Dynaflex prosthesis in total phalloplasty.

Because of the high rate of complications and because voiding while standing is a priority for most female-to-male transsexuals, until recently, I have refrained from implantation of a rigidity prosthesis in total phalloplasty. However, promising results have been obtained with self-contained Dynaflex hydraulic penile implants. The results and complications observed in my first five cases are reported in order to help prevent failure in future cases. I advocate implantation as a secondary procedure after the neophallus has gained sensitivity. The penile prosthesis should be covered by a Dacron prosthesis to ensure optimal encapsulation and collagen ingrowth. Since the neophallus girth will not allow for two prostheses to be implanted, and because properly serviceable crus penis is lacking in female-to-male transsexuals, I further advocate fixation of the one cylinder to the pubic symphysis. For insertion, the neoscrotal approach is superior. I maintain that combination of a neourethra and a rigidity prosthesis in one neophallus remains a challenge, both to the patient and to the surgeon.