XVI Harry Benjamin International Gender Dysphoria Association Symposium
17 - 21 August 1999, London

Reflections on "Transsexualism and Sex Reassignment" 1969 -1999

Urological Implications of Total Phalloplasty: Experience in 26 Patients

Hoebeke P.*, Huybrechts* S., Monstrey S.°
*Dpt Paediatric Urology and Urogenital reconstruction, ° Dpt Plastic Surgery

University Hospital Gent Belgium

• Introduction
• Material and Methods
• Results
• Conclusion

INTRODUCTION: Voiding while standing is a priority for the female to male transsexual. In order to reach this goal a competent urethra has to be constructed in the neophallus. A new urethra with mean length of 18 cm has to be reconstructed. Urethral surgery has the well-known complications of fistula formation and stenosis development. In order to investigate these urological complications in total phalloplasty the files of 26 consecutive patients were reviewed.

MATERIAL AND METHODS: During a study period from August 1993 till August 1998, 26 patients underwent free sensate radial forearm flap phalloplasty, which was part of a one stage procedure for gender reassignment surgery (mastectomy, hysterectomy, colpectomy, phalloplasty).

RESULTS: Mean age at time of surgery was 28 yr. and 7 mo. and mean follow up is 23 months. Fourteen patients developed 25 fistulae. Of these, 15 fistulae healed spontaneously. Ten patients developed 11 urethral strictures or stenoses. Four were meatal stenoses and 7 were at the junction of the perineal to the phallic urethra. In total 11 patients (42%) underwent a major surgical procedure under general anesthesia to correct a complication. In total 18 patients (69%) developed a urological complication. Actually all patients out of this study group, void while standing without stenosis and without fistula.

CONCLUSION: Obtaining a competent urethra in total phalloplasty remains a challenge. Although a high complication rate is described, these complications are relatively easily treated with high success rate. Suggestions are made to further reduce the urological complication rate in total phalloplasty.