spontaneously in 8 patients, while the remaining patients required revision surgery. Urethral stricture developed in 33 patients (22.4%), and there were 13 strictures in the neophallic segment and 20 cases of bulbar strictures. All strictures required surgical repair, in 22 patients urethroplasty with buccal mucosa graft was performed. Fistula between remnant vaginal cavity and neourethral lumen was noted in 21 patients (14.3%). Vaginal remnant was excised through perineal approach and urethral opening was closed and covered with local vascularized tissue to prevent fistula formation.CONCLUSIONS: The musculocutaneous latissimus dorsi (MLD) phalloplasty combined with urethral lengthening can provide satisfactory esthetic and functional outcomes. Although urethral complication rate is still high, use of vascularized flaps for neourethra has satisfactory outcomes.
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