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Zisman et al. Plast Aesthet Res 2022;9:15 https://dx.doi.org/10.20517/2347-9264.2021.113 Page 5 of 10

Figure 2. Urethral fistula and Pars fixa urethral stricture repair with local skin flap. (A) Fistula site marked. (B) Incision of fistula and
stricture. (C) Phallus after repair.

Figure 3. Post-phalloplasty pendulos pan-urethral stricture on retrograde urethrogram (RUG).

MANAGEMENT OF NEO-PHALLIC STRICTURES
Urethral dilation
A variety of techniques can be utilized to dilate a urethral stricture after both phalloplasty and
metoidioplasty. These techniques include placement of progressive larger sounds in the urethra, placement
of urethral balloon which is inflated at the site of a stricture, placement of a guidewire with progressively
larger sounds and/or a filiform and progressively larger followers. Clean intermittent catheterization (CIC)
has been utilized in an attempt to maintain urethral patency and effectively form repeated urethral dilations.

Internal urethrotomy can be accomplished with either a cold knife or a laser and with or without
concomitant steroids. Use of concomitant local corticosteroids injection into the stricture has been
[14]
advocated to prevent recurrence in cis-gender urethral strictures but has not shown significant efficacy
and has not been evaluated in the transgender population.

There is very little data on the use of dilations or urethrotomy for urethral stricture in the neo-phallus.
Repeat dilations in the cis-gender population have been shown to be ineffective. Because the majority of
neo-phallic strictures occur from ischemic phenomenon, there is little reason to suspect that dilations are an
effective or curative form of treatment in this population. Direct vision internal urethrotomy has poor
results in neophallic stricture disease with failure rates of 87% .
[15]