Inflatable penile prosthesis implantation after gender affirming phalloplasty with radial forearm free flap

We aimed to review all information on penile prosthetic surgery in patients with prior phalloplasty and give a detailed description of the authors’s preferred technique. A nonsytematic review of the articles that were published in English and indexed on Pubmed, Google Scholar, and Embase databases was conducted. The relevant literature reports mainly on the outcomes of penile prosthesis (PP) implantation following gender affirming phalloplasty with the radial forearm free flap technique. Three-piece inflatable penile prostheses (IPP) have been the most commonly utilized hardware in this setting. PP implantation in a neophallus is a complex procedure and contains some technical nuances. Creation of spaces within the neophallus for the cylinder(s), wrapping the cylinder(s) with synthetic materials or allografts, and fixation of the prosthesis to the pubic bony structures can be considered as the most important steps of this procedure. Five-year IPP retention rates in flap phalloplasty range between 42 and 78% which is lower than the rate observed in anatomic phallus. In addition, complication and mechanical failure rates are higher in flap phalloplasty. However, satisfaction rates after PP implantations in anatomic penis versus neophallus seem to be similarly high. Infection, migration, and mechanical failure are the most frequent complications.