Abstracts from the New England Section of the AUA 2021

© The Canadian Journal of Urology TM : International Supplement, October 2021 P17 Urethral Complications in Transmasculine Genital Reconstructive Surgery (TMGRS): A Systematic Review Christopher D. Ortengren, MD 1 , Gaines Blasdel, BS 2 , Ella A. Damiano, MD 1 , Peter Scalia, PhD MSc 3 , John F. Nigriny, MD 1 , William Bihrle, III, MD 1 , Benjamin Boh, DO 1 , Pamela Bagley, PhD MLIS 4 , Heather B. Blunt, MSILS 4 , Glyn Elwyn, MD PhD 1 , Mang Chen, MD 5 , Jeremy B. Myers, MD 6 , Rachel A. Moses, MD 1 1 Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; 2 New York University, New York, NY, USA; 3 Geisel School of Medicine at Dartmouth, Hanover, NH, USA; 4 Dartmouth College, Hanover, NH, USA; 5 G.U. Recon, San Francisco, CA, USA; 6 University of Utah, Salt Lake City, UT, USA Intreoduction: The purpose of this systematic review is to evaluate urethral related outcomes in Transmasculine Genital Reconstructive Surgeries (TMGRS) with urethral lengthening (UL), which includes metoidioplasty and phalloplasty. Materials & Methods: A systematic review was planned in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines by 4 independent reviewers and one content expert. A search for metoidioplasty and phalloplasty related literature was preformed utilizing MEDLINE, Cochrane Library, Web of Science, EMBASE, Preprint, Google Scholar, Trial Registries, and Conference Proceedings. The search was registered with Open Science Framework. Publication quality was assessed using the Methodological Index for Non-Randomized Studies criteria (MINORS). Primary outcomes extracted included demographics, phallus length, standing micturition, phalloplasty type, glanular meatus, mucocele, urethral stricture, and fistula. Results and ranges of outcome probabilities were summarized in a qualitative analysis using descriptive statistics. Studies or specific patient cohorts within studies were excluded if patients did not have a vaginectomy. Results: Using Population, Intervention, Comparison and Outcomes tool, 2,881 articles were identifiedwith 12 articles meeting criteria. All articles were retrospective reviews with an average (avg) patient age of 33(SD5) years with aMINORS score of 4.3/16. Evaluated phalloplasty cohorts include those who underwent the Radial Forearm Free Flap (RFFF), Anterolateral Thigh Flap (ALT), or Musculocutaneous Latissimus Dorsi Flap (MLD) with vaginectomy. Six metoidioplasty studies yielded the following results: N=874, avg length of follow up (LOF) 31 months, phallus length 5.6-7cm, standing micturition 48%-100%, stricture 1.4% - 63%, fistula 8%-50%, and mucocele 1%- 12%. Four RFFF phalloplasty studies yielded: N= 288, avg LOF 18 (SD9) months, phallus length 11cm (1 study), standing micturition 99% (1 study), glanular meatus 70%-100%, stricture 11%-81%, and fistula 10%-79%. Three studies were identified for ALT flap: N=85, avg LOF 50 (SD36) months, standing micturition 56-100%, glanular meatus 75 - 100%, stricture 20%-38%, and fistula 20%-25%. One study met criteria for MLD flap: N= 129, avg LOF 43 months, phallus length 14.6cm, glanular meatus 15% (or 63%with 2+ planned surgeries), stricture 27%, and fistula 26%. Conclusions: Despite a continued increase in TMGRS performed with UL, in this comprehensive systematic review we demonstrate urethral related complications remain high. Further, the existing published literature remains heterogeneous and of limited methodologic quality. Concurrent Poster Session II PresentingComplaints of TransgenderWomenRequiringUrethral Revision After Feminizing Genital Gender-Affirming Surgery Khushabu Kasabwala, MD 1 , Rachel A. Mann, MD 2 , M. Ryan Farrell, MD 1 , Alex J. Vanni, MD 1 , Nicholas Kim, MD 2 , Joseph J. Pariser, MD 2 1 Lahey Hospital and Medical Center, Burlington, MA, USA; 2 University of Minnesota, Minneapolis, MN, USA Introduction: Vaginoplasty is themost common feminizing gender-affirming surgery performed for the male-to-female patient and is an effective treatment for gender dysphoria. More 20% of patients require re-operation for complications following surgery for functional or aesthetic issues. Voiding symptoms following surgery are distressing and non-affirming and may be related to a variety of issues including meatal stenosis or stricture, urethral angulation, urethral fistulas, or external scarring. Given the lack of standardized patient-reported outcome measures, it is often difficult to identify patients who require revision surgery for voiding-related issues. Our aim was to evaluate the presenting symptoms of patients who required revision surgery for voiding complaints after feminizing vaginoplasty. Materials & Methods: We performed a retrospective review of all patients who had revision surgery for voiding complaints after feminizing vaginoplasty for gender dysphoria from January 2017 to April 2021 at two institutions. Demographic and clinical characteristics, including pre-operative voiding complaints and examfindings, as well as surgical data were reviewed for each subject. Results: A total of 22 patients were identified. The median age at revision urethral surgery was 39 (interquartile range [IQR] 30-61) years. The median time fromdate of primary vaginoplasty to reconstructive urethral surgerywas 39 (IQR 15-50) months. The majority of patients had prior penile inversion vaginoplasty (n= 20, 90.9%). Most patients presented with 2 or more voiding complaints (n = 15, 68.2%). The most common complaints included anterior stream(68.2%), weak streamand straining (36.4%) andhygiene issues including urine pooling (27.3%).Anteriorly located urethras (n=15, 68.2%) were themost common indication for subsequent urethral surgery, followedbymeatal stenosis (n=5, 22.7%). Revision surgerywas done in amajority of patients using a ventral urethrotomy or 1st stage Johanson urethroplasty (90.9%).At the time of urethral revision, 18 patients (81.8%) had simultaneous procedures performed (such as labiaplasty, clitoroplasty, or procedure for canal stenosis). Conclusions: Presenting complaints for revision urethral surgery after primary vaginoplasty can be diverse and evaluation of the external genitalia is essential for diagnosis and surgical planning. The most common complaint was deviated urinary stream secondary to an anteriorly-locatedmeatus. This was most frequently repaired with first-stage Johanson type urethroplasty. A thorough review of symptoms should be performed prior to surgery as patients may have other genital-related concerns that require intervention at the time of urethral revision. P16 42

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