Rigi10™ Malleable Penile Prosthesis
Definition
A neophallus is a surgically constructed penis, created through a complex procedure known as phalloplasty. This procedure typically involves harvesting a flap of tissue, including skin, subcutaneous tissue, nerves, and blood vessels, from a donor site on the patient’s body, such as the forearm (radial forearm free flap) or thigh (anterolateral thigh flap).3 This flap is then meticulously shaped and transferred to the genital area to form the new penis. The primary purpose of creating a neophallus is to enable male-typical urination (voiding while standing, if urethral lengthening is performed), achieve an aesthetic appearance consistent with a natal penis, and allow for tactile and erogenous sensation, as well as penetrative sexual function, often with the subsequent insertion of a penile prosthesis.2,3 Initially, the neophallus construction may focus on the shaft, with additional staged procedures potentially required for creating the glans (head), extending the urethra (urethroplasty), creating a scrotum (scrotoplasty), and implanting erectile devices.3
Clinical Context
A neophallus is most commonly created as a central component of gender-affirming surgery for transmasculine individuals seeking to align their physical characteristics with their male gender identity.3 It is also utilized in reconstructive urology for cisgender men who have experienced penile loss due to trauma, cancer, or congenital anomalies. Patient selection for phalloplasty is a rigorous process, involving comprehensive physical health assessments and mental health evaluations, often requiring letters of support from qualified mental health professionals, particularly in the context of gender affirmation.3
The surgical creation of a neophallus via phalloplasty is a highly specialized and lengthy procedure, typically lasting 8-10 hours or more, and may be performed in multiple stages over a period of 12 to 18 months to allow for adequate healing and to address different aspects of construction (e.g., shaft creation, urethroplasty, glansplasty, scrotoplasty, and penile prosthesis implantation).3 Common donor sites for the tissue flap include the radial forearm free flap (RFFF), known for generally good cosmetic outcomes and sensory potential, and the anterolateral thigh flap (ALTFF), which can offer greater penile length and less conspicuous donor site scarring.3
Expected outcomes include the creation of a neophallus that is aesthetically male-typical and allows for standing urination (if urethroplasty is successful).3 While tactile sensation in the neophallus is typically reduced compared to the donor tissue or a natal penis, a significant majority of individuals (over 90%) report experiencing some degree of tactile sensitivity, and over 88% report erogenous sensation.1 Sensory recovery is a gradual process and can improve over time.1 Penile prostheses (inflatable or malleable) can be implanted to provide rigidity for penetrative sexual intercourse; however, this carries a notable risk of complications, with one systematic review finding that 36.2% of patients experienced a prosthesis-related complication, though 83.9% reported achieving penetration.2 Overall satisfaction with the neophallus appearance and function is generally high among patients.3