TY - JOUR
T1 - Surgical outcomes and proposal for a treatment algorithm for urethral strictures in transgender men
AU - de Rooij, Freek P. W.
AU - Peters, Femke R. M.
AU - Ronkes, Brechje L.
AU - van der Sluis, Wouter B.
AU - Al-Tamimi, Muhammed
AU - van Moorselaar, R. Jeroen A.
AU - Bouman, Mark-Bram
AU - Pigot, Garry L. S.
N1 - Publisher Copyright: © 2021 The Authors. BJU International published by John Wiley & Sons Ltd on behalf of BJU International.
PY - 2022/1
Y1 - 2022/1
N2 - Objectives: To assess our results of surgical treatment for urethral strictures in transgender men, and to provide a surgical treatment algorithm. Patients and methods: A single centre, retrospective cohort study was conducted of transgender men who underwent surgical correction of their urethral stricture(s) between January 2013 and March 2020. The medical charts of 72 transgender men with 147 urethral strictures were reviewed. The primary outcomes were the success and recurrence rates after surgical treatment for urethral strictures. Results: The median (interquartile range [IQR]) follow-up was 61 (25–202) months. At last follow-up, 50/72 (69%) were able to void while standing (after one [60%], two [20%], three [6%], four [8%], five [4%], or seven [2%] procedures), 10/72 (14%) await further treatment, two of the 72 (3%) sat to void despite good urodynamic function, and 10/72 (14%) had a definitive urethrostomy. Of 104 surgical treatments included in separate success rate analysis, 65 (63%) were successful (43/75 [57%] after phalloplasty, 22/29 [76%] after metoidioplasty). The highest success rates in short urethral strictures were seen after a Heineke-Mikulicz procedure (six of seven cases), and in longer or more complicated urethral strictures after two-stage with graft (four of six), two-stage without graft (10/12), pedicled flap (11/15, 73%), and single-stage graft (seven of seven) urethroplasties. Grafts used were buccal mucosa or full-thickness skin grafts. Success rates improved over time, with success rates of 38% and 36% in 2013 and 2014, to 71% and 73% in 2018 and 2019, respectively. We concluded with a surgical treatment algorithm based on previous literature, stricture characteristics, and our surgical outcomes. Conclusion: The highest success rates were seen after a Heineke-Mikulicz procedure in short urethral strictures; and after graft, pedicled flap, or two-stage urethroplasties in longer or more complicated urethral strictures. Finally, most of the transgender men were able to void while standing, although in some multiple surgical procedures were necessary to accomplish this.
AB - Objectives: To assess our results of surgical treatment for urethral strictures in transgender men, and to provide a surgical treatment algorithm. Patients and methods: A single centre, retrospective cohort study was conducted of transgender men who underwent surgical correction of their urethral stricture(s) between January 2013 and March 2020. The medical charts of 72 transgender men with 147 urethral strictures were reviewed. The primary outcomes were the success and recurrence rates after surgical treatment for urethral strictures. Results: The median (interquartile range [IQR]) follow-up was 61 (25–202) months. At last follow-up, 50/72 (69%) were able to void while standing (after one [60%], two [20%], three [6%], four [8%], five [4%], or seven [2%] procedures), 10/72 (14%) await further treatment, two of the 72 (3%) sat to void despite good urodynamic function, and 10/72 (14%) had a definitive urethrostomy. Of 104 surgical treatments included in separate success rate analysis, 65 (63%) were successful (43/75 [57%] after phalloplasty, 22/29 [76%] after metoidioplasty). The highest success rates in short urethral strictures were seen after a Heineke-Mikulicz procedure (six of seven cases), and in longer or more complicated urethral strictures after two-stage with graft (four of six), two-stage without graft (10/12), pedicled flap (11/15, 73%), and single-stage graft (seven of seven) urethroplasties. Grafts used were buccal mucosa or full-thickness skin grafts. Success rates improved over time, with success rates of 38% and 36% in 2013 and 2014, to 71% and 73% in 2018 and 2019, respectively. We concluded with a surgical treatment algorithm based on previous literature, stricture characteristics, and our surgical outcomes. Conclusion: The highest success rates were seen after a Heineke-Mikulicz procedure in short urethral strictures; and after graft, pedicled flap, or two-stage urethroplasties in longer or more complicated urethral strictures. Finally, most of the transgender men were able to void while standing, although in some multiple surgical procedures were necessary to accomplish this.
KW - genital gender-affirming surgery
KW - metoidioplasty
KW - phalloplasty
KW - surgical outcome
KW - transgender men
KW - treatment algorithm
KW - urethral stricture
UR - http://www.scopus.com/inward/record.url?scp=85108110168&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/bju.15500
DO - https://doi.org/10.1111/bju.15500
M3 - Article
C2 - 34046987
SN - 1464-4096
VL - 129
SP - 63
EP - 71
JO - BJU international
JF - BJU international
IS - 1
ER -