What is a Urinary Fistula?
A urinary fistula is an opening in the urethra that causes urine leakage. When Metoidioplasty is performed with Urethral Lengthening, fistulas most commonly occur at the junction of the native and neourethra (although they can occur anywhere along the neourethra.) A fistula that heals with excessive scarring may eventually lead to stricture formation.
While there aren't enough studies to offer precise estimates of the risk of fistula some reliable data exists:
|Study||Rate of Fistula
|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
|Comparison of Two Different Methods for Urethral Lengthening in Female to Male (Metoidioplasty) Surgery. Djordjevic ML, Bizic MR. J Sex Med. 2013 Feb 27. doi: 10.1111/jsm.12108.||7.72%||207|
|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.||8.5%||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.||37%||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||13.6%||22|
What Causes a Urinary Fistula?
- Inadequate blood supply to the urethra
- Too much moisture causing junction of native and neourethra to not heal well
- Urethral catheters left in too long1
How Is a Urinary Fistula Treated?
While most urethral fistulas can be managed using non-surgical options and/or urinary diversion with a catheter, up to 15% of patients required revision surgery in the study with the longest follow-up duration, to date.2
For fistula repair surgery, Reconstructive Urologist Dr. Dmitriy Nikolavsky uses a fasciocutaneous groin flap or a labial fat pad flap harvested from the neoscrotum.3
Footnotes1. David J. Ralph. "Urethral Complications in Phalloplasty", http://library.transgenderzone.com/?page_id=1680.
2. Morrison, Shane D., Chen, Mang L., Crane, Curtis N. An overview of female-to-male gender-confirming surgery, Nature Reviews Urology, 14, 486–500 (2017). http://www.nature.com/nrurol/journal/v14/n8/full/nrurol.2017.64.html
3. 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.)