Urethral complications after female to male gender reassignment surgery

For over 98% of patients seeking female to male gender confirmation surgery, one of the more important goals is to void from a standing position. This involves construction of a neourethra with either a phalloplasty or... [ view full abstract ]

For over 98% of patients seeking female to male gender confirmation surgery, one of the more important goals is to void from a standing position. This involves construction of a neourethra with either a phalloplasty or metoidioplasty. Complications from neourethral construction are common (37%-61%), and are usually occur at anastomotic sites.

We aim to examine and understand the basis for complications following female to male gender reassignment surgery in order to improve outcomes of salvage reconstruction. [ view full abstract ]

We aim to examine and understand the basis for complications following female to male gender reassignment surgery in order to improve outcomes of salvage reconstruction.

Retrospective analysis of consecutive patients who presented to our institutions from August 2013 to October 2016 for salvage reconstruction after urethral complications of adult female to male gender-reassignment surgery were... [ view full abstract ]

Retrospective analysis of consecutive patients who presented to our institutions from August 2013 to October 2016 for salvage reconstruction after urethral complications of adult female to male gender-reassignment surgery were identified and reviewed. Patient demographics, clinical presentation, pre- and intraoperative findings and pathologic data are reported.

This is a descriptive study, we did not have pre-identified outcomes [ view full abstract ]

This is a descriptive study, we did not have pre-identified outcomes

22 patients were included in the study. The average age at presentation of complication was 32.5 years (17-54), and 3.7 months (1-12) after gender reassignment surgery. The initial reconstruction was more often phalloplasty... [ view full abstract ]

22 patients were included in the study. The average age at presentation of complication was 32.5 years (17-54), and 3.7 months (1-12) after gender reassignment surgery. The initial reconstruction was more often phalloplasty versus metoidoplasty. Patient presented with urinary retention, 13 required suprapubic catheter, 4 with urethral self-calibration and 3 with perineal urethrostomy.
The most common preoperative findings were neourethral stricture in 86%, cutaneous fistulization 68%, and anastomotic leak from the native urethral opening to a pelvic cavity 45%.
Fistula repair required buccal mucosa in 60% of cases, with rotational local tissue flaps. In 9 patients a second surgery was necessary, and required mobilization of large thigh flaps for additional coverage.
Intraoperatively, a vaginal remnant was identified in 63%, despite history of vaginectomy. Neourethral in 82% of patients, the majority had isolated anastomotic strictures. 40% of patients with strictures had obliteration of the entire urethra and many had concurrent meatal stenosis. 92% of urethral stricture cases required buccal mucosa, and 13% of patients required a perineal urethrostomy for staged repair.
In total 92% of patients had at least two complications following transgender surgery: neourethral stricture, remnant vagina, urethrocutaneous fistula, or meatal stenosis.

The majority of patients with urethral complications after adult female to male gender reassignment surgery will have multiple concurrent pathologies. Distal obstruction by a neourethral stricture may predispose to... [ view full abstract ]

The majority of patients with urethral complications after adult female to male gender reassignment surgery will have multiple concurrent pathologies. Distal obstruction by a neourethral stricture may predispose to fistulization proximal to the anastomosis causing urethrocutaneous fistula and dilation of previously obliterated vaginal cavity. Most patients will have more than one problems. These findings are important in understanding of the complex nature of the urinary complications after female to male gender reassignment, and for planning salvage reconstruction in these patients.