What does this research mean for the field?

A novel fused double-cylinder technique using a 2-piece inflatable penile prosthesis in transgender men post-phalloplasty without urethral lengthening provides enhanced cylinder stability, fuller erections, and minimal scarring with a low explant rate. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

Describe a novel technique for two-piece inflatable penile prosthesis (IPP) insertion using a fused double-cylinder method in transgender men post-urethral lengthening.

June 6, 2026

(437) Fused Double-Cylinder Penile Prosthesis Placement After Phalloplasty Without Urethral Lengthening: A Novel Technique Using A 2-Piece IPP

Key Points

Describe a novel technique for two-piece inflatable penile prosthesis (IPP) insertion using a fused double-cylinder method in transgender men post-urethral lengthening.
Retrospective chart review of transgender men undergoing IPP insertion post-phalloplasty over 6 years.
Included 28 patients with a mean age of 40.8 years; 11 had phalloplasty without urethral lengthening.
Technique involves fitting two cylinders in a Dacron vascular graft secured in the neoscrotal pocket.
34 IPP implants performed, with 2 requiring explantation (5.9%) due to infection and traumatic injury.
The technique provided enhanced neoscrotal pocket formation and improved stability with a 17% increase in girth.
Minimal scarring was noted, indicating successful aesthetic and functional outcomes.

Abstract

Abstract Introduction Transgender men (TM) undergoing phalloplasty often desire erectile function, typically achieved via inflatable penile prosthesis (IPP) insertion. All U.S. FDA-approved IPPs are designed for cisgender male anatomy, and there is no standardized technique for IPP placement in TM post-phalloplasty. For patients not prioritizing voiding from the penile tip, phalloplasty without urethral lengthening (P-UL) offers favorable cosmetic and functional results with a lower complication rate. A short distal urethra (1.5 cm) provides a natural appearance. Additionally, testicular prosthesis implantation during Stage 1 phalloplasty creates a capsule-lined pocket ideal for housing the IPP pump later. Without a neourethra in the shaft, space allows for dual-cylinder insertion, improving prosthetic performance. Objective Our specific aims are: 1. Describe a novel technique for two-piece IPP insertion using a fused double-cylinder method in TM post P-UL. 2. Report clinical outcomes over a six-year period. Methods Retrospective chart review of TM undergoing IPP insertion post-phalloplasty at our center over 6-years. 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 phalloplasty with urethral lengthening, and 11/28 (39.3%) had P-UL. All had ipsilateral testicle prosthesis implant beforehand. IPP implants were with the 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 for traumatic-injury wound-dehiscence 3-weeks post-op: 1/38(2.9%). Our technique for 2-piece IPP insertion in TM after P-UL with both cylinders fitted completely into a Dacron vascular graft, which is secured to Obturator ramus with 2-0 Ethibond sutures. The IPP pump fits into the explanted testicle site. Conclusions This method offers multiple advantages: enhanced neoscrotal pocket formation, improved cylinder stability, fuller/symmetric erection (+17% girth), and minimal scarring. It represents a promising approach for optimal functional and aesthetic outcomes in TM post-phalloplasty. Further multi-center studies are recommended. Disclosure No

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