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Colpectomy reduces the risk of urethral fistula after urethroplasty in transgender men undergoing genital gender confirming surgery

Al-tamimi, M1; Pigot, GL1; van der Sluis, WB1; van de Grift, TC1; Mullender, M1; Groenman, F1; Bouman, MB1

1: VU University medical center, Netherlands

Objectives: Urethral fistulas develop frequently after genital gender confirming surgery (CGS) with urethroplasty in transgender men. These fistulas can impede the possibility to void while standing. We hypothesize that removal of the vaginal cavity results in a firm urethral anastomosis between the native and fixed part of the urethra and provides sufficient well-vascularized tissue which is important to prevent fistulas. Therefore, in our hospital, a colpectomy is mandatory before undergoing GCS with urethroplasty since 2009.We aim to assess the effect of performing a colpectomy prior to genital urethroplasty in transgender men on the incidence of urethral fistulas.

Material and Methods: Retrospective analysis of medical records of all transgender men who underwent GCS with urethral lengthening from 1989 to November 2016 at a tertiary referral center. Patient demographics, surgical characteristics, urethral fistulas and their management, pre-GCS and secondary performed colpectomy were recorded using standardized case report forms.

Results: Two hundred ninety-four transgender men underwent GCS with urethral lengthening. Of 232 patients without colpectomy, 111 (48%) developed a fistula. Of 62 patients who underwent prior colpectomy, 13 (21%) developed a fistula(p<0.01). Secondary colpectomy was performed in 17 patients as effective treatment for fistulas of the proximal urethral anastomosis and the fixed urethra.

Conclusion: Performing a colpectomy prior to GCS with urethral lengthening drastically decreases the incidence rate of urethral fistula. Also, secondary colpectomy can be performed as effective treatment for fistula proximal to the anastomosis between the native urethra and the fixed urethra


Work supported by industry: no.

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