What is a Urethral Stricture?
Urethral stricture is a narrowing or closure of the new urethra caused by scar tissue in the urethra. Urethral stricture is a complication that typically develops 6-12 months after Metoidioplasty. Symptoms include a weak urine stream and difficulty urinating.
While there aren't enough studies to offer precise estimates of the risk of stricture some reliable data exists:
|Study||Rate of Stricture
|The Role of Clitoral Anatomy in Female to Male Sex Reassignment Surgery.
Vojkan Vukadinovic, Borko Stojanovic, Marko Majstorovic, and Aleksandar Milosevic. The Scientific World Journal, Volume 2014 (2014), Article ID 437378, 7 pages
|Metoidioplasty as a single stage sex reassignment surgery in female transsexuals: Belgrade experience. Djordjevic ML, Stanojevic D, Bizic M, Kojovic V, Majstorovic M, Vujovic S, Milosevic A, Korac G, Perovic SV. J Sex Med. 2009 May;6(5):1306-13. Epub 2009 Oct 27.||2.43%||82|
|Long-term outcome of metaidoioplasty in 70 female-to-male transsexuals. Hage JJ, van Turnhout AA. Ann Plast Surg. 2006 Sep;57(3):312-6.||35.71%||70|
|Metoidioplasty: a variant of phalloplasty in female transsexuals. S.V. Perovic, M.L. Djordjevic. BJU International, Volume 92, Issue 9, pages 981-985, December 2003||9.1%||22|
How Is a Urethral Stricture Treated?
Successfully treating urethral strictures in Metoidioplasty patients can be challenging for several reasons:1
- Absence of corpus spongiosum leads to poor coverage of any urethral reconstruction.
- Absence of foreskin, elastic penile skin, and scrotal skin makes reconstruction with preputial, penile, and scrotal skin grafts or flaps impossible.
- Wound-healing problems can lead to dense local scar tissue.
There are a number of different treatment options depending on the size and location of the stricture:2
- For short strictures near the tip of the penis, a small cut can be made to enlarge the opening of the urethra.
- For short strictures in the junction of the of the native and neo urethras, excision and closure of the stricture may be possible.
- For longer strictures in the junction of the of the native and neo urethras, or in cases where the above solution failed, excision and closure of the stricture augmented by buccal (inside of cheek) or bladder mucosa can be done in a single stage.
- For longer strictures in the shaft of the penis, or in cases where the above solution failed, excision and closure of the stricture augmented by buccal mucosa (inside of cheek)—or less commonly, remnants of vaginal mucosa, or rectal mucosa—can be done in in two stages, separated by 6 months.
- If difficult cases of persistent strictures, a final option is to relocate the urethra back to the perineum. Standing up to urinate without a device would not be possible.
1. Lumen, Nicolaas et al. Urethroplasty for Strictures After Phallic Reconstruction: A Single-Institution Experience. European Urology , Volume 60 , Issue 1 , 150 - 158, http://www.europeanurology.com/article/S0302-2838(10)01083-3/fulltext#sec0010
2. Dmitriy Nikolavsky et al, "Management of Unfavorable Urologic Sequelae After Phalloplasty in Transgender Patients," in Gender Affirmation: Medical and Surgical Perspectives (Thieme, Dec 1, 2016.)