Urethral complications after gender reassignment surgery: a systematic review

Imaging in Gender Affirmation Surgery

“…Leaks or fistulae may be watched for several months for spontaneous resolution before a decision is made to re-operate. Urethral strictures can occur at any time but typically arise 6 to 18 months postoperatively [17]. These can be endoscopically dilated or, if recurrent, re-operated with a one-or two-stage repair using a buccal graft [18•].…”

“…Pelvic MRI with a perianal fistula protocol can provide additional information for surgical planning by displaying the entire length of the fistula/sinus tracts and can help with diagnosis when fluoroscopy fails to detect an abnormality. Occasionally, fistulae can arise between the neourethra and the vaginectomy site, which can be clinically diagnosed and closed surgically [17]. More insidiously, internal fistulas can develop and present as recurrent urinary tract infections, urosepsis, urinomas, or urine per rectum.…”

“…Neourethral complications constitute the most common and challenging complications of phalloplasty. Because of the length of the neourethral construct, two anastomotic sites, and its relative flaccidity, postoperative phalloplasties suffer from urethral strictures, stenosis, fistulas, sinuses, and diverticula [17]. Patients may present at any point in their postoperative course up to several years later with a secondary stream, dribbling, acute urinary retention, infection, sepsis, or renal failure.…”

“…However, a stricture can be overdiagnosed on fluoroscopic studies and may require urodynamic studies to determine whether detected areas of narrowing are clinically significant (Fig. 1c) [17]. Three locations are implicated in the vast majority of urethral complications: the native urethra-pars fixa anastomosis, pars fixa-pars pendulans anastomosis, and the ventral pars pendulans, which has an entire suture line running along its course as part of the "tube-within-a-tube" neophallus construct and strictures can develop anywhere along this course.…”

“…Superficial wound dehiscence is a relatively common complication as well and treated conservatively. Meatal stenosis is common in patients who have undergone transfeminine GAS [17]. In an effort to create a neovagina of adequate length and depth, over dissection of the rectoprostatic space may lead to rectal or bladder injury with eventual rectovaginal, vesicovaginal, and urethrovaginal fistulae formation [30].…”