(177) FUSED DOUBLE-CYLINDER PENILE PROSTHESIS PLACEMENT AFTER PHALLOPLASTY WITHOUT URETHRAL LENGTHENING: A NOVEL TECHNIQUE USING A 2-PIECE IPP

Abstract Introduction Transgender men (TM) undergoing phalloplasty commonly desire erections for sexual activity. All U.S. FDA-approved inflatable penile prostheses (IPPs) are designed for cisgender anatomy. There is no gold-standard IPP-insertion technique post-phalloplasty. For TM seeking phalloplasty who don’t prioritize urinating from their penis-tip, phalloplasty without urethral lengthening (P-UL) offers similar cosmetic and functional outcomes with significantly lower risk-profiles. Also, the absence of a neourethra within the shaft affords sufficient room for 2-cylinders, instead of just one. Objective To describe 1) Our technique for insertion of a 2-piece IPP in TM using a fused, double-cylinder technique, and 2) To evaluate our outcomes over a 6-year period. Methods 1) Retrospective, single-center chart review of TM undergoing IPP insertion post-phalloplasty over 6-years. 2) We illustrate our technique for placement of 2-piece AMS Ambicor™ IPP using 2-cylinders, for TM post-P-UL (URL: https://youtu.be/9u7MMP0li4g). Results 28 patients underwent 34 IPP-implants between April/2017-Oct/2023 (Mean Age = 40.8 years±13.8(SD). 17/28 (60.7%) patients underwent P + UL, and 11/28 (39.3%) underwent P-UL. All had ipsilateral testicle prosthesis implant beforehand. IPP implants used were AMS 700™ 3-piece (first 5/34 = 14.7%; all 1 cylinder), or AMS Ambicor™ 2-piece IPP (all subsequent 29/34 = 85.3%; [22/29 (76%) = 1 cylinder and 7/29(24%) = 2 cylinders). 2/34(5.9%) IPP’s required explant: infection, 1/38(2.9%); and traumatic-injury wound-dehiscence 3-weeks postoperatively: 1/38(2.9%). Our technique for 2-piece IPP insertion in TM after P-UL: (Fig. 1). Both cylinders fitted completely into a Dacron vascular graft is secured to Obturator ramus with 2-0 Ethibond sutures. The IPP pump fits into the explanted testicle site. Conclusions Our “2-cylinders in a single sock” technique has key advantages: 1. Pre-IPP ipsilateral testicle implant expands the neoscrotum, making a capsule-lined pocket to protect the pump; 2. The Dacron vascular-graft fuses and allows anchoring of both cylinders, increasing stability/reducing migration; 3. Two-cylinders yield a more symmetric-appearing, fuller erection (+17% erection girth); 4. Our small, 4-cm parascrotal incision provides adequate exposure, and maintains good cosmesis. The approach we describe here provides excellent functional and cosmetic results. Disclosure No.