Presentation Authors: Andrew Nimal Christopher*, Giulio Garaffa, David Ralph, London, United Kingdom
Introduction: Since 2001, 764 inflatable penile prostheses have been inserted into 550 distinct phalloplasties from 547 Female to male transsexual (FTM) patients from our database
Methods: Analysis was performed to see if there was any difference between the different devices used by using Kaplan-Meier survival curves and Log Rank Statistical analysis
Results: Device distribution was 398 AMS700CX, 337 Coloplast Titan, 20 AMS Ambicor, 8 AMS CXR and 1 AMS LGX. Initial infection rate was 7% in the first 2 months rising to 10% by the 1st year. Median survival to explant for any reason was 9.68 years with median follow-up of 4.22 years. Mechanical failure at 12 years was 50%. Until 2010 all prostheses were AMS devices but from 2010, Coloplast Titan devices were introduced. Subset analysis for inflatable prostheses from 2010 onwards was performed for comparative analysis. This subgroup consisted of 558 inflatable devices in 480 phalloplasties from 479 patients. Device distribution was 337 Coloplast Titan, 234 AMS700CX, 10 Ambicor, 6 AMS CXR and 1 AMS LGX. Median survival to explant for any reason was 8.47 years with median follow-up of 3.32 years. There was no statistically significant difference in time to explant (p=0.45) or infection ( p=0.9) between Titan and AMS700CX devices. There was however a significant difference in time to mechanical failure between the Titan and AMS700CX devices (p=0.0055, 80% vs 60% still functioning at 8 years) in favour of the Titan device. Further analysis revealed that this was specific to radial artery phalloplasty (RAP, CX=165, Titan=269) group with no statistical difference noted for the Pubic phalloplasty (PP, CX=65, Titan=49) and anterolateral thigh phalloplasty (ALT, CX=2, Titan=13) groups. It was noted that there was considerable delay between the time that mechanical failure was confirmed to when the device was explanted and replaced which would account for the explant rates not showing a difference between devices. Further analysis on the 20 Ambicor devices since 2001 revealed a mechanical failure rate of 60% at 7.7 years which is worse than the 3-piece devices.
Conclusions: It appears that the Titan device has better longevity from mechanical failure than the AMS700CX device at 8 years of follow-up in radial artery phalloplasty transsexual patients and that the Ambicor device has a higher mechanical failure than the 3 piece devices.