Introduction: After phalloplasty, insertion of a penile implant is needed in order to achieve rigidity of the phallus enabling sexual intercourse. In this study, we present our experience with the malleable and inflatable ZSI penile implants specially designed for phalloplasties.
Methods: Transgender men who had a penile implant inserted between 01-01-2017 and 01-09-2021 were included and demographic data, type of penile implant (malleable or inflatable), operative data, and intra- and postoperative complications were recorded. In addition, it was examined what percentage of the men were sexually active with penetrative sex.
Results: A total of 58 penile implants were placed, 16 malleable (ZSI FTM 100) and 42 inflatable (ZSI FTM 475). Relevant demographic history was a stroke (n=1) and diabetes mellitus (n=1). The mean age at the time of implantation was 37 ± 11 years. Duration of surgery was 85 ± 19 minutes for malleable and 99 ± 18 minutes for inflatable implants (p=0.052). The mean clinical follow-up duration was 13 months.
Of the 16 malleable implants, one (6%) was removed postoperatively due to imminent erosion of the implant, four (25%) were changed to the inflatable because of dissatisfaction, and three (19%) implants were broken at the base and required replacement. All trans-men with a malleable penile implant in situ at the time of analysis were sexually active with penetrative sex.
Of the 42 inflatable implants, 38 (90%) were placed primary and four (10%) secondary. Postoperatively, four (10%) implants were removed because of an infection, four (10%) longer implants had to be placed, and five (12%) reoperations occurred because of material problems, such as leakage. Additionally, due to ongoing pain, the cylinder and the pump were removed in one case, and in another the reservoir was surgically moved to intra-abdominal and later replaced for a smaller reservoir. The vast majority with an inflatable implant in situ were able to achieve an erection.
Conclusions: Implantation of the penile implant developed for phalloplasty shows favorable results. The majority of men are capable of penetrative sex.