Falcone Marco, Garaffa Giulio, Gillo Arianna, Dente Dino, Christopher Andrew N, Ralph David J
Institute of Urology, University College London Hospitals, London, UK.
Urology Department, Città della Salute e della Scienza, Torino, Italy.
BJU Int. 2018 Jan;121(1):139-144. doi: 10.1111/bju.14027. Epub 2017 Oct 20.
To assess the oucomes of penile prosthesis (PP) implantation after total phallic reconstruction secondary to gender dysphoria.
We conducted a retrospective single-centre analysis of 247 consecutive patients. The recruitment period was January 2001 to October 2015. A total of 328 inflatable PPs were implanted. A two-staged inflatable PP implantation was carried out. As a first step, an extraperitoneal reservoir placement was performed simultaneously with the glans sculpture and the insertion of a single large testicular prosthesis into the labia majora. Subsequently, cylinder(s) and pump placement was performed. A Dacron envelope was fitted around the proximal and distal aspect of the cylinder(s) to anchor the device to the pubic bone and to prevent apical protrusion. The outcomes measured were postoperative complications, eventual need for revision surgery, and long-term survival of the implants. Patient and partner satisfaction rates were extrapolated from the administered non-validated questionnaires. The data were analysed using non-parametric tests, multivariate logistic regression analysis, and a Kaplan-Meier survival curve.
The mean follow-up was 20 months. In all, 88% of patients were satisfied with the result, although only 77% used their device for sexual intercourse. The overall 5-year device survival was 78%, with no one device being superior. Device infection occurred in 8.5% of patients with an overall revision rate of 43%. According to the multivariate logistic regression analysis, only type of phalloplasty significantly affected the infection risk (P = 0.013).
Implantation of a PP into a neophallus is a complex procedure but yields high satisfaction rates. Nevertheless, complication rates are high and patients must be warned that multiple revisions will be necessary throughout their lifetime.
评估性别焦虑症继发全阴茎重建术后阴茎假体（PP）植入的效果。
我们对247例连续患者进行了一项回顾性单中心分析。招募期为2001年1月至2015年10月。共植入328个可膨胀阴茎假体。采用两阶段可膨胀阴茎假体植入术。第一步，在进行龟头塑形的同时进行腹膜外贮液器放置，并将单个大型睾丸假体插入大阴唇。随后，进行圆柱体和泵的放置。在圆柱体的近端和远端周围安装涤纶包膜，将装置固定在耻骨上并防止顶端突出。测量的结果包括术后并发症、最终翻修手术的必要性以及植入物的长期存活率。患者和伴侣的满意度是根据所发放的未经验证的问卷推断得出的。使用非参数检验、多因素逻辑回归分析和Kaplan-Meier生存曲线对数据进行分析。
平均随访时间为20个月。总体而言，88%的患者对结果满意，尽管只有77%的患者使用该装置进行性交。装置总体5年存活率为78%，没有一种装置表现更优。8.5%的患者发生装置感染，总体翻修率为43%。根据多因素逻辑回归分析，只有阴茎成形术的类型显著影响感染风险（P = 0.013）。
将阴茎假体植入人造阴茎是一个复杂的过程，但满意度较高。然而，并发症发生率较高，必须告知患者一生中需要多次翻修。
