Urethral Complications After Metoidioplasty for Genital Gender Affirming Surgery

Waterschoot, Mieke; Verla, Wesley; Spinoit, Anne‐Françoise; Waterloos, Marjan; Sinatti, Céline; Buncamper, Marlon E.; Lumen, Nicolaas

doi:10.1016/j.jsxm.2020.06.023

Cited by 12 publications

(7 citation statements)

References 29 publications

(49 reference statements)

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“…This analysis did not demonstrate BMI as an independent predictor of urethral complications. Concomitant vaginectomy was assessed as a risk factor given the risk to the bladder and rectum during the vaginectomy portion of the surgery, but this did not demonstrate increased independent risk either (60).…”

Section: Metoidioplastymentioning

confidence: 99%

Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy

Fascelli¹,

Sajadi²,

Dugi³

et al. 2023

Transl Androl Urol

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Transgender and non-binary (TGNB) individuals are seeking penile reconstruction in greater numbers; many pursue urethral lengthening surgery with a goal of voiding while standing. Changes in urinary function and urologic complications-i.e., urethrocutaneous fistulae and urinary stricture-are common. Familiarity with presenting symptoms and management strategies for urinary complaints after genital gender-affirming surgery (GGAS) can improve patient counseling and outcomes. We will describe current gender-affirming penile construction options with urethral lengthening and review associated urinary complications that present as urinary incontinence. The incidence and impact of lower urinary tract symptoms after metoidioplasty and phalloplasty are poorly characterized due to limited post-operative follow-up. Post-phalloplasty, urethrocutaneous fistula is the most common urethral complication, ranging in incidence from 15-70%. Assessment of concomitant urethral stricture is necessary. No standard technique exists for management of these fistula or strictures. Metoidioplasty studies report lower rates of stricture and fistula, 2% and 9% respectively. Other common voiding complaints include dribbling, urethral diverticula and vaginal remnants. History and physical exam in the post-GGAS evaluation require understanding of prior surgeries and attempted reconstructive efforts; adjuncts to physical exam include uroflowmetry, retrograde urethrography, voiding cysto-urethrogram, cystoscopy, and MRI. Following gender-affirming penile construction, TGNB patients may experience a host of urinary symptoms and complications that impact quality of life. Due to anatomic differences, symptoms require tailored evaluation which can be done by urologists in an affirming environment.

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Section: Metoidioplastymentioning

confidence: 99%

Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy

Fascelli¹,

Sajadi²,

Dugi³

et al. 2023

Transl Androl Urol

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“…A staged approach to metoidioplasty employs additional maneuvers performed in a second surgical setting designed to improve the excursion and the appearance of the neophallus. As described by Odeluga et al, the first stage involves phallic and urethral lengthening, vaginectomy, and scrotoplasty [20] . The second stage is tailored to the patient and includes repair of complications from stage one (fistula, stricture, vaginectomy wound complications, release of tethering scars), escutcheonectomy, and/or reduction of scrotal tissue (i.e., former labia majora), reduction to improve appearance.…”

Section: Metoidioplasty Techniquesmentioning

confidence: 99%

A narrative review of outcomes following metoidioplasty: complications and satisfaction

Jahromi¹,

Spellman²,

Horen³

et al. 2022

Plast Aesthet Res

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Metoidioplasty consists of lengthening and straightening the hormonally hypertrophied clitoris. The goals of the procedure include masculinizing the external genitalia and enabling standing micturition. Metoidioplasty may be performed as a stand-alone procedure or an interval procedure prior to phalloplasty. While most often performed with urethral lengthening, metoidioplasty may also be performed as a “simple release” (i.e., without urethral lengthening). Secondary procedures typically include scrotoplasty and placement of testicular implants. While satisfaction with this procedure is high, complications can occur. Complications are commonly categorized as either urologic (i.e., strictures and fistula) or wound healing (i.e., wound disruption, infection, bleeding, etc.). This narrative review discusses postoperative outcomes, including both satisfaction and complications. Published data on complications include fistula and stricture rates from 0%-50% and 0%-63%, respectively. Overall satisfaction with appearance ranges from 48%-100%, and patient ability to void while standing ranges from 67%-100%. Metoidioplasty is a safe and effective procedure for transgender men. Further research regarding surgical techniques and outcomes will help reduce complications and improve overall patient satisfaction.

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“…23 In metoidioplasty, additional urethral lengthening is a significant predictor of all urethral complications (OR 15.5). 24…”

Section: Urologic Complicationsmentioning

confidence: 99%

“…Secondary phalloplasty, which follows primary metoidioplasty, has comparable complication rates to primary phalloplasty including 30% fistula and 35% stricture occurrence 23 . In metoidioplasty, additional urethral lengthening is a significant predictor of all urethral complications (OR 15.5) 24 …”

Section: Urologic Complicationsmentioning

confidence: 99%

Evaluation and management of urologic complications following transmasculine genital reconstructive surgery

Elyaguov

Isakov

Nikolavsky

2022

Neurourology and Urodynamics

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Aims Transmasculine genital reconstructive surgery involves the creation of a neourethra by way of metoidioplasty or phalloplasty. We aim to describe approaches in identifying complications associated with these procedures as well as the various reparative techniques that can be utilized to reestablish the neourethral tract. Methods We prepared a guide to diagnostic and procedural interventions for urologic complications following transmasculine genital reconstructive surgery based on our clinical experience as well as those of our colleagues. We reviewed all current peer‐reviewed publications based on this topic. Results These procedures have a considerable revision rate for urologic complications, which include urethrocutaneous fistulae, persistent vaginal remnant, and urethral strictures. These complications often present simultaneously and require appropriate workup and treatment. Conclusions Several reconstructive techniques can be employed to restore the neourethral tract, as we describe in detail.

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Urethral Complications After Metoidioplasty for Genital Gender Affirming Surgery

Cited by 12 publications

References 29 publications

Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy

Urinary symptoms after genital gender-affirming penile construction, urethral lengthening and vaginectomy

A narrative review of outcomes following metoidioplasty: complications and satisfaction

Evaluation and management of urologic complications following transmasculine genital reconstructive surgery

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