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Salvage of (partial) neo-urethral necrosis after phalloplasty in transgender men

Al-tamimi, M1; van der Sluis, WB1; Pigot, GL1; Buncamper, ME1; Bouman, MB1

1: VU University medical center, Netherlands

Objectives: Some transgender men express the desire to void while standing. In order to enable this, urethral lengthening is required, preferably using a fasciocutaneous flap. Vascular complications in these flaps are rare but can result in necrosis and impede the possibility to void while standing. We describe the (micro)surgical reconstructive management after neo-urethral necrosis in phalloplasty in transgender men.

Material and Methods: Four consecutive cases of (partial) neo-urethral necrosis management after free flap phalloplasty in transgender men are presented. As salvage surgery we performed a secondary modified free radial forearm flap (FRFF) or a groin flap.

Results: All of the flaps remained vital. After a 1.5-year follow-up three out of four patients could void while standing with a good urinary flow. One patient cannot void while standing due to a spraying urinary stream and is awaiting minor surgical correction. All patients are satisfied with the results.

Conclusion: Neo-urethral necrosis in transgender men undergoing double flap or tube-in-tube phalloplasty is a rare, but serious complication causing major discomfort for those with the wish to void while standing. Nevertheless, it can be successfully salvaged using a modified FRFF or a groin flap to facilitate postoperative voiding.


Work supported by industry: no.

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