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  • Friday, June 17, 2016
  • 0706-000221 Poster 195 - UROLOGIC MANAGEMENT OF A RECONSTRUCTED URETHRA

    June 20, 2016 8:00 AM - June 20, 2016 6:00 PM

    • Nikita Abhyankar, MD ;
    • Loren Schechter, MD ;
    • Ervin Kocjancic, MD

    Purpose

    Urologic complications after female to male transgender phalloplasty have been shown to occur in 41% of patients.  Management of the completely reconstructed penile urethra can pose distinct challenges. The purpose of this study is to provide an overview of management strategies for the female to male transgender urethra after phalloplasty. 

    Materials and Methods

    We describe options based on our experience with urologic management of the urethra after female to male transgender phalloplasty. 

    Results

     

    Complications after female to male transgender phalloplasty using a radial forearm flap include urinary tract infections, urethrocutaneous fistula, stricture, diverticula or hair within the urethra. Initial assessment of the lower urinary tract is performed in all patients after phalloplasty to evaluate for possible anatomic abnormalities. This assessment involves cystoscopy, voiding or retrograde urethrogram and cystogram.

    Meatal stenosis can be treated using Van Buren sounds or a balloon dilator to dilate the meatus. The meatus can also be self-calibrated by the patient themselves.

    Urethral strictures can be managed using endoscopic or open techniques. Endoscopic techniques include direct visual internal urethrotomy using laser or cold knife. Open techniques include a one or two stage urethroplasty using buccal mucosal graft if needed. The surgical technique varies from that in the native penile urethra due to the dorsal vascular supply and the clitoral nerve. If a buccal graft is used, it is placed on the ventral urethra for this reason.

    Fistulous tracts can be managed using a one or two-stage repair. Buccal mucosa can also be utilized for the repair if there is insufficient healthy tissue to close the defect.

    Residual hair or suture within the urethra can cause stone formation in the future. This can be addressed endoscopically using Holmium laser to obliterate these.

     

     

    Conclusion

    In conclusion, urologic complications following phalloplasty can be managed by adapting general urologic principles to this unique situation.




    Category: Surgery