Pang Karl H, Christopher Nim, Ralph David J, Lee Wai Gin
Department of Urology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2PG, UK.
Division of Surgery and Interventional Sciences, University College London, London, UK.
Ther Adv Urol. 2023 Sep 14;15:17562872231199584. doi: 10.1177/17562872231199584. eCollection 2023 Jan-Dec.
Devices such as inflatable penile prostheses (IPP) can be used to achieve erectile rigidity after phalloplasty in assigned female at birth (AFAB) individuals. The approach to inserting an IPP in a neophallus is different and more challenging compared to that of an anatomical penis due to the absence of anatomical structures such as the corpora cavernosa, and the more tenuous blood supply of the neophallus and reconstructed urethra. In addition, the ideal surgical techniques and devices for use in the neophallus have not been defined. This review systematically summarises the literature on the insertion of IPP in the neophallus of individuals AFAB. In particular, the described techniques, types of devices used and peri-operative and patient-reported outcomes are emphasised. An initial search of the PubMed database was performed on 16 September 2022 and an updated search was performed on 26 May 2023. Overall, 185 articles were screened for eligibility and 15 studies fulfilled the inclusion criteria and were included in the analysis. Two studies reported outcomes on the zephyr surgical implant 475 FTM device and the others reported outcomes on the Boston Scientific AMS 600/700 CX 3-piece inflatable, AMS Ambicor 2-piece inflatable, Coloplast Titan or Dynaflex devices. Overall, 1106 IPPs were analysed. The infection rate was 4.2%-50%, with most studies reporting an infection rate of <30%. Mechanical failure or dysfunction occurred in 1.4%-36.4%, explantation was required in 3.3%-41.6%, and implant revision or replacement was performed in 6%-70%. Overall, 51.4%-90.6% of patients were satisfied and 77%-100% were engaging in sexual intercourse. An IPP in a neophallus is an acceptable option to achieve rigidity for sexual intercourse. However, this challenging procedure has good reports of patient and partner satisfaction despite significant risks of complications.
诸如可膨胀阴茎假体（IPP）之类的装置可用于在出生时被指定为女性（AFAB）的个体进行阴茎成形术后实现勃起硬度。与解剖学阴茎相比，在新阴茎中插入IPP的方法有所不同且更具挑战性，这是因为缺乏海绵体等解剖结构，以及新阴茎和重建尿道的血液供应更脆弱。此外，用于新阴茎的理想手术技术和装置尚未确定。本综述系统地总结了关于在AFAB个体的新阴茎中插入IPP的文献。特别强调了所描述的技术、使用的装置类型以及围手术期和患者报告的结果。于2022年9月16日对PubMed数据库进行了初步搜索，并于2023年5月26日进行了更新搜索。总体而言，筛选了185篇文章以确定其是否符合资格，15项研究符合纳入标准并被纳入分析。两项研究报告了Zephyr手术植入475 FTM装置的结果，其他研究报告了波士顿科学AMS 600/700 CX三件式可膨胀装置、AMS Ambicor两件式可膨胀装置、柯洛普拉斯Titan或Dynaflex装置的结果。总体而言，分析了1106个IPP。感染率为4.2%-50%，大多数研究报告感染率<30%。机械故障或功能障碍发生率为1.4%-36.4%，需要取出植入物的发生率为3.3%-41.6%，进行植入物翻修或更换的发生率为6%-70%。总体而言，51.4%-90.6%的患者感到满意，77%-100%的患者进行了性交。新阴茎中的IPP是实现性交硬度的可接受选择。然而，尽管存在重大并发症风险，但该具有挑战性的手术在患者和伴侣满意度方面有良好的报告。
