Semi Rigid Penile Prosthesis in Neophallus for Epispadias

Joshi, P.M.

Neophallus, Phalloplasty, penile Prosthesis

Total penile rehabilitation is important in patients with neophallus. Neophallus is usually performed as a part of transgender surgery. Patients with Epispadias and Neophallus have the advantage of having the native corpora. Penile prosthesis is challenging due to the vascular pedicle of the Neophallus which should not get injured.

We describe step by step video of performing Semi rigid penile prosthesis after phalloplasty. We have series of 5 patients with post epispadias neophallus and prosthesis surgery. A preoperative MRI is performed to look for anatomy of Native corpora. A CT Scan with contrast is performed to look for the vascular pedicle. A through pre operative surgical planning is performed. A Foleys catheter is inserted in the neourethra. Incision is made at the junction of Neophallus and Scrotum.Dissection is done to locate the native corpora. Stay stiches are taken and corpora dilated. Similar dilatation is performed in the neophallus. We use a ingenious Shahs penile prosthesis.

On the other side the corpora was atrophic. The pubic bone was identified and anchoring sutures were taken on the bone. Intraoperative penile doppler is performed to look for the pedicle of neophallus The prosthesis was attached to the pubic bone .Haemostasis is achieved and wound closed in layers . The prosthesis becomes functional 6 weeks after the surgery.We describe step by step approach for insertion of prosthesis in neophallus .