Prosthetics: Erectile Implant, Testicular Implants

Erectile ability is a common goal for transgender men seeking phalloplasty, which necessitates prosthesis placement in most phalloplasty techniques. In the absence of preexisting corpora, implant placement is associated with increased risk of poor proximal fixation, device migration, distal erosion, and neurovascular compromise, infection, and malfunction. Modifications to conventional surgical technique, such as avoidance of critical structures, proximal prosthesis anchoring, and distal cushioning with vascular or synthetic grafts, are common techniques to address anatomic challenges. Further training for urologic surgeons, technical optimization of procedures, and development of standardized outcome measures are important future developments in prosthesis surgery for transgender men. This chapter describes the current state of penile and testicular implant surgery for transmasculine patients.