To evaluate outcomes of three urethroplasty techniques for pars fixa (PF) urethral strictures and provide a treatment algorithm based on stricture characteristics. The PF is an essential anatomic region of the neourethra created in gender-affirming phalloplasty and metoidioplasty.
Urethral strictures in this region present a reparative challenge given its unique anatomy and vascularization.
A total of 41 urethroplasties performed on 41 patients between March 2018 and June 2021 were reviewed at two surgical centers. A Heineke-Mikulicz (HM) repair was done for strictures under 20 mm when the proximal and distal urethral segments were mobile and supported a tension-free closure. Substitution urethroplasty with ventral onlay buccal mucosal graft was utilized for strictures under 40 mm not suitable for HM repair. Complex or long (≥ 40 mm) strictures were treated by two-stage Johansen urethroplasty. Success of each surgical approach was defined by a minimum of 12-month follow-up without the need for a repeat intervention.
Mean follow-up was 30.2 months (range: 12.4 - 52.0 months). Mean stricture length was 16.9 mm (range: 2 - 55 mm). Most strictures (46%) were located at the distal PF. HM urethroplasty had a success rate of 44% (n = 16). Substitution urethroplasty had a success rate of 92% (n = 13). Two-stage Johansen urethroplasty had a success rate of 75% (n = 12).
The success rates of PF urethral stricture repair ranged from 44 to 92% depending on the surgical approach, and the best reparative procedure depends on stricture length, severity, and local tissue mobility.
Urology. 2023 Jul 17 [Epub ahead of print]
Hoyoung Jung, Mang L Chen, Richard Wassersug, Smita Mukherjee, Sahil Kumar, Peter Mankowski, Krista Genoway, Alex Kavanagh
Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Gender Surgery Program, Vancouver Coastal Health, Vancouver, British Columbia, Canada., G.U. Recon, San Francisco, California, USA., Gender Surgery Program, Vancouver Coastal Health, Vancouver, British Columbia, Canada., Gender Surgery Program, Vancouver Coastal Health, Vancouver, British Columbia, Canada; Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada., Gender Surgery Program, Vancouver Coastal Health, Vancouver, British Columbia, Canada; Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/37467808