Fistula

Penis

Phalloplasty

Surgery

Urethral stricture

Urethra

Urinary Fistula

Perioperative

Medicine

The Journal of Urology

No AccessJournal of UrologyAdult Urology1 Jul 2020Functional Outcomes and Urological Complications after Genital Gender Affirming Surgery with Urethral Lengthening in Transgender Men H. Veerman, F. P. W. de Rooij, M. Al-Tamimi, B. L. Ronkes, M. G. Mullender, M. B. Bouman, W. B. van der Sluis, and G. L. S. Pigot H. VeermanH. Veerman *Correspondence: Department of Urology, Amsterdam University Medical Centers, location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands telephone: +34634092283; E-mail Address: [email protected] Department of Urology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands More articles by this author , F. P. W. de RooijF. P. W. de Rooij Department of Urology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands More articles by this author , M. Al-TamimiM. Al-Tamimi Department of Plastic Surgery, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands More articles by this author , B. L. RonkesB. L. Ronkes Department of Plastic Surgery, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands More articles by this author , M. G. MullenderM. G. Mullender Department of Plastic Surgery, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands More articles by this author , M. B. BoumanM. B. Bouman Department of Plastic Surgery, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands More articles by this author , W. B. van der SluisW. B. van der Sluis Department of Plastic Surgery, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands More articles by this author , and G. L. S. PigotG. L. S. Pigot Department of Urology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000795AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We determined the urological complications and lower urinary tract function after genital gender affirming surgery with urethral lengthening in transgender men. Materials and Methods: A single center, retrospective cohort study was performed from January 2013 to January 2018. Patient demographics, medical history, perioperative data, surgical and urological complications, and preoperative and postoperative urological outcomes were obtained. Results: Of the 63 patients included in the study 8 (13%) underwent metoidioplasty and 55 (87%) phalloplasty, comprised of 27 (43%) free radial forearm flap, 19 (30%) anterolateral thigh flap and 9 (14%) superficial circumflex iliac artery perforator flap surgeries. In phalloplasty the types of urethral lengthening were tube-in-tube free radial forearm flap in 27 (49%), free radial forearm flap (second fasciocutaneous flap) in 18 (33%), superficial circumflex iliac artery perforator flap in 5 (9%) or labial in 5 (9%). Mean followup was 23 months (range 12 to 71). Stricture formation occurred in 35 (63%) phalloplasty and 5 (63%) metoidioplasty cases. Urethral fistula formation occurred in 15 (27%) phalloplasty and 4 (50%) metoidioplasty cases. Mean time to strictures and fistulas was approximately 3 months. Overall 46 (73%) patients needed revision surgery because of fistulas/strictures. After treatment 44 (70%) patients were able to void from the tip of the phallus. No clinically relevant differences in International Prostate Symptom Scores, frequency volume charts and uroflowmetry were found preoperatively vs postoperatively. Conclusions: Genital gender affirming surgery with urethral lengthening is a complex procedure with a high complication rate. After treating complications no clinically relevant differences in urological functioning were recorded. The majority of transgender men could void from the tip of the penis and showed favorable urological outcomes. References 1. : Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgend 2011; 13: 165. Google Scholar 2. : Double flap phalloplasty in transgender men: surgical technique and outcome of pedicled anterolateral thigh flap phalloplasty combined with radial forearm free flap urethral reconstruction. Microsurgery 2017; 37: 917. 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Google Scholar 11. : Urologic complications after phalloplasty or metoidioplasty. Clin Plast Surg 2018; 45: 425. Google Scholar 12. : Phalloplasty: a review of techniques and outcomes. Plast Reconstr Surg 2016; 138: 594. Google Scholar 13. : Quality of life and sexual health after sex reassignment surgery in transsexual men. J Sex Med 2011; 8: 3379. Google Scholar 14. : Effectiveness of preoperative depilation of the urethral donor site for phalloplasty: neourethral hair growth and its effects on voiding. Eur Urol Focus 2019; doi: 10.1016/j.euf.2019.04.005. Crossref, Google Scholar 15. : Colpectomy significantly reduces the risk of urethral fistula formation after urethral lengthening in transgender men undergoing genital gender affirming surgery. J Urol 2018; 200: 1315. Link, Google Scholar 16. : Labial ring flap: a new flap for metaidoioplasty in female-to-male transsexuals. J Plast Reconstr Aesthet Surg 2008; 63: 318. Google Scholar 17. : Scrotal reconstruction in female-to-male transsexuals: a novel scrotoplasty. Plast Reconstr Surg 2009; 123: 1710. Google Scholar 18. : Urethral lengthening in metoidioplasty (female-to-male sex reassignment surgery) by combined buccal mucosa graft and labia minora flap. Urology 2009; 74: 349. Google Scholar 19. : Smith & Tanagho’s General Urology, 18th ed.New York: McGraw-Hill, Inc. 2013; p 171. Google Scholar 20. : Urethral complications after transgender phalloplasty: strategies to treat them and minimize their occurrence. Clin Anat 2018; 31: 187. Google Scholar 21. : Urethroplasty for strictures after phallic reconstruction: a single-institution experience. Eur Urol 2011; 60: 150. Google Scholar 22. : An overview of female-to-male gender-confirming surgery. Nat Rev Urol 2017; 14: 486. Google Scholar 23. : Phalloplasty with urethral lengthening: addition of a vascularized bulbospongiosus flap from vaginectomy reduces postoperative urethral complications. Plast Reconstr Surg 2017; 140: 551e. Google Scholar No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySmith J (2020) This Month in Adult UrologyJournal of Urology, VOL. 204, NO. 1, (1-3), Online publication date: 1-Jul-2020. Volume 204Issue 1July 2020Page: 104-109Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsgender dysphoriasex reassignment procedurespostoperative complicationslower urinary tract symptomsMetricsAuthor Information H. Veerman Department of Urology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands *Correspondence: Department of Urology, Amsterdam University Medical Centers, location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands telephone: +34634092283; E-mail Address: [email protected] More articles by this author F. P. W. de Rooij Department of Urology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands More articles by this author M. Al-Tamimi Department of Plastic Surgery, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands More articles by this author B. L. Ronkes Department of Plastic Surgery, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands More articles by this author M. G. Mullender Department of Plastic Surgery, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands More articles by this author M. B. Bouman Department of Plastic Surgery, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands More articles by this author W. B. van der Sluis Department of Plastic Surgery, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands More articles by this author G. L. S. Pigot Department of Urology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands More articles by this author Expand All No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement Loading ...

Functional Outcomes and Urological Complications after Genital Gender Affirming Surgery with Urethral Lengthening in Transgender Men