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Zisman et al. Plast Aesthet Res 2022;9:15 Plastic and
DOI: 10.20517/2347-9264.2021.113
Aesthetic Research

Review Open Access

Management of urethral strictures after
masculinizing genital surgery in transgender men

Ariel Zisman, Joseph A. Baiocco, Rajveer S. Purohit

Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10075, USA.
Correspondence to: Dr. Ariel Zisman, Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 445 E. 77th
Street, New York, NY 10075, USA. E-mail: ariel.zisman@mountsinai.org

How to cite this article: Zisman A, Baiocco JA, Purohit RS. Management of urethral strictures after masculinizing genital surgery
in transgender men. Plast Aesthet Res 2022;9:15. https://dx.doi.org/10.20517/2347-9264.2021.113

Received: 8 Oct 2021 First Decision: 16 Dec 2021 Revised: 1 Jan 2022 Accepted: 17 Jan 2022 Published: 16 Feb 2022

Academic Editors: Stan Monstrey, ML Djordjevic Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Transgender men undergoing phalloplasty and metoidioplasty have a high rate of urethral stricture. Evaluation of
stricture includes evaluation of symptoms and uroflow, cystoscopy, and retrograde urethrogram. Important
anatomic differences between the phallus of cis-gender and transgender men increase the likelihood and
complexity of treating urethral strictures in transgender men after surgery. Urethral strictures after masculinizing
procedures are more likely to require open surgical treatment and recur after treatment. There is a paucity of data,
but less invasive options such as dilation and urethrotomy have had minimal success. Open surgical options with a
variety of techniques, including one-stage and two-stage techniques, have higher success rates in treating
strictures, but there is minimal comparative data on outcomes. We present a review on management options for
urethral reconstruction in transgender men and our data on urethroplasty for these patients.

Keywords: Phalloplasty, urethroplasty, urethral stricture disease, gender-affirming surgery, metoidioplasty

INTRODUCTION
Phalloplasty and metoidioplasty are technically challenging masculinizing genital surgeries for transgender
men. A metoidioplasty with urethral lengthening is a definitive option offering a sensate phallus and
permitting urination while standing. For other men, the final end-point is a phalloplasty with urethral
construction and with penile implants, one that permits penetrative intercourse. The creation of the

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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