Outcomes of One-Stage Neourethral Reconstruction in Transgender Men Post-Phalloplasty

Overview

This study evaluates surgical and patient-reported outcomes following one-stage neourethral reconstruction for urethral strictures and fistulas in transgender men after phalloplasty. It highlights the effectiveness of various surgical techniques and the impact on patient satisfaction within a homogenous cohort.

Background

Gender-affirming surgeries, including phalloplasty, are critical for transgender men to align physical characteristics with gender identity. Urethral complications such as strictures and fistulas are common after phalloplasty, occurring in 14–60% of patients and often requiring revision surgeries. These complications significantly affect quality of life and patient satisfaction. Despite advances, there is a lack of standardized guidelines and high-quality data on optimal surgical management and patient-centered outcomes.

Data Highlights

The study retrospectively analyzed transgender men undergoing urethral reconstruction between December 2017 and April 2023, excluding those under 18 and certain phalloplasty types. Surgical techniques included excision and primary anastomosis, buccal mucosal graft augmentation, and modified flap techniques. Postoperative follow-up involved clinical exams, uroflowmetry, and voiding cystourethrography to assess functional outcomes and stricture recurrence. Stricture recurrence was defined by symptomatic need for intervention or imaging evidence.

Key Findings

• Urethral strictures and fistulas remain frequent complications after phalloplasty, necessitating revision surgeries in the majority of cases.
• One-stage neourethral reconstruction using tailored surgical techniques based on intraoperative findings showed promising functional outcomes.
• Patient-reported outcomes were collected and analyzed for the first time in this homogenous cohort, emphasizing the importance of patient satisfaction.
• Standardized perioperative management following WPATH guidelines, including continuation of hormonal therapy, was feasible and safe.
• Postoperative imaging and uroflowmetry are critical for early detection of stricture recurrence and guiding further management.

Clinical Implications

Clinicians should consider individualized surgical approaches for urethral reconstruction in transgender men with strictures or fistulas post-phalloplasty, guided by intraoperative assessment and patient history. Incorporating patient-reported outcomes into routine care can enhance understanding of surgical success beyond anatomical repair. Adherence to standardized perioperative protocols supports optimal recovery and functional results.

Conclusion

One-stage neourethral reconstruction in transgender men with phalloplasty-related urethral complications can achieve favorable surgical and patient-reported outcomes. Further research is needed to establish standardized guidelines and optimize long-term results.

References

1. Source Article 2024 -- Outcomes Reported by Patients Following One-Stage Neourethral Reconstruction in Transgender Men