PD22-02 SURGICAL OUTCOMES OF URETHRAL REVISION SURGERY AFTER GENDER AFFIRMING, SINGLE STAGE RADIAL FOREARM PHALLOPLASTY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II (PD22)1 Sep 2021PD22-02 SURGICAL OUTCOMES OF URETHRAL REVISION SURGERY AFTER GENDER AFFIRMING, SINGLE STAGE RADIAL FOREARM PHALLOPLASTY Mang Chen, Amanda Chi, Brad Figler, Rachel Moses, Bauback Safa, and Andrew Watt Mang ChenMang Chen More articles by this author , Amanda ChiAmanda Chi More articles by this author , Brad FiglerBrad Figler More articles by this author , Rachel MosesRachel Moses More articles by this author , Bauback SafaBauback Safa More articles by this author , and Andrew WattAndrew Watt More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002011.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral strictures and fistulas are common after gender affirming phalloplasty with urethral lengthening. We report our experience in urethroplasty and fistula repairs after single stage radial forearm (RF) free flap phalloplasty. METHODS: We retrospectively reviewed a high volume, single center database of 128 transmen who underwent index, single stage RF phalloplasty between October 2017 and January 2021. Urethral fistulas and strictures were characterized by repair technique, length, and location, which is further categorized as the pars pendulans (PP) urethra, pars pendulans-pars fixa (PP-PF) urethral anastomosis, and pars fixa (PF) urethra. RESULTS: In total, 25% (32/128) of patients with a median follow up of 21.5 months needed urethral revision surgery for solitary fistula (3/128), stricture (21/128), and combination stricture and fistula (8/128). Solitary fistulas developed at the PP-PF (1), PF (1), and PF-native urethra anastomosis (1). These were repaired in one stage using fistula tract excision, primary urethral closure, and dermal autograft interposition without evidence of recurrence. Remaining fistulas were successfully repaired at time of urethroplasty. Strictures developed in 29 patients and were identified in the distal PP (4), PP-PF (18), and PF (12) urethra, with a mean length of 1.4cm (range 0.5 mm-3 cm); 6 patients had more than 1 stricture. Urethroplasty techniques utilized include staged Johanson (4), Heineke-Mikulicz (HM) (18), excision and primary anastomosis (3), and substitution (10) urethroplasty—with 8 patients needing buccal mucosal graft (BMG), and 2 needing split thickness skin grafts. Of the 29 patients undergoing stricture repair, 8 (28%) developed recurrent strictures requiring additional substitution (3) and HM (4) urethroplasty, and dilation (1). Two of the 8 (25%) required a third urethral intervention. No patients required a perineal urethrostomy, and no fistula recurrences were seen in those that needed simultaneous fistula repair. CONCLUSIONS: In a single center series of gender affirming RF phalloplasty, 25% of patients developed urethral strictures and/or fistulas requiring urethral revision, most frequently at the PP-PF anastomosis. Urethroplasty and fistula repair was successful in 75% of patients. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e380-e380 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mang Chen More articles by this author Amanda Chi More articles by this author Brad Figler More articles by this author Rachel Moses More articles by this author Bauback Safa More articles by this author Andrew Watt More articles by this author Expand All Advertisement Loading ...