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Surgical repair of urethral complications after metoidioplasty for genital gender affirming surgery

International Journal of Impotence Research volume 33, pages 771–778 (2021)Cite this article

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Abstract

Metoidioplasty as form of genital gender affirming surgery (GGAS) is frequently complicated by urethral fistulas and/or strictures. Knowledge on how to treat these complications is scarce. This series aims to describe the techniques used to treat urethral fistulas and strictures and will report the outcomes of these techniques. For this purpose, a retrospective analysis was done of a database containing 74 transmen who underwent metoidioplasty and retrieved 26 patients who underwent surgical treatment for a urethral complication. Four patients suffered both a stricture and fistula after metoidioplasty. Fistula repair was done by 3-layer closure in 18 patients and failed in 7 (39%) cases after a median follow-up of 27 months. Urethroplasty was done by different techniques according to the type of stricture and failed in 4 (33%) out of 12 cases after a median follow-up of 15 months. No high-grade complications (Dindo-Clavien ≥grade 3) were reported after fistula repair or urethroplasty. This series highlights that fistulas and strictures are frequent after metoidioplasty, but can be successfully treated by respectively 3-layer closure and urethroplasty in about 2 out of 3 cases.

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Fig. 1: Heineke-Mikulicz urethroplasty.

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References

  1. Djordjevic ML, Stojanovic B, Bizic M. Metoidioplasty: techniques and outcomes. Transl Androl Urol. 2019;8:248–53.

    Article  Google Scholar 

  2. Kocjancic E, Acar O, Talamini S, et al. Masculinizing genital gender-affirming surgery: metoidioplasty and urethral lengthening. Int J Impot Res. 2020. https://doi.org/10.1038/s41443-020-0259-z.

  3. Nikolavsky D, Yamaguchi Y, Levine JP, Zhao LC. Urologic sequelae following phalloplasty in transgendered patients. The Urologic Clin North Am. 2017;44:113–25.

    Article  Google Scholar 

  4. Johnsen NV, Voelzke BB. Autologous rectus fascia graft interposition repair of urethrocutaneous fistulae in female-to-male metoidioplasty patients. Urology. 2018;116:208–12.

    Article  Google Scholar 

  5. Erickson BA, Elliott SP, Voelzke BB, Myers JB, Broghammer JA, Smith TG III, et al. Multi-institutional 1-year bulbar urethroplasty outcomes using a standardized prospective cystoscopic follow-up protocol. Urology. 2014;84:213–6.

    Article  Google Scholar 

  6. Selvaggi G, Hoebeke P, Ceulemans P, Hamdi M, Van Landuyt K, Blondeel P, et al. Scrotal reconstruction in female-to-male transsexuals: a novel scrotoplasty. Plast Reconstr Surg. 2009;123:1710–8.

    Article  CAS  Google Scholar 

  7. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  Google Scholar 

  8. Stojanovic B, Bizic M, Bencic M, Kojovic V, Majstorovic M, Jeftovic M, et al. One-stage gender-confirmation surgery as a viable surgical procedure for female-to-male transsexuals. J Sex Med. 2017;14:741–6.

    Article  Google Scholar 

  9. Djordjevic ML, Bizic MR. Comparison of two different methods for urethral lengthening in female to male (metoidioplasty) surgery. J Sex Med. 2013;10:1431–8.

    Article  Google Scholar 

  10. Perovic SV, Djordjevic ML. Metoidioplasty: a variant of phalloplasty in female transsexuals. BJU Int. 2003;92:981–5.

    Article  CAS  Google Scholar 

  11. Hage JJ, van Turnhout AA. Long-term outcome of metaidoioplasty in 70 female-to-male transsexuals. Ann Plast Surg. 2006;57:312–6.

    Article  CAS  Google Scholar 

  12. Takamatsu A, Harashina T. Labial ring flap: a new flap for metaidoioplasty in female-to-male transsexuals. J Plast Reconstructive Aesthetic Surg. 2009;62:318–25.

    Article  CAS  Google Scholar 

  13. Veerman H, de Rooij FPW, Al-Tamimi M, Ronkes BL, Mullender MG, Bouman M, et al. Functional outcomes and urologic complications after genital gender affirming surgery with urethral lengthening in transgender men. J Urology. 2020:101097JU0000000000000795.

  14. Vukadinovic V, Stojanovic B, Majstorovic M, Milosevic A. The role of clitoral anatomy in female to male sex reassignment surgery. TheScientificWorldJournal. 2014;2014:437378.

    Article  Google Scholar 

  15. Dy GW, Granieri MA, Fu BC, Vanni AJ, Voelzke B, Rourke KF, et al. Presenting complications to a reconstructive urologist after masculinizing genital reconstructive surgery. Urology. 2019;132:202–6.

    Article  Google Scholar 

  16. Lumen N, Hoebeke P, Oosterlinck W. Ventral longitudinal stricturotomy and transversal closure: the Heineke-Mikulicz principle in urethroplasty. Urology. 2010;76:1478–82.

    Article  Google Scholar 

  17. Fu Q, Zhang Y, Zhang J, Xie H, Sa YL, Jin S. Substitution urethroplasty for anterior urethral stricture repair: comparison between lingual mucosa graft and pedicled skin flap. Scand J Urol. 2017;51:479–83.

    Article  Google Scholar 

  18. Chauhan S, Yadav SS, Tomar V. Outcome of buccal mucosa and lingual mucosa graft urethroplasty in the management of urethral strictures: a comparative study. Urol Ann. 2016;8:36–41.

    Article  CAS  Google Scholar 

  19. Wang CX, Zhang WP, Song HC. Complications of proximal hypospadias repair with transverse preputial island flap urethroplasty: a 15-year experience with long-term follow-up. Asian J Androl. 2019;21:300–3.

    Article  CAS  Google Scholar 

  20. Fahmy O, Khairul-Asri MG, Schwentner C, Schubert T, Stenzl A, Zahran MH, et al. Algorithm for optimal urethral coverage in hypospadias and fistula repair: a systematic review. Eur Urol 2016;70:293–8.

    Article  Google Scholar 

  21. Saavedra AA, Rourke KF. Characterization and outcomes of urethroplasty for hypospadias-associated urethral strictures in adults [published online ahead of print, 2019 Apr 26]. Can Urol Assoc J. 2019;13:E335-E340. https://doi.org/10.5489/cuaj.5863.

  22. Markiewicz MR, Lukose MA, Margarone JE III, Barbagli G, Miller KS, Chuang SK. The oral mucosa graft: a systematic review. J Urol. 2007;178:387–94.

    Article  Google Scholar 

  23. Lumen N, Monstrey S, Goessaert AS, Oosterlinck W, Hoebeke P. Urethroplasty for strictures after phallic reconstruction: a single-institution experience. Eur Urol. 2011;60:150–8.

    Article  Google Scholar 

  24. Verla W, Oosterlinck W, Waterloos M, Spinoit AF, Lumen N. Perineal urethrostomy for complicated anterior urethral strictures: indications and patient’s choice. an analysis at a single institution. Urology. 2020;138:160–5.

    Article  Google Scholar 

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Author notes

  1. These authors contributed equally: Lumen Nicolaas, Waterschoot Mieke

Authors and Affiliations

  1. Department of Urology, Ghent University Hospital, Ghent, Belgium

    Nicolaas Lumen, Mieke Waterschoot, Wesley Verla & Piet Hoebeke

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  1. Nicolaas Lumen
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  2. Mieke Waterschoot
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  4. Piet Hoebeke
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Correspondence to Nicolaas Lumen.

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Lumen, N., Waterschoot, M., Verla, W. et al. Surgical repair of urethral complications after metoidioplasty for genital gender affirming surgery. Int J Impot Res 33, 771–778 (2021). https://doi.org/10.1038/s41443-020-0328-3

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