Urethral stricture
ICD-10 N35ICD-11 GC03

Urethral Stricture in Transgender Males (Transmen): Surgical Management at Least Six Months After Neophalloplasty

Urethral stricture is a recognised complication following neophalloplasty in transgender males. The optimal surgical approach depends on stricture location within the neourethra and its length, and timing relative to the phalloplasty procedure is a critical determinant of which interventions are appropriate.

Clinical scenario

This protocol applies to transgender males (transmen) who present with urethral stricture and are at least six months post-neophalloplasty. The six-month interval is a minimum threshold before open reconstructive or endoscopic procedures should be considered.

Timing note: Endoscopic incision and urethroplasty should not be performed within six months after neophalloplasty. Additionally, endoscopic incision should not be repeated more than twice for strictures in transmen, except with palliative intent.
Approach overview

Once the six-month window has passed and surgical reconstruction is indicated, the approach to open repair differs depending on whether the stricture is located at the urethral anastomosis or within the neophallic urethra itself. Surgical options include excision-based reconstruction for certain short anastomotic strictures, as well as staged reconstructive procedures for strictures of the neophallic urethra.

The full protocol details the specific surgical criteria, staging considerations, and reconstructive strategies — access it via the link below.

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References

  1. Do not perform endoscopic incision or urethroplasty within six months after neophalloplasty.
  2. Do not perform more than two endoscopic incisions for strictures in transmen unless with palliative intent.
  3. After failure of endoscopic incision or in case of a (nearly-) obliterative short stricture at the anastomosis, excision and primary anastomosis has been proposed with a 57.1% patency rate.
  4. Perform staged urethroplasty for strictures at the neophallic urethra if open reconstruction is indicated.
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