Insertion of erectile device following phalloplasty in individuals assigned male at birth: a systematic review.

[INTRODUCTION] Erectile devices can be used to achieve erectile rigidity after phalloplasty in assigned male at birth (AMAB) individuals for congenital or acquired penile inadequacy. The insertion technique in a neophallus is different and more challenging compared to that of an anatomical penis.

[OBJECTIVE] To perform a systematic review, summarizing the literature on the insertion of erectile devices in the neophallus of individuals AMAB focusing on techniques, types of devices used, postoperative complications and patient reported outcomes.

[METHOD] The review was performed according to the PRISMA statement. A search of the PubMed database was performed on June 17, 2023 (updated on September 11, 2024) retrieving 86 articles. Overall, 15 studies fulfilled the inclusion criteria and were included in the analysis.

[RESULTS] 184 AMAB individuals had an erectile device inserted. The indications for phalloplasty were penile inadequacy secondary to bladder exstrophy-epispadias complex (46.5%), penile cancer (18.6%), trauma (16.7%), disorder of sex differentiation or micropenis/hypospadias (14.7%), male-female reversal (2.7%), and infection (0.8%). A radial artery forearm free flap was used in 91.1% of patients. The AMS 700 inflatable prosthesis was the most common device inserted. Most studies used a graft to cover the distal cylinder tips to reduce the risk of erosion. Up to 64.3% of patients experienced a complication. Infection, mechanical failure/dysfunction, and malposition/migration/under-sizing occurred in up to 33.3%, 28.6% and 40%, respectively. Explantation was required in up to 40% of patients for erosion. Up to 33.3% of patients had their erectile device revised or replaced. Overall, 80%-100% were satisfied with the outcomes.

[CONCLUSION] Erectile device insertion in AMAB individuals following phalloplasty for penile inadequacy is an acceptable and satisfying option to achieve rigidity for sexual intercourse. However, this is a challenging procedure associated with significant risks of complication.