Endoscopic Incision of Short (<3 cm) Urethral Strictures After Phallic Reconstruction

Abstract

Introduction: Urethral stricture formation is a frequent complication after phallic reconstruction, but little is known about the treatment. Endoscopic cold-knife incision has long been applied for short urethral strictures. Can this treatment be used for strictures in the phalloplasty patients as well? Materials and Methods: Thirty-two endoscopic urethrotomies were done in 22 patients with a phalloplasty. Only noncomplicated strictures shorter than 3 cm were considered appropriate for endoscopic incision. The stricture was treated by a cold-knife incision. The urethral catheter was maintained for at least 2 weeks. Followup was done every 3 months during the first year and annually thereafter. Comparing failures with successful cases, prognostic factors for success are assessed. Results: Median follow-up is 51 months (range, 8-95 months). In 14 patients, no previous intervention was done. Mean stricture length is 1 cm (range, 0.5-2.5 cm). Endoscopic incision was successful in 14=32 cases (43.8%). First incision was successful in 10=22 cases (45.5%), a second incision was successful in 4=7 cases (57.1%), but three or more incisions were never successful (0=3). The only significant difference between failures and successful cases is the interval between phalloplasty and endoscopic incision (32 vs. 9.9 months; p ¼ 0.00008). Conclusions: Endoscopic incision for short (<3 cm) urethral strictures after phallic reconstruction can solve the problem in about half of the cases. Three or more incisions seem to be useless. Endoscopic incision is significantly better when performed with a long-term interval after phalloplasty, indicating that a well-healed phallic urethra is more prone to a successful endoscopic incision.

Urethral stricture after phalloplasty

“…DVIU has been advocated by some in short urethral strictures as a viable option with modest success while others have reported extremely low success rate of 13% (14,15). In our practice, we have not found DVIU to be useful as a definitive strategy; its main role is as a temporizing measure to achieve urinary drainage until the patient is ready for definitive urethroplasty.…”

Single versus two-stage phalloplasty for transgender female-to-male patients: a systematic review of the literature

“…Urethral strictures occur more commonly in areas with poor blood flow due to ischemia such as the anastomotic sites (21,(23)(24)(25). The first-line treatment recommended for these cases is endoscopic dilation especially for short and single strictures (26). Definitive treatment is accomplished with urethroplasty through a staged procedure with buccal graft or direct repair (1).…”

Urethroplasty in Phalloplasty: Surgical Outcomes and Complications a Critical Review

“…9 Furthermore, grafting techniques, whether using vaginal or buccal mucosa, also have a low urethral stricture rate, at 4.5% and 0%, respectively. 15,16 Much knowledge regarding urethral stricture is based on reports by Lumen et al 17,18 Their original papers indicated that the urethral anastomosis site is the most common location for stricture. Other indicated sites were the meatus, phallic urethra, fixed part urethra, and combined complex strictures, in descending order of incidence.…”

“…Endoscopic incision, in the form of internal urethrotomy, was later reported as a minimally invasive alternative with similar outcomes, though its use was limited to short (less than 3 cm) stenosis. 17 They further stated that there is no reason to go beyond two incisions and that better results are to be expected if the incision is performed a long period after phalloplasty.…”