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.
Highlights
Phalloplasty and metoidioplasty are technically challenging masculinizing genital surgeries for transgender men
In the first stage of urethral reconstruction after the musculocutaneous latissimus dorsi (MLD), local flaps including from the labia or from tissue available from a metoidioplasty were used to lengthen the urethra to reach the middle of the neophallus, and in the second stage, buccal mucosa was used to lengthen the urethra distally
To evaluate the urethra proximal to the stricture or the presence of complicating factors such as a fistula or vaginal remnant, we have found a retrograde urethrogram (RUG) and/or voiding cystourethrogram to be critical prior to corrective surgery
Summary
Phalloplasty and metoidioplasty are technically challenging masculinizing genital surgeries for transgender men. The reasons for the high rate of stricture disease after metoidioplasty and phalloplasty are numerous and involve the complex anatomy of the neo-urethra. We will address the magnitude, etiology, treatment options and outcomes for urethral stricture disease after metoidioplasty and for phalloplasty in patients undergoing gender affirmation surgery and describe our experience with managing these complex patients.
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