of Urethral Stricture after Radial Forearm Flap Phalloplasty for Female to Male Gender Confirmation Surgery A Case Series Nikita Abhyankar 1 Neha Malhotra 1 Jason Huang 1 Loren Schechter ID: 656541
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Abstract 18035Urethroplasty of Urethral Stricture after Radial Forearm Flap Phalloplasty for Female to Male Gender Confirmation Surgery – A Case SeriesNikita Abhyankar1, Neha Malhotra1, Jason Huang1, Loren Schechter2, Ervin Kocjancic11Department of Urology, University of Illinois at Chicago 2University Plastic Surgery; Department of Surgery, Division of Plastic Surgery, University of Illinois at ChicagoAbstract 18491
Introduction
Methods
Results
Phalloplasty
using a radial forearm
flap in
the female to male transgender population is a complex surgery with a reported rate of urologic complications up to 41%Complications such as fistulae and strictures of significant length can be managed by adapting conventional urethroplasty techniquesWe present a case series of such urethroplasties
We analyzed the treatment of all patients undergoing buccal mucosal graft urethroplasty for urethral complications of female to male radial forearm flap phalloplasty at a single site over a fifteen month periodAll urethroplasties were performed by a single reconstructive urologist; phalloplasties were performed by a plastic surgery in conjunction with reconstructive urology
Conclusion
Common urologic complications following phalloplasty include urethral fistula and stricture developmentLimited data exists around management This series shows conventional urethroplasty techniques can be successfully adapted to treat these complications Two-stage urethroplasty appears to be a viable option to repair urethral stricture and fistula in patients who have undergone radial forearm flap phalloplasty.
As seen in Table 1,
t
wo
of the strictures were limited to the
neourethra
, while 5 involved the native urethra-
neourethra anastomosis.
Three patients underwent a single stage urethroplasty and five have undergone the first stage of a 2-stage urethroplastyA buccal mucosal graft was placed to augment the neo-urethra in 4 patientsThe early post-operative course was uncomplicated for all patients.
At median follow up of 11 weeks (+/-8 weeks), 3 patients developed a recurrent
strictureTwo of these patients had undergone a single stage urethroplasty (66% recurrence rate) and one had undergone the first stage of a two-stage urethroplasty (20% recurrence rate)One of these patients went on to have a two-stage urethroplasty to repair the recurrent stricture and the other two were treated with laser incision and dilation (See Table 3)
A total of 7 patients undergoing 8
urethroplasties
were included
Mean age was 35 years old (+/-9 years)
Mean time between the initial
phalloplasty
and the diagnosis of the first
neourethral
stricture was 12 weeks (+/-8 weeks)