A Novel Technique of Urethroplasty Could Reduce Urethra-Related Complications in Phalloplasty With Urethral Lengthening

Hong Gao, MD; Dan Wu, MD; Xiangjing Kong, MD; Lie Zhu, MD; Xiang Jie, MD; Wenjun Zhang, MD; Zheyuan Hu, MD; Xiaohai Zhu, MD

Sexual Medicine (Dec 2022)

A Novel Technique of Urethroplasty Could Reduce Urethra-Related Complications in Phalloplasty With Urethral Lengthening

Hong Gao, MD,
Dan Wu, MD,
Xiangjing Kong, MD,
Lie Zhu, MD,
Xiang Jie, MD,
Wenjun Zhang, MD,
Zheyuan Hu, MD,
Xiaohai Zhu, MD

Affiliations

Hong Gao, MD: Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital (Chang Zheng Hospital) of Naval Medical University, Huangpu District, Shanghai, China.
Dan Wu, MD: Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital (Chang Zheng Hospital) of Naval Medical University, Huangpu District, Shanghai, China.
Xiangjing Kong, MD: Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital (Chang Zheng Hospital) of Naval Medical University, Huangpu District, Shanghai, China.
Lie Zhu, MD: Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital (Chang Zheng Hospital) of Naval Medical University, Huangpu District, Shanghai, China.
Xiang Jie, MD: Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital (Chang Zheng Hospital) of Naval Medical University, Huangpu District, Shanghai, China.
Wenjun Zhang, MD: Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital (Chang Zheng Hospital) of Naval Medical University, Huangpu District, Shanghai, China.
Zheyuan Hu, MD: Corresponding Authors: Xiaohai Zhu, MD, Zheyuan Hu, MD, Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital (Chang Zheng Hospital) of Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China; Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital (Chang Zheng Hospital) of Naval Medical University, Huangpu District, Shanghai, China.
Xiaohai Zhu, MD: Corresponding Authors: Xiaohai Zhu, MD, Zheyuan Hu, MD, Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital (Chang Zheng Hospital) of Naval Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China; Department of Plastic and Reconstructive Surgery, Second Affiliated Hospital (Chang Zheng Hospital) of Naval Medical University, Huangpu District, Shanghai, China.

Journal volume & issue: Vol. 10, no. 6
p. 100571

Abstract

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Introduction: Urethral lengthening in phalloplasty could bring many postoperative complications, such as urethra fistula and stricture, which greatly affects the patient's mental health and quality of life. Aim: To describe a novel technique of vaginal mucosal graft for prelamination urethra (VMGPU) combined with modified urethral anastomosis (MUA) for the reconstruction of a neourethra. Methods: A retrospective study of transgender men between January 2006 and March 2021 was conducted. Patients were divided into three groups according to the surgical methods : traditional group（TG，VMGPU group（VG） and VMGPU+MUA group (VMG). Main Outcome Measure: The main outcomes measures were demographics, surgical characteristics, complications, International Prostate Symptom Score（IPSS，Quality of Life（QOL） score，and voiding frequency conditions. Results: Of 80 eligible transgender men（TG:n = 39，VG:n = 31, VMG:n = 10), the urethral fistula developed in 19/39 (49%) patients in TG, 8/31 (26%) in VG, and 1/10 (10%) in VMG (P = 0.034). The urethral stricture formed in 15/39 (38%) patients in TG, 4/31 (13%) in VG, and 1/10 (10%) in VMG (P = 0.028). Compared with TG, the VG got more favorable IPSS. The QOL scores showed that patients in VG or VMG were more satisfied with their postoperative status. Clinical Implications: VMGPU combined with MUA may help reduce urethral complications for transgender men who wish to undergo phalloplasty with urethral lengthening. Strength & Limitations: VMGPU combined with MUA focuses on reducing the urethra-related complications in the anastomotic stoma between the fixed and the penile urethra, which has not been noticed in the past. The limitations of this study are that the retrospective study design is prone to bias; the study using VMGPU+MUA technique is only in the preliminary stage, and more cases are needed to prove its effectiveness; the median follow-up in VMG was only 2 years, and longer-term follow-up results are inconclusive; the IPSS, QOL, and the voiding frequency chart were not validated in transgender men. Conclusion: Our pilot study suggests that VMGPU combined with MUA may reduce the urethra-related complications, especially the urethral fistula in the anastomosis stoma between the fixed and the penile urethra.Gao H, Wu D, Kong X, et al. A Novel Technique of Urethroplasty Could Reduce Urethra-Related Complications in Phalloplasty With Urethral Lengthening. Sex Med 2022;10:100571.

Published in Sexual Medicine

ISSN: 2050-1161 (Online)
Publisher: Oxford University Press
Country of publisher: United Kingdom
LCC subjects: Medicine
Website: https://academic.oup.com/smoa

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