mitigation of device erosion rates. Utilizing human cadaver pericardium (Tutoplast®) graft in distal and proximal cylinder coverage shows positive preliminary outcomes in our patients. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Run Wang, MD, FACS is a consultant for Boston Scientific and Teleflex.