PS-7-15 Novel Classification of Urethral Complications in Female to Male Gender Affirming Surgery

Abstract

Penile reconstruction (phalloplasty) can ameliorate the psychological distress and suicide risk of transgender men. Surgery is challenging, and urethral complications occur in up to 75% of patients. The use of free flap microsurgical reconstruction with “tube-in-tube” urethra have improved outcomes but there is no accepted gold standard. Debate continues on immediate (during phalloplasty) compared to staged urethral join-up. A classification system was developed for urethral complications to improve reporting, classification and understanding of this common adverse outcome. All men undergoing phalloplasty in the United Kingdom over three consecutive years (2014 - 2016) were included. Data were extracted retrospectively from a prospective database following urethral construction by radial forearm free flap urethroplasty or radial forearm or anterolateral thigh (free or pedicled) flap phalloplasty with “tube-in-tube” urethra. Phalloplasty was staged: 1) construction of a phallus, 2) glansplasty and urethral lengthening (anastomosis of the phallic urethra to the native urethra) with or without hysterectomy, bilateral salpingo-oopherectomy and vaginectomy, 3) insertion of an erectile device and testicular prosthesis. The rate, timing and management of urethral complications were collated.