Functional Outcomes and Urological Complications after Genital Gender Affirming Surgery with Urethral Lengthening in Transgender Men.
PURPOSE
We determined the urological complications and lower urinary tract function after genital gender affirming surgery with urethral lengthening in transgender men.


MATERIALS AND METHODS
A single center, retrospective cohort study was performed from January 2013 to January 2018. Patient demographics, medical history, perioperative data, surgical and urological complications, and preoperative and postoperative urological outcomes were obtained.


RESULTS
Of the 63 patients included in the study 8 (13%) underwent metoidioplasty and 55 (87%) phalloplasty, comprised of 27 (43%) free radial forearm flap, 19 (30%) anterolateral thigh flap and 9 (14%) superficial circumflex iliac artery perforator flap surgeries. In phalloplasty the types of urethral lengthening were tube-in-tube free radial forearm flap in 27 (49%), free radial forearm flap (second fasciocutaneous flap) in 18 (33%), superficial circumflex iliac artery perforator flap in 5 (9%) or labial in 5 (9%). Mean followup was 23 months (range 12 to 71). Stricture formation occurred in 35 (63%) phalloplasty and 5 (63%) metoidioplasty cases. Urethral fistula formation occurred in 15 (27%) phalloplasty and 4 (50%) metoidioplasty cases. Mean time to strictures and fistulas was approximately 3 months. Overall 46 (73%) patients needed revision surgery because of fistulas/strictures. After treatment 44 (70%) patients were able to void from the tip of the phallus. No clinically relevant differences in International Prostate Symptom Scores, frequency volume charts and uroflowmetry were found preoperatively vs postoperatively.


CONCLUSIONS
Genital gender affirming surgery with urethral lengthening is a complex procedure with a high complication rate. After treating complications no clinically relevant differences in urological functioning were recorded. The majority of transgender men could void from the tip of the penis and showed favorable urological outcomes.
['Veerman|H|H|', 'de Rooij|F P W|FPW|', 'Al-Tamimi|M|M|', 'Ronkes|B L|BL|', 'Mullender|M G|MG|', 'B Bouman|M|M|', 'van der Sluis|W B|WB|', 'Pigot|G L S|GLS|']
D015331:Cohort Studies D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D011183:Postoperative Complications D012086:Reoperation D012189:Retrospective Studies D057830:Sex Reassignment Surgery D013524:Surgical Flaps D063106:Transgender Persons D014189:Transsexualism D014521:Urethra D014525:Urethral Stricture D014548:Urinary Fistula D014554:Urination
gender dysphoria lower urinary tract symptoms postoperative complications sex reassignment procedures