Table 1 Qualitative synthesis of the systematic review of the literature.
From: Systematic review of the outcomes of urethroplasty following urethral lengthening in transgender men
Study | Procedure | Population | Type of genital reconstruction | Urethral Disease | PRO | Recurrence Rate | Mean follow-up duration (months) | Key Findings |
|---|---|---|---|---|---|---|---|---|
PHALLOPLASTY | ||||||||
Beamer et al. (2021) [18] | Single stage double-face BMGU (Group 1); Stage urethroplasty (Group 2) | 14 transgender men (9 group-1; 5 group 2) | RFFF | Stricture (Prior treatment 56% in Group-1, 100% Group-2) Majority with additional complications (fistulas, vaginal remnant, additional strictures). | Mean IPSS 1 (group1) 3.9 (group2) Post-void dribbling 50%-100% | 22% Group1 0% Group2 | 33.9 (12–60) | Staged repairs effective; single-stage feasible with healthy tissue. Treatment algorithm introduced |
Lumen et al. (2011) [23] | HMP, EPA, free graft urethroplasty, pedicled flap, 2-stage | 79 (76 transgender men; 3 cis men) | 73 RFFF 6 ALT | 118 Stricture (52 initial) | NR | 41% | 39 | High recurrence rate for single-stage procedures; staged repairs recommended. |
Paganelli et al. (2023) [7] | Meatoplasty, EPA, BMGU, skin graft urethroplasty | 89 (78 transgender men; 11 cis men) | 26 RFFF 19 PESP 2 ALT 1 latissimus dorsi | Stricture (n = 48) and other phalloplasty associated complications | LUTS score 8.4 + /− 4.9 | 30% | 66 ( + /− 44) | High complication rates regardless of reconstruction type. |
Pariser et al. (2015) [17] | 1-stage BMGU | 10 patients (9 transgender men; 1 cis men) | RFFF | Stricture | NR | 50% | 9.5 (2.7–84) | BMGU may be more effective than endoscopic management, but failure remains common |
Reddy et al. (2023) [24] | HMP, EPA, 1-stage Johansen urethroplasty | 71 transgender men | 39 RFFF 29 ALT 2 latissimus dorsi 1 other | Stricture | NR | 52% Overall 58% after EPA 25% after 1-stage urethroplasty | 30 | Staged urethroplasty has the lowest failure rate among urethroplasties |
Rohrmann et Jakse (2003) [19] | EPA, BMGU, 2-stage urethroplasty | 25 transgender men | RFFF | 14 Strictures and fistulas | NR | 28% | NR | Pedicle skin graft is the best option for fistulas associated with short stricture |
Schardein et al. (2020) [21] | Double-face BMGU | 8 transgender men | RFFF | Stricture | Mean IPSS 3.1 (0–11), IPSS QoL 0.9 (0–3) | 25% | 31 (10–56) | High patient satisfaction with upright voiding restoration. |
Schardein et al. (2022) [20] | Staged BMGU for long pendulous strictures Redo vaginectomy (7/17) | 17 transgender men | 15 RFFF 2 ALT | Stricture > 7 cm | Improved markedly in 11/13 (85%), moderately in 2/13 (15%) | 12% | 24 (4–77) | Staged approaches effective for strictures >7 cm with high patient satisfaction. |
Verla et al. (2019) [22] | EPA urethroplasty | 44 transgender men | 35 RFFF; 9 ALT | Short isolated stricture ≤3 cm after DVIU failure | NR | 43% | 40 (7–125) | Stricture length and extravasation at first voiding are predictors of failure. |
Wilson et al. (2016) [27] | Fasciocutaneous flap reinforcement of BMGU | 3 patients (2 transgender men; 1 cis men) | RFFF | Stricture, 2 fistula | All voiding while standing | 33% | 7-43 | Fasciocutaneous reinforcement reduces tension, improves outcomes. |
METOIDIOPLASTY | ||||||||
Lumen et al. (2020) [26] | Fistuloplasty, ventral meatotomy, HMP, 2-stage, pedicled flap | 26 transgender men | Metoidioplasty | 14 fistula 8 stricture 4 both | NR | 33% after urethroplasty 39% after fistuloplasty | 15 | Fistuloplasty and urethroplasty are associated with failure in one-third of patients. |
De Rooij et al. (2022) [25] | Open urethroplasty (HMP, BMGU, fistulectomy, redo vaginectomy) | 96 transgender men | Metoidioplasty | 31 Stricture 44 Fistula 21 Both | NR | 18% after open urethroplasty for urethral stricture 28% after open urethroplasty for fistula | 36 (14–123) | Open techniques superior to endoscopic methods; colpectomy improves outcomes. |
BOTH PHALLOPLASTY AND METOIDIOPLASTY | ||||||||
De Rooij et al. (2022) [10] | HMP, EPA, 2-stage with or without graft, graft, pedicled flap, DVIU, Dilation | 72 transgender men | 56 Phalloplasty 16 Metoidioplasty | 147 Sticture (78 initial, 69 recurrent) | NR | 37% (43% after phalloplasty, 24% after metoidioplasty) | 61 (25–202) | Highest success rates were seen after HMP in short strictures; and after graft, pedicled flap, or 2 stage urethroplasties in longer or more complicated strictures. Higher success rates after metoidioplasty vs phalloplasty |
Jung et al. (2023) [40] | HMP, BMGU, 2-stage Johansen urethroplasty | 41 transgender men | 36 Phalloplasty 5 Metoidioplasty | Stricture (46% were located at the distal pars fixa including the pars fixa / pars pendulum anastomosis) | NR | 8% for BMGU 66% for HMP 25% for 2-stage Johansen | 30 (12–52) | Substitution urethroplasty optimal for mid-length strictures; staged for longer strictures. |
