Marko Bencic

Aim: One of the main goals of neophalloplasty is to provide the possibility of penetrative sexual intercourse. For individuals undergoing neophalloplasty, the implantation of malleable or inflatable penile prostheses is currently the main option for achieving reliable erectile function. The aim of this study was to assess surgical outcomes after the implantation of specially designed malleable and inflatable penile implants for transgender men, following musculocutaneous latissimus dorsi free flap neophalloplasty. Methods: Between January 2022 and January 2025, 20 transgender men underwent ZSI FTM 475 or ZSI FTM 100 penile prostheses insertion following musculocutaneous latissimus dorsi free flap neophalloplasty. The dorsal approach was used in all cases for prostheses insertion and plate fixation to the pubic periosteum. The space for the prosthesis was created in the neophallus, behind the muscle. For inflatable prostheses, the pump was placed into the left hemiscrotum and connected to the reservoir in the left inguinal region. Patient satisfaction was evaluated using the International Index of Erectile Function (IIEF). Results: The mean follow-up period was 21 months (range 4-36 months), and the mean interval between neophalloplasty and prosthesis implantation was 44 months (range 6-120 months). No intraoperative complications occurred. The most significant complication observed was fracture of the penile implant (n = 2, 10%). All patients who engaged in penetrative sexual intercourse reported satisfactory penetration, with a mean IIEF score of 21.1. Conclusion: These novel penile prostheses for transgender men demonstrate favorable surgical outcomes after latissimus dorsi neophalloplasty, with a high rate of patient satisfaction.

Introduction: Feminizing genitoplasty for congenital adrenal hyperplasia (CAH) includes clitoroplasty, vaginoplasty, urethroplasty and labioplasty. The aim is to achieve normal female anatomy without compromising sexual function. We present our technique and outcomes of reduction clitoroplasty. Methods: A total of 21 patients with CAH, aged from 13 months to 24 years (median 16 months), underwent feminizing genital reconstruction in our center between January 2011 and December 2020. Surgical treatment included reduction clitoroplasty and labioplasty, with or without urethroplasty and vaginoplasty. Clitoroplasty was performed by complete disassembly of the clitoris into glans with neurovascular bundle and cavernosal bodies. Glans CAP was separated from the tips of the cavernosal bodies, avoiding injury of the arteries that run lateroventrally. Cavernosal bodies were completely removed, followed by glans reconstruction and reassembly of all entities, to attain normal clitoral morphology. For hypothesis testing, we used the Mann-Whitney test and Fisher's exact test. Results: Follow-up ranged from 44 to 162 months (median 84 months). An excellent aesthetic outcome with normal appearance of the genitalia was achieved in all cases. Five patients (24%) reached puberty, and all have regular menstrual cycle. Postoperative complications were observed in 5 (24%) cases. No correlation was found between complications and age at the time of surgery (p=0.131) or duration of surgery (p=0.136). Conclusion: Reduction clitoroplasty by clitoral disassembly presents a good choice for clitoromegaly repair in patients with CAH. This approach leaves the neurovascular bundle intact and completely preserves the glans CAP and urethral plate blood supply. Long-term follow-up is necessary for the evaluation of sensation and sexual function.

INTRODUCTION AND OBJECTIVE:Isolated male epispadias is one of the most serious congenital genital anomalies that require surgical correction. The objective of the surgery is to facilitate normal vo...

Isolated male epispadias is one of the most severe congenital genital anomalies that require surgical correction. The goals of the surgery are to reach good aesthetic and functional outcomes. The aim of this retrospective study was to analyze the long-term outcomes of surgical reconstruction of male epispadias. A total of 31 patients with a mean age of 17 years, who underwent surgical repair of isolated male epispadias from January 2000 to January 2015, were involved. The main outcome measures were defined as: aesthetic outcome, continence, postoperative complications, sexual function, and quality of life. The follow-up period ranged from 8 to 23 years, with an average of 14.4 years. Each patients underwent an average of 2.2 surgical procedures in this period. The most common postoperative complications were urethral fistula and residual curvature, in 22.6% and 12.9%, respectively. Satisfactory aesthetic outcome was reported in 71.4% of cases. The repair of male epispadias usually includes more than two procedures with satisfactory aesthetic outcome. Unsolved urinary incontinence remains a significant issue and has a high impact on the quality of life. Follow-up should be extended even after complete sexual maturity. Comprehensive long-term evaluation is necessary for proper treatment of isolated epispadias.