Clinical Scorecard: Outcomes Reported by Patients Following One-Stage Neourethral Reconstruction in Transgender Men with Strictures and Fistulas Related to Phalloplasty

At a Glance

Key Highlights

• Urethral strictures and fistulas occur in 14–60% of transgender men post-phalloplasty, with 94–96% requiring revision surgeries
• Surgical techniques include excision and primary anastomosis, buccal mucosal graft augmentation, and modified flap techniques tailored intraoperatively
• Patient-reported outcomes and functional results are critical to assessing surgical success and guiding perioperative management

Guideline-Based Recommendations

Diagnosis

• Preoperative evaluation with combined retrograde urethrography and voiding cystourethrography to locate and measure strictures
• Uroflowmetry and urine culture to exclude infection prior to surgery
• Stricture recurrence defined by symptomatic need for intervention or imaging evidence

Management

• Surgical reconstruction performed at least three months after phalloplasty or last urethral intervention
• Use of 18-French Foley catheter postoperatively; suprapubic tube placement at surgeon's discretion
• Single intravenous dose of cefuroxime 1.5 g administered at surgery start
• Hormonal therapy continued perioperatively without interruption
• Choice of surgical technique based on intraoperative findings including tissue availability and scar extent

Monitoring & Follow-up

• Postoperative clinical check-ups with voiding cystourethrography approximately 21 days after catheter removal
• Uroflowmetry and clinical examination during follow-up visits
• Monitoring for 30-day complications using Clavien-Dindo classification

Risks

• High recurrence rates of strictures and fistulas necessitating multiple revision surgeries
• Complications influenced by prior surgical scarring and tissue vascularity
• Potential for urinary retention requiring suprapubic tube placement

Patient & Prescribing Data

Transgender men undergoing one-stage neourethral reconstruction for distal urethral strictures and fistulas post-phalloplasty

Perioperative management follows standardized protocols aligned with WPATH; hormonal therapy is maintained; antibiotic prophylaxis is routinely administered; surgical approach individualized based on intraoperative assessment

Clinical Best Practices

• Perform urethral reconstruction at least three months after phalloplasty or last urethral surgery to optimize healing
• Use combined imaging modalities preoperatively for precise stricture assessment
• Maintain hormonal therapy perioperatively to avoid disruption of patient care
• Administer perioperative antibiotic prophylaxis to reduce infection risk
• Tailor surgical technique intraoperatively considering tissue availability and prior interventions
• Implement structured postoperative follow-up with imaging and uroflowmetry to detect recurrence early
• Engage multidisciplinary teams in high-volume centers for optimal surgical outcomes

References

• World Professional Association for Transgender Health (WPATH) Standards of Care