Zhao, Lee C.

Abstract Introduction Many transmen chose to pursue penile prosthesis (PP) implantation as a stage of genital gender affirming surgery. The prosthesis facilitates penetrative intercourse, as the neophallus lacks rigid erectile tissue. While PP placement is a well-established and relatively low-risk surgical treatment option for erectile dysfunction is the cis-male population, published series of post-phalloplasty prosthesis placement have demonstrated a higher rate of complications and subsequent explant. Objective To demonstrate that an integrated surgical team that participates in all stages of phalloplasty creation can improve penile prosthesis outcomes in transmen. Methods We performed a retrospective review of all transmen who underwent PP implantation at our institution from January 2015 through October 2021, yielding a cohort of 44 men. Men who underwent phalloplasty for another reason (trauma, infection, priapism) were excluded. Both malleable (MPP) and inflatable (IPP) prostheses were included in the cohort. Home phalloplasty refers to phalloplasty performed at our institution, and outside phalloplasty at another institution. The surgical technique emphasizes exclusion of urinary flora from the operative field and avoiding excess anchor material to minimize niduses for infection. We analyzed preoperative, operative, and post-operative characteristics, stratified by whether the phalloplasty was performed at our institution. We also performed logistic regression for predictors of explant in the cohort. Results Cohort characteristics and outcomes are represented in Table 1. 44 PPs were implanted 28 at our institution, 16 at an outside institution. Average age was 32 and 33 in the cohorts, respectively. IPPs were more commonly implanted than MPP. Notably, operative time was significantly lower if the phalloplasty had been constructed at our institution (p=0.014). 16 men total required explant, 7/28 (25%) in the home phalloplasty group and 9/16 (56.3%) in the outside phalloplasty group. Predictors of explantation are shown in Table 2. Significant predictors included age (p=0.013), smoking (p=0.030), operative time (p=0.007), whether the phalloplasty was performed at our institution (p=0.043), and the number of pre-PP revision surgeries (p=0.047). On multivariate logistic regression including all variables significant on univariate analysis, only age (p=0.032) and operative time (p=0.010) remained significant predictors. Conclusions We present a large post-phalloplasty penile prosthesis cohort, demonstrating exceedingly low infection rate and improved explant rate in a cohort of men who all underwent both phalloplasty and prosthesis placement with the same surgical team. Our analysis suggests that phalloplasty characteristics, patient characteristics, and operative time can influence penile prosthesis outcomes. Disclosure No

The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap that has been used successfully in the reconstruction of defects across the body. In specific cases, it may prove superior to more commonly used options (e.g., anterolateral thigh flap and radial forearm free flap). Historically, a disadvantage of the MSAP flap is the relatively small surface area it provides for reconstruction. We recently encountered a patient with extensive pelvic injuries from prior trauma resulting in significant scarring and contracture of the groin, tethering of the penis, and loss of the scrotum and one testicle. The patient was unable to achieve erection from tethering and his remaining testicle had been buried in the thigh. In considering the reconstructive options, he was not a suitable candidate for a thigh-based or forearmbased flap. An extended MSAP flap measuring 25 cm×10 cm was used for resurfacing of the groin and pelvis as well as for the formation of a neoscrotum. This report is the first to document an MSAP flap utilized for simultaneous groin resurfacing and scrotoplasty. Additionally, the dimensions of this flap make it the largest recorded MSAP flap to date.