Introduction: After phalloplasty, insertion of a penile implant is necessary for achieving rigidity of the phallus enabling sexual intercourse. High complication and reoperation rates are described after insertion of penile implants in phalloplasty. Little is known about the influence of Urethral Lengthening (UL) in phalloplasty on the surgical and functional outcomes. The aim of this study was to compare surgical outcomes after insertion of penile implants between transgender men who underwent phalloplasty with versus without UL.
Methods: Transgender men who had a phalloplasty with or without UL between 01-2009 and 01-2021 were evaluated. Of the men who had a penile implant, demographic data, time to implantation, type of penile implant (malleable or inflatable), operative data, and intra- and postoperative complications were recorded.
Results: In total, 156 transgender men were evaluated, 104 (67%) after phalloplasty with and 52 (33%) without UL. In the group with UL, 52 (50%) were ready for implantation of a penile implant, of which 39 (38%) had an implantation. Without UL, 25 (48%) were ready for implantation, and 19 (37%) had a penile implant. In the group with UL, 21 (54%) malleable and 18 (46%) inflatable implants were placed, and without UL, 8 (42%) malleable and 11 (58%) inflatable (p=0.4).
The median (IQR) interval between phalloplasty and being ready for implantation was 24 (17-44) months in case of UL and 19 (12-28) months in case of without UL (p=0.02). A non-significant difference was observed in the median time interval between phalloplasty and insertion of a penile implant for patients with and without UL (39 vs. 32 months resp., p=0.24). Complications after insertion of a penile implant were seen more often in the group with UL (27/39 (69%) vs. 7/19 (37%) respectively, p=0.02). Complications scored were wound infection, urethral fistula, extrusion, malfunction, or loose implant. Although not significant, reoperations of the penile implant were conducted more often after phalloplasty with UL vs without UL (22/39 (56%) vs. 6/19 (32%) resp., p=0.08). Four (10%) men who previously had UL, noticed a change in voiding after insertion of the penile implant, compared to no men in the group without UL.
Conclusions: Transgender men after phalloplasty without UL are sooner eligible for implantation of a penile implant compared to phalloplasty with UL. Complications after insertion of a penile implant were seen more often in transgender men who previously underwent phalloplasty with compared to without UL, with consequently the necessity of more reoperations.