Functional Outcomes and Urological Complications after Genital Gender Affirming Surgery with Urethral Lengthening in Transgender Men

Veerman, Hans; Rooij, Freek P. W. de; Al-Tamimi, Muhammed; Ronkes, Brechje; Mullender, Margriet G.; Bouman, Mark‐Bram; Sluis, Wouter B. van der; Pigot, Garry L.S.

doi:10.1097/ju.0000000000000795

Cited by 72 publications

(63 citation statements)

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“…Furthermore, we found that the use of tubularized vascularized flaps is less prone to stricture and fistulae, likely owing to their robust blood supply and the geometry of the suture line. Variations of the ring technique have been utilized by other centers [9,10] , but to our knowledge this is the first report to describe the technique and report on the outcomes. Indeed, we found that a large majority (87.9%) of patients were able to stand and urinate (primary outcome).…”

Section: Discussionmentioning

confidence: 99%

Metoidioplasty using labial advancement flaps for urethroplasty

Meltzer¹,

Esmonde²

2020

Plast Aesthet Res

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Aim: A variation of the ring metoidioplasty has been performed for masculinizing transgender surgery by the senior surgeon since 2010. It does not require buccal grafts or vaginal wall flaps. An excisional vaginectomy was completed in all patients. We sought to evaluate the urologic outcomes and complications for this technique. Further, we provide a detailed technical description of the technique, including ancillary masculinizing procedures. Methods: This is a retrospective, single surgeon chart review of all patients undergoing metoidioplasty from 2010 to 2020. Demographics, outcomes, and complications are reported. A self-reported patient questionnaire provided data on patient-perceived urologic outcomes. Results: Ninety-one patients were included in the study, with 80 (87.9%) patients reporting ability to stand and void with a strong stream. We observed five strictures (5.5%) and one fistula (1%). Scrotoplasty with tissue expanders and testicular implants were performed in 75 (82.4%) patients, while monsplasty was performed in 54 (59%) patients. Conclusion: Our technique has a low complication rate and patients report a strong urinary stream and the ability to stand in the large majority of cases. Ancillary masculinizing procedures are common. The limitations of metoidioplasty, in general, still persist, which are the small phallus size and variable ability to clear the zipper without lowering the pants to void.

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Section: Discussionmentioning

confidence: 99%

Metoidioplasty using labial advancement flaps for urethroplasty

Meltzer¹,

Esmonde²

2020

Plast Aesthet Res

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“…The free radial forearm flap (RFFF) and the anterolateral thigh pedicled or free flap (ALT) are, by a considerable margin, the most common donor site choices currently. The latissimus dorsi (LD) myocutaneous flap [32,33] and the superficial circumflex iliac artery flap (SCIP) [34,35] are used at select centers. The free fibula osteocutaneous flap [35][36][37] and the lower abdominal pedicled flap [29,38] are used less frequently.…”

Section: Phalloplastymentioning

confidence: 99%

“…Photos courtesy of Dr. Jens Berli have limited the wide use of the LD flap for phalloplasty; most significant are the inability to restore cutaneous sensation in the phallus and the need to construct a penile urethra using a second flap or staged skin grafting. The SCIP has also seen limited use for both neophallic and penile urethral construction [34,35] . Limitations in the cutaneous skin paddle size, the arc of rotation of the flap, and the difficulty in restoring cutaneous sensation have restricted its use to isolated centers [34,35] .…”

mentioning

confidence: 99%

“…The SCIP has also seen limited use for both neophallic and penile urethral construction [34,35] . Limitations in the cutaneous skin paddle size, the arc of rotation of the flap, and the difficulty in restoring cutaneous sensation have restricted its use to isolated centers [34,35] . The fibula osteoseptocutaneous flap was also conceptualized as a way to provide for penile rigidity, but its use is limited by the complex dissection necessary, the morbidity of the donor site, an insufficient cutaneous island to construct a penile urethra, and the inconvenience and complications resulting from a permanently rigid neophallus [36] .…”

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confidence: 99%

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Phalloplasty: understanding the chaos

2020

Plast Aesthet Res

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Wide variation in overall strategies and surgical specifics for masculinizing genital surgery has created a "phalloplasty chaos" that is confusing to both surgeons and patients seeking gender confirming surgery. The purpose of this article is to review masculinizing genital confirming surgery, or "phalloplasty", focusing on specific goals and categorizing each component of the surgical process. Experienced surgeons from several highvolume centers review and categorize the commonly employed strategies and techniques for gender confirming phalloplasty, including the permutations of approaches to cutaneous flap for phallic construction, the sequence and staging of procedures, and strategies for urethral construction. There is no clear advantage or reduction in complications associated with particular sequences of urethral and phallic reconstruction. Because no single technique or staging strategy has proven superior for gender confirming genital surgery, it is paramount that surgeons are knowledgeable of all available options and the associated advantages, disadvantages, and risks.

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“…Each option comes with different physical requirements, expected outcomes, and risk of complications. 2,12,13 Whether or not to undergo surgery and which surgical option to choose depends on various factors including gender identity, personal expectations (eg, desire for childbearing), costs, feasibility and risks, and coping abilities. 1,14e17 Over the past decades, major improvements in surgical approaches have been made, and follow-up studies repeatedly show positive effects on psychosocial outcomes.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Decision Aid for Genital Surgery in Transmen

Mokken

Özer

Grift

et al. 2020

The Journal of Sexual Medicine

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Background: Multiple options of genital gender-affirming surgery are available to transmen. The transman should be able to weigh these options based on the outcomes, risks, and consequences that are most important to him. For this reason, a decision aid for genital surgery in transmen (DA-GST) was developed. It aims to support the transman in making thoughtful choices among treatment options and facilitate shared decision-making between the healthcare professionals and the transindividual. Aim: The aim of this study was to evaluate the newly developed DA-GST. Methods: This was a cross-sectional study using mixed methods. Transmen considering to undergo genital surgery were eligible to partake in the study. The questionnaires used in this study were developed by adapting the validated Dutch translation of the "Decisional Conflict Scale," the "Measures of Informed Choice," and the "Ottawa Preparation for Decision-Making Scale." Qualitative interviews were conducted querying their subjective experience with the DA-GST. The data from the questionnaires were statistically analyzed, and the data from the interviews were thematically analyzed. Outcomes: The main outcome measures were decisional conflict and decisional confidence measured via selfreport items and qualitative data regarding the use of the DA-GST via interviews. Results: In total, 51 transmen participated in the questionnaires study, 99 questionnaires were analyzed, and 15 interviews were conducted. Although confident in their decision, most transmen felt responsible to collect the necessary information themselves. The ability to go through the decision aid independently aided the decision-making process by providing information and highlighting their subjective priorities. Suggested additions are pictures of postoperational outcomes and personal statements from experienced transmen. Clinical Translation: The DA-GST could be implemented as an integral part of transgender health care. Clinicians could take the individual personal values into account and use it to accurately tailor their consult. This would ultimately improve the doctor-patient relationship and decrease decisional regret by enhancing effective shared decision-making. Strengths & Limitations: This mixed-method design study confirmed the use of the DA-GST while taking a broad range of decisional factors into account. Limitations include the absence of a baseline analysis and the limited power for the comparison of treatment groups. Conclusions: This study suggests that the DA-GST helped transmen feel more prepared for their personal consult with the surgeon, reduced decisional conflict, and increased their decisional confidence. Mokken SE, Özer M, van de Grift TC, et al. Evaluation of the Decision Aid for Genital Surgery in Transmen. J Sex Med 2020;17:2067e2076.

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Functional Outcomes and Urological Complications after Genital Gender Affirming Surgery with Urethral Lengthening in Transgender Men

Cited by 72 publications

References 0 publications

Metoidioplasty using labial advancement flaps for urethroplasty

Metoidioplasty using labial advancement flaps for urethroplasty

Phalloplasty: understanding the chaos

Evaluation of the Decision Aid for Genital Surgery in Transmen

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