Functional Outcomes and Urologic Complications after Genital Gender Affirming Surgery with Urethral Lengthening in Transgender Men.
To determine the urologic complications and lower urinary tract functions after genital gender affirming surgery (gGAS) with urethral lengthening (UL) in transmen.A single-center, retrospective cohort study was performed from January 2013 to January 2018. Patient demographics, medical history, perioperative data, surgical and urologic complications and pre- and postoperative urologic outcomes were obtained.Of all 63 patients included, 8 (13%) underwent metoidioplasty and 55 (87%) phalloplasty (27 (43%) free radial forearm flap (FRFF), 19 (30%) anterolateral thigh (ALT flap, 9 (14%) superficial circumflex iliac artery perforator flap (SCIP)). In phalloplasty, types of UL were tube-in-tube FRFF 27 (49%), FRFF (second fasciocutaneous flap) 18 (33%), SCIP 5 (9%) or labial 5 (9%). Mean follow-up time was 23 months (range 12 to 71). Stricture formation occurred in 35 (63%) phalloplasty and 5 (63%) metoidioplasty cases. Urethral fistula formation occurred in 15 (27%) phalloplasty and 4 (50%) metoidioplasty cases. Mean time to strictures and fistulae was approximately 3 months. Forty-six (73%) patients needed revision surgery because of fistulae/strictures. After treatment, 44 (70%) patients were able to void from the tip of the phallus. No clinically relevant differences in international prostate symptom scores, frequency volume charts and uroflowmetry were found pre- and postoperatively.GGAS with UL is a complex procedure with a high complication rate. After treating complications, no clinically relevant differences in urologic functioning were recorded the majority of transgender men could void from the tip of the penis and showed favorable urologic outcomes.