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

Abstract

Phalloplasty is the main treatment for gender dysphoria disorder. It is difficult to ascertain if staging of phalloplasty influences the rate of complications. We aim to describe and compare the rates of complication between single versus two-stage phalloplasty for transgender female-to-male patients. PubMed, Ovid Medline, EMBASE and SCOPUS databases were queried for studies reporting complications of female-to-male transgender patients who underwent phalloplasty. The keywords "phalloplasty", "female to male", "outcome", "complication" and synonyms in different combinations were used for the search. Only studies that could identify whether phallic shaft creation was performed in a single or twostage procedure were included. From a total of 336 articles, 20 met the inclusion criteria. Sixteen studies reported complications associated with a single-stage phalloplasty and seven studies identified complications after a two-stage procedure. The most common complications found for both groups of staging were fistula, stricture and total/partial flap necrosis. Patients who underwent two-stage phalloplasty had higher complication rates (partial or total flap necrosis and fistulas), compared with the single-stage procedure (P<0.05). In conclusion, this systematic review identified the impact of staging in the rate of complications related to phalloplasty for transgender female-to-male patients; a two-stage phalloplasty has a higher rate of complications.

Complications Following Gender-Affirming Phalloplasty: A NSQIP Review

“…These complications were studied by Huayllani et al who demonstrated significantly higher complication rates in two-stage phalloplasties. 18 Similar findings were reported by Remington et al when specifically comparing staging of urethroplasty, where staged procedures had higher rates of flap and urethral complications. 13 Although there is a paucity of evidence to support staging versus no staging in phalloplasty, our results show no significant difference in 30-day complications, including flap failure causing unplanned reoperation, between the two techniques.…”

“…16 Multistage procedures have demonstrated poor urethral and flap-related outcomes, with complication rates of 34% and 10% respectively. 17,18 In a large review comparing flap choice in gender-affirming phalloplasty, urethral strictures and fistulas were more common in RFFF, but flap failure rates were higher in This article is protected by copyright. All rights reserved.…”

„Wahl der Lappenplastik zur Phalloplastik – was ist zeitgemäßer Standard“ – Konsensus-Bericht der deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße

“…Vervielfältigung nur mit Zustimmung des Verlages. [77,78]. Die Aussage der Studie wird jedoch durch die Tatsache beschränkt, dass alle nicht tube-in-tube-fähigen Phalloplastiken in die Gruppe der geplanten, mehrschrittigen Urethrakonstruktionen fallen, deren Komplikationsrate durch eine präformierte Urethra mit einem Hauttransplantat ohnehin erhöht erscheint.…”

“…Des Weiteren können die verlängerte und die penoidale Urethra, unabhängig von der Art ihrer Konstruktion, sofort oder verzögert anastomosiert werden. Eine Meta-Analyse aus 50 Studien fand eine höhere Komplikationsrate sowie ein schlechteres Outcome (Urinieren im Stehen, Sexualfunktion, Patientenzufriedenheit) bei mehrschrittig durchgeführten Urethroplastiken gegenüber primären Urethraanastomosen [77,78]. Die Aussage der Studie wird jedoch durch die Tatsache beschränkt, dass alle nicht tube-in-tube-fähigen Phalloplastiken in die Gruppe der geplanten, mehrschrittigen Urethrakonstruktionen fallen, deren Komplikationsrate durch eine präformierte Urethra mit einem Hauttransplantat ohnehin erhöht erscheint.…”

30 Years of Experience in Musculocutaneous Latissimus Dorsi Flap Phalloplasty with Reinnervation: Optimal Principles

“…10,11 Recently, the phalloplasty method using the latissimus dorsi flap (LDF) has attracted interest as evidenced by frequent publications and presentations by colleagues from various countries. 12,13 However, the radial forearm free flap and anterolateral thigh flap methods were dominant. The authorship of this method of phalloplasty using an LDF in these publications is not definitely cited and is mainly attributed to Perovic.…”