Indian Journal of Urology Users online:1117  
Home Current Issue Ahead of print Editorial Board Archives Symposia Guidelines Subscriptions Login 
Print this page  Email this page Small font sizeDefault font sizeIncrease font size

Year : 2008  |  Volume : 24  |  Issue : 1  |  Page : 107-108

Shah's Indian penile prosthesis placement after phallic reconstruction with radial forearm flap

1 Department of Urology, LTMMC and LTMGH, Sion, Mumbai, India
2 Lilavati Hospital and Research Centre, Bandra, Mumbai, India

Correspondence Address:
Sujata K Patwardhan
Department of Urology, College Building, R.No - 220, 2nd Floor, LTMMC and LTMGH, Sion, Mumbai - 400 022
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-1591.38613

Rights and Permissions


We report a successful implantation of Indian penile prosthesis after total phallic reconstruction. The differential stiffness of the Shah penile prosthesis is felt to have less potential for erosion, the most common complication of rigid prosthetic stiffening devices when used in a neo-phallus. This prosthesis is an alternative to the inflatable prosthesis in patients who choose a rigid prosthesis due to economical constraints.

Keywords: Neo-phallus, radial forearm flap, rigid penile prosthesis

How to cite this article:
Patwardhan SK, Shah R, Kulkarni V, Varma RR. Shah's Indian penile prosthesis placement after phallic reconstruction with radial forearm flap. Indian J Urol 2008;24:107-8

How to cite this URL:
Patwardhan SK, Shah R, Kulkarni V, Varma RR. Shah's Indian penile prosthesis placement after phallic reconstruction with radial forearm flap. Indian J Urol [serial online] 2008 [cited 2023 Mar 27];24:107-8. Available from:

   Introduction Top

Penile amputation is an uncommon injury resulting from self-mutilation, accidental trauma or felonious assault. [1] Phallic replacement is the treatment of choice, when the amputated segment is lost or nonviable. Microsurgical free radial forearm flap is the current mainstay of penile reconstruction therapy. [2]

We report a successful case report of placement of Shah's Indian penile prosthesis in a reconstructed penis using radial forearm flap.

   Case Report Top

A 21-year-old, unmarried, computer operator, had self-amputated his penis by using surgical blade after self-local anesthesia with Injection lignocaine in March 2005. As per history, patient held the penis responsible for weakness and his poor physique, hence decided to self-amputate the penis. The patient discarded the amputated segment. After six months of psychiatric therapy the patient opted for phallic reconstruction and underwent a radial forearm flap neo-phallus reconstruction. Patient presented to us after one year of surgery with a request for penile prosthesis implantation as he was planning to get married.

On examination, [Figure - 1] 1 inch of fibrotic corpora was palpable at the base of the penis and the rest of the palpable corpora (1 inch) was supple. He had mid-penile hypospadias, which could be calibrated up to 12 French. The neo-phallus had sensations of light touch and vibration. A Biomedical Biosthesiometer was not used to document tactile sensibility of the penis. The scrotal sac and both the testes were normal. Ultrasound of the perineum and abdomen revealed no evidence of fibrosis in the posterior crura and his post-void residual was nil. Psychiatric referral ruled out any active psychiatric illness.

After vertical penoscrotal skin incision, a cruciate incision was taken on the fibrotic anterior tip of the crura. The fibrosis of the anterior corpora was difficult to dilate, but was eventually possible using sharp dissection. This was then continued into the subcutaneous tissue in the forearm flap which was carefully dilated. A distal cushion of tissue measuring 1.5 cm was preserved. The posterior crura were serially dilated. WH 09 the Shah Indian penile prosthesis - (model WH09) - was selected for insertion. Length of prosthesis inserted was 17 cm with both sleeves peeled off to reduce the diameter of the implant from 13 mm to 9 mm (another unique feature of the Shah implant). Implant was not fixed to the any part of the neo-phallus or corpora. Urethral catheter was kept for seven days postoperatively. Patient was given intravenous antibiotics for seven days followed by oral cephalosporins for the next 14 days. Postoperatively, the patient had no complications [Figure - 2]. On five months follow-up patient had normally functioning prosthesis with no evidence of any graft infection/erosion.

   Discussion Top

Penile injury is a rare injury resulting from self-mutilation, accidental trauma or felonious assault. Though there are various methods of replacing nonviable penile tissue, microsurgical free radial forearm flap is the mainstay of penile replacement therapy. [2]

The goal of achieving reliable phallic rigidity has remained a challenge to surgeons till date. Bogoraz and Frumken first suggested the use of a stiffener and reported initial satisfaction with costal cartilage. [3] Goodwin and Scott used autogenous costal cartilage rods to substitute the corpora cavernosa. [3] Long-term results were not reported. Chang and Hwang incorporated a cartilage stiffener that could be removed to provide space for future prosthesis placement [2] . A successful osteocutaneous radial forearm flap using a portion of radial bone was reported with a 10-month follow-up. [3]

Autogenous materials like cartilage and bone fail to remain rigid because of resorption and do not provide a normal erectile angle.

Later, surgical innovations led to use of acrylic and silicon rods. The problems with their use were erosion, spontaneous dislodgment and poor concealibility. Jordan et al., created a neotunica with Goretex graft which acts a sleeve surrounding the actual implant. [4] The inflatable cylinder is ensheathed in the Gortex Sleeve.

The main problems in a rigid penile implant relate to ischemic damage due to chronic pressure and shear forces. This in turn leads to the dreaded complication of erosion. The Indian penile prosthesis is a differential rigidity implant and is made of implantable grade silicon of varying softness. The tip of the implant is soft and made of 25 shore A silicon - this minimizes the pressure on the tip of the neo-phallus and reduces the chances of pressure necrosis and erosion. The anterior shaft of the implant is 75 shore A, ensuring adequate stiffness. The central part of the implant acts as a hinge and is made of 25 shore A silicon - this flexibility at the hinge further helps reduce the axial pressure exerted by the implant. The posterior zone of the implant is of 50 shore A silicon and is narrow in diameter, allowing it to be placed even in fibrous crura.

In patients who cannot afford an inflatable device worth Rs. 2,25 lacs the Shah Indian penile prosthesis is an economical alternative. The malleable hinge and soft tip have less potential for erosion as compared to the malleable implant.

Long-term follow-up of this patient when he becomes sexually active will further validate the use of the Shah implant in a neo-phallus.

   Conclusion Top

Implantation with Indian penile prosthesis is a safe, affordable option in the Indian scenario if the patient cannot afford imported rigid or inflatable penile prosthesis.

   References Top

1.Jezior JR, Brady JD, Schlossberg SM. Management of penile amputation injuries. World J Surg 2001;25:1602-9.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Chang TS, Hwang WY. Forearm flap in one-stage reconstruction of the penis. Plast Reconstr Surg 1984;74:251-8.  Back to cited text no. 2  [PUBMED]  
3.Levine LA, Zachary LS, Gottliee LJ. Prosthesis placement after total phallic reconstruction. J Urol 1993;149:593-8.  Back to cited text no. 3    
4.Jordan GH, Alter GJ, Gilbert DA, Horton CE, Devine CJ Jr. Penile prosthesis implantation in total phalloplasty. J Urol 1994;152:410-4.  Back to cited text no. 4  [PUBMED]  


  [Figure - 1], [Figure - 2]

This article has been cited by
1 Re: Shah R. Twenty five years of the low cost, non-inflatable, Shah Indian prosthesis: The history of its evolution. Indian Journal of Urology 2021;37:113-5
GG Laxman Prabhu, P Venugopal
Indian Journal of Urology. 2021; 37(3): 299
[Pubmed] | [DOI]
2 Twenty-five years of the low-cost, noninflatable, Shah Indian penile prosthesis: The history of its evolution
Rupin Shah
Indian Journal of Urology. 2021; 37(2): 113
[Pubmed] | [DOI]
3 The Etiology and Treatment of the Softened Phallus after the Radial Forearm Osteocutaneous Free Flap Phalloplasty
Seok-Kwun Kim,Tae-Heon Kim,Jin-Il Yang,Myung-Hoon Kim,Min-Soo Kim,Keun-Cheol Lee
Archives of Plastic Surgery. 2012; 39(4): 390
[Pubmed] | [DOI]
4 The etiology and treatment of the softened phallus after the radial forearm osteocutaneous free flap phalloplasty
Kim, S.-K. and Kim, T.-H. and Yang, J.-I. and Kim, M.-H. and Kim, M.-S. and Lee, K.-C.
Archives of Plastic Surgery. 2012; 39(4): 390-396
5 Early and delayed management of penile injuries
Pechuho, T.A., Aslam, M., Abro, A., Qureshi, A.M., Chugtai, M.N.
Medical Forum Monthly. 2010; 21(12): 41-45


Print this article  Email this article
Previous article Next article


   Next article
   Previous article 
   Table of Contents
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (115 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

    Case Report
    Article Figures

 Article Access Statistics
    PDF Downloaded254    
    Comments [Add]    
    Cited by others 5    

Recommend this journal