Urological outcomes favourable after genital gender affirming surgery in transgender men

The complication rate is high in transgender men undergoing genital gender affirming surgery with urethral lengthening, which is considered a complex procedure, but no clinically relevant differences in urological functioning have been recorded following treatment of these complications, reports a study.

“The majority of transgender men could void from the tip of the penis and showed favourable urological outcomes,” the authors said.

Sixty-three patients were included in this study, of which eight (13 percent) underwent metoidioplasty and 55 (87 percent) phalloplasty, comprising 27 (43 percent) free radial forearm flap, 19 (30 percent) anterolateral thigh flap, and nine (14 percent) superficial circumflex iliac artery perforator flap surgeries.

The types of urethral lengthening in phalloplasty were as follows: tube-in-tube free radial forearm flap (n=27; 49 percent), free radial forearm flap (second fasciocutaneous flap; n=18; 33 percent), superficial circumflex iliac artery perforator flap (n=5; 9 percent), or labial (n=5; 9 percent).

Over a mean follow-up of 23 months (range, 12–71), stricture formation occurred in 35 (63 percent) phalloplasty and five (63 percent) metoidioplasty cases, while urethral fistula formation occurred in 15 (27 percent) phalloplasty and four (50 percent) metoidioplasty cases.

Mean time to strictures and fistulas was about 3 months. Revision surgery owing to fistulas or strictures was required in 46 (73 percent) patients. After treatment, 44 (70 percent) patients could void from the tip of the phallus. There were no clinically relevant differences found in International Prostate Symptom Scores, frequency volume charts, and uroflowmetry whether pre- or postoperatively.

This single-centre, retrospective cohort study was conducted from January 2013 to January 2018 to determine the urological complications and lower urinary tract function after genital gender affirming surgery with urethral lengthening in transgender men. The authors obtained patient demographics, medical history, perioperative data, surgical and urological complications, and pre- and postoperative urological outcomes.