Management of urethral strictures after masculinizing genital surgery in transgender men

Abstract

Transgender men undergoing phalloplasty and metoidioplasty have a high rate of urethral stricture. Evaluation of stricture includes evaluation of symptoms and uroflow, cystoscopy, and retrograde urethrogram. Important anatomic differences between the phallus of cis-gender and transgender men increase the likelihood and complexity of treating urethral strictures in transgender men after surgery. Urethral strictures after masculinizing procedures are more likely to require open surgical treatment and recur after treatment. There is a paucity of data, but less invasive options such as dilation and urethrotomy have had minimal success. Open surgical options with a variety of techniques, including one-stage and two-stage techniques, have higher success rates in treating strictures, but there is minimal comparative data on outcomes. We present a review on management options for urethral reconstruction in transgender men and our data on urethroplasty for these patients.

Keywords

Phalloplasty / urethroplasty / urethral stricture disease / gender-affirming surgery / metoidioplasty

References

[1] Santucci RA,Wise M.Male urethral stricture disease.J Urol2007;177:1667-74

[2] Monstrey S,Selvaggi G.Penile reconstruction: is the radial forearm flap really the standard technique?.Plast Reconstr Surg2009;124:510-8

[3] Ascha M,Morrison SD,Chen ML.Outcomes of single stage phalloplasty by pedicled anterolateral thigh flap versus radial forearm free flap in gender confirming surgery.J Urol2018;199:206-14

[4] Bettocchi C,Pryor JP.Pedicled pubic phalloplasty in females with gender dysphoria.BJU Int2005;95:120-4

[5] Djordjevic ML,Bizic M.Metoidioplasty as a single stage sex reassignment surgery in female transsexuals: Belgrade experience.J Sex Med2009;6:1306-13

[6] Doornaert M,Ceulemans P,Heylens G.Penile reconstruction with the radial forearm flap: an update.Handchir Mikrochir Plast Chir2011;43:208-14

[7] Rohrmann D.Urethroplasty in female-to-male transsexuals.Eur Urol2003;44:611-4

[8] Lumen N,Goessaert AS,Hoebeke P.Urethroplasty for strictures after phallic reconstruction: a single-institution experience.Eur Urol2011;60:150-8

[9] Hage JJ.Long-term outcome of metaidoioplasty in 70 female-to-male transsexuals.Ann Plast Surg2006;57:312-6

[10] Rooker SA,DiFilippo EC,Morrison SD.The rise of the neophallus: a systematic review of penile prosthetic outcomes and complications in gender-affirming surgery.J Sex Med2019;16:661-72

[11] Garaffa G,Christopher N.Total urethral construction with the radial artery-based forearm free flap in the transsexual.BJU Int2010;106:1206-10

[12] Salgado CJ, Nugent A, Hadeed J, et al. Two-stage prelaminated mucosal neourethra radial forearm flap phalloplasty for transgender men.Glob J Med Res2021;1:1-3

[13] Djordjevic ML,Kojovic V.Musculocutaneous latissimus dorsi flap for phalloplasty in female to male gender affirmation surgery.World J Urol2019;37:631-7

[14] Yıldırım ME,Ozyuvali E.The effectiveness of local steroid injection after internal urethrotomy to avoid recurrence.Arch Ital Urol Androl2016;87:295-8

[15] Levine LA.Urethroplasty following total phallic reconstruction.J Urol1998;160:378-82

[16] Bracka A.A versatile two-stage hypospadias repair.Br J Plast Surg1995;48:345-52

[17] Santucci RA,Aninch JWMC.Anastomotic urethroplasty for bulbar urethral stricture: analysis of 168 patients.J Urol2002;167:1715-9

[18] Verla W,Spinoit AF,Monstrey S.Excision and primary anastomosis for isolated, short, anastomotic strictures in transmen.Plast Reconstr Surg Glob Open2020;8:e2641 PMCID:PMC7159955

[19] Markiewicz MR,Barbagli G.Oral mucosa harvest: an overview of anatomic and biologic considerations.EAU-EBU Update Series2007;5:179-87

[20] Beamer MR,Shakir N.One or two stage buccal augmented urethroplasty has a high success rate in treating post phalloplasty anastomotic urethral stricture.Urology2021;156:271-8