Introduction and Objectives
Urethral reconstruction presents one of the most complex surgical procedures in metoidioplasty. We appraised the role of local vascularized genital flaps (vaginal wall, clitoral and labial skin) in urethral reconstruction as a part of one stage metoidioplasty.
Material and Methods
Total of 112 patients underwent metoidioplasty from August 2003 to February 2009. Urethral reconstruction consists of two parts: (I) creation of proximal part of the neourethra by joining of the flap formed from anterior vaginal wall and proximal part of divided urethral plate, (II) reconstruction of distal part of neourethra using different genital local flaps; in 21 cases longitudinal island clitoral skin flap was button-holed ventrally and tabularized (group 1); combined buccal mucosa graft and dorsal island skin flap was used in 33 patients (group 2), while in remaining 58 patients combined buccal mucosa graft and labia minora skin flap was used for urethral reconstruction (group 3). One stage metoidioplasty was done as previously reported.
The mean follow up was 37.5 months (range 4–71 months). All patients reported voiding while standing. Comparing these different types of urethral reconstruction, better results are achieved in groups with combined buccal mucosa graft and vascularized genital flaps, especially labia minora flap, where success rate was 92%. In this group of patients fistula occured in 4 patients and was resolved three months later by minor surgical procedure. One patient had distal urethral stricture which was resolved by simple dialation.
Urethral reconstruction in female to male transsexuals, undergoing metoidioplasty as one stage surgical procedure, relies on appropriate and versatile use of different genital flaps. Permanent improvement in technique and results are needed for minimal complication rate. Combination of buccal mucosa graft and labia minora skin flap presents the most successful alternative for urethral reconstruction in these patients.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.