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Review
. 2022 Dec;11(12):1762-1770.
doi: 10.21037/tau-22-174.

Urethral outcomes in metoidioplasty and phalloplasty gender affirming surgery (MaPGAS) and vaginectomy: a systematic review

Christopher D Ortengren  1 , Gaines Blasdel  2 , Ella A Damiano  3 , Peter D Scalia  4 , Tamara S Morgan  1 , Pamela Bagley  5 , Heather B Blunt  5 , Glyn Elwyn  4 , John F Nigriny  6 , Jeremy B Myers  7 , Mang L Chen  8 , Rachel A Moses  1
Affiliations
Review

Urethral outcomes in metoidioplasty and phalloplasty gender affirming surgery (MaPGAS) and vaginectomy: a systematic review

Christopher D Ortengren et al. Transl Androl Urol. 2022 Dec.

Abstract

Background: There is currently a paucity of data on urethral-related outcomes in metoidioplasty and phalloplasty gender affirming surgery (MaPGAS) with urethral lengthening (UL)and vaginectomy.

Methods: A systematic review was performed utilizing MEDLINE, Web of Science, Cochrane Library, Europe PMC, OSF Preprints, and EMBASE. Methodologic quality was scored using Methodological Index for Non-Randomized Studies (MINORS) criteria. Four independent reviewers performed the article evaluation, data extraction, and methodologic quality assessment. Primary outcomes included standing to urinate/pee (STP), penile length, glanular meatus, urethral stricture, fistula, and flap necrosis. Results were summarized qualitatively with descriptive statistics.

Results: A total of 2,881 articles of which 11 retrospective reviews of 13 cohorts met criteria; 4.3/16 average (avg) MINORS score. Six metoidioplasty cohorts had an average penile length of 6 cm, 74% reported successful STP, and a quarter developed stricture or fistula. Phalloplasty cohorts included radial forearm flap (RF) and Anterolateral Thigh flap (ALT). Of the 4 RF studies nearly a third developed a stricture or fistula and only one study reported 99% STP with a glanular meatus. Three ALT studies reported no length but had 80-90% STP with a glanular meatus and a quarter with stricture or fistula.

Conclusions: Urethral complications in MaPGAS-UL in a cohort with prior vaginectomy are common and variably reported. Patient centered outcome measures as well as clearly defined outcome metrics created in partnership with community members are needed.

Keywords: Systematic review; metoidioplasty; phalloplasty; transgender; urethral stricture.

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Conflict of interest statement

Conflicts of interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-22-174/coif). All authors report that this work was supported by a grant 1R21DK124733-01 from the National Institute of Diabetes and Digestive Diseases. JBM reports a grant from R21 NIH Decision making in transmasculine surgery. MLC reports that AUA 2022 New Orleans Registration fee waived for presenting on implants. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers.
See this image and copyright information in PMC

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References

    1. Canner JK, Harfouch O, Kodadek LM, et al. Temporal Trends in Gender-Affirming Surgery Among Transgender Patients in the United States. JAMA Surg 2018;153:609-16. 10.1001/jamasurg.2017.6231 - DOI - PMC - PubMed
    1. Hage JJ, De Graaf FH. Addressing the ideal requirements by free flap phalloplasty: some reflections on refinements of technique. Microsurgery 1993;14:592-8. 10.1002/micr.1920140910 - DOI - PubMed
    1. Ganor O, Taghinia AH, Diamond DA, et al. Piloting a Genital Affirmation Surgical Priorities Scale for Trans Masculine Patients. Transgend Health 2019;4:270-6. 10.1089/trgh.2019.0038 - DOI - PMC - PubMed
    1. Al-Tamimi M, Pigot GL, van der Sluis WB, et al. The Surgical Techniques and Outcomes of Secondary Phalloplasty After Metoidioplasty in Transgender Men: An International, Multi-Center Case Series. J Sex Med 2019;16:1849-59. 10.1016/j.jsxm.2019.07.027 - DOI - PubMed
    1. Takamatsu A, Harashina T. Labial ring flap: a new flap for metaidoioplasty in female-to-male transsexuals. J Plast Reconstr Aesthet Surg 2009;62:318-25. 10.1016/j.bjps.2008.11.038 - DOI - PubMed