follow up, all the patient passed urine within normal uroflow. At 6 months follow up, uroflow remained excellent with a Qmax of 22.3ml/sec. 1 patient had proximal narrowingThere was no chordee, urinary tract infections or sexual dysfunction. There were no local complications.CONCLUSIONS: BMG Urethroplasty is the preferred augmentation material for strictures. The results of Penile skin and BMG are almost comparable. In Asian subcontinent, many men have an intact prepuce. By harvesting a spiral long graft, we avoid junctional strictures (which can take place at the site of 2 BMG). The graft is long and there is no need to harvest another graft. There is no oral morbidity. We also preserve the preputial dartos, which preserves the neurovascular supply.

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catheter and closed in a layered fashion. Methylene blue confirmed urethral integrity. Shaft skin was wrapped around the phallic portion of the urethra and closed in a layered fashion. The left ilioinguinal nerve was clipped for later coaptation with the lateral femoral cutaneous nerve. The flap was passed beneath the rectus femoris, sartorius, and then subcutaneously into the recipient site over the pubic symphysis. The anastomosis between the phallic urethra and elongated native urethra was performed over an 18 Fr. council tip catheter using interrupted stitches. Scrotoplasty was performed using labia majora flaps. The flap was then inset in a layered fashion. The donor site was closed by reapproximation and advancing the skin edges. A split-thickness skin graft was harvested from the thigh and applied over the donor site. The donor site was dressed with wound VAC. The procedure lasted 12 hours with an estimated blood loss of 550 ml. The patient was discharged on day 18. The urethral catheter was removed after a 30 days retrograde urethrogram (RUG). SPT was removed a month later. The patient initially voided without issues but then started to notice urine leakage through a phallic skin defect. RUG demonstrated distal phallic urethral stricture and a small urethrocutaneous fistula just proximal to it. The stricture was dilated with sounds. The patient was instructed to do intermittent selfcalibration. Voiding improved, stricture did not recur and fistula healed spontaneously. No other urinary complications were encountered.CONCLUSIONS: ALT flap is a valid option for gender-affirming phalloplasty. It can be considered in patients with favorable body habitus who are concerned with donor-site scarring.

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