PD31-10 NOVEL CLASSIFICATION OF URETHRAL COMPLICATIONS IN FEMALE TO MALE GENDER AFFIRMATION SURGERY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II (PD31)1 Sep 2021PD31-10 NOVEL CLASSIFICATION OF URETHRAL COMPLICATIONS IN FEMALE TO MALE GENDER AFFIRMATION SURGERY Wai Gin Lee, Virginia Li, David Ralph, and Nim Christopher Wai Gin LeeWai Gin Lee More articles by this author , Virginia LiVirginia Li More articles by this author , David RalphDavid Ralph More articles by this author , and Nim ChristopherNim Christopher More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002032.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Genital gender affirmation surgery (GAS) is challenging, and urethral complications are common. The use of free flap phallus construction with integrated urethra have improved outcomes but there is no accepted gold standard. Debate also continues on immediate versus staged urethral lengthening (anastomosis of phallus to native urethra). We propose a classification system for urethral complications to improve reporting, classification and management of this common adverse outcome. METHODS: All transgender men undergoing any phalloplasty including free flap urethroplasty, with staged urethral lengthening, in the United Kingdom over five consecutive years (2014–2019) were retrospectively included. The incidence, timing and management of urethral complications were extracted from a prospective database. Types of phalloplasty include forearm flap, anterolateral thigh flap and abdominal flap. RESULTS: Three hundred and seventeen men with median follow-up of 4.3 years (interquartile range 3.6–5.0 years) were included. Almost half of patients (43.5%) developed a urethral complication (fistula, stricture, severe post-micturition dribbling or urethral hair/stone); most commonly fistulas (49%) followed by strictures (37.6%). Forty-four patients (12.4%) developed more than one complication. The location was in the phallus (flap-related) (72.2%) followed by scrotal and perineal urethra. Repairs before and during routine second stage urethral lengthening were mostly for phallus (88.4%) complications comprising fistulas and strictures (99.1%). Strictures were more common than fistulas after urethral lengthening compared to before (p<0.001). Urethral hair, stones and post-micturition dribble were also more common. Staging the urethral lengthening allowed 60% of men to be asymptomatic while awaiting routine repair. CONCLUSIONS: The largest series of patients to date suggests that urethral complications continue to be common following transgender phalloplasty and are mostly phallus or flap related. The nature of urethral complications change depending on the stage of genital GAS and should be classified based on type, location and timing of occurrence. This standardises reporting and will help guide the approach for surgical correction. For example, complications in the phallus urethra relate to an issue with the free flap and therefore require a different approach compared to complications following urethral lengthening. A majority of complications occur prior to urethral lengthening and can be repaired routinely at the time. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e542-e542 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wai Gin Lee More articles by this author Virginia Li More articles by this author David Ralph More articles by this author Nim Christopher More articles by this author Expand All Advertisement Loading ...