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(4) Although vaginectomy at the time of pars fixa urethral construction is done successfully at many
centers, anecdotal reports of the colpectomy cavity becoming a urinary diverticulum should be considered
when performing these procedures simultaneously.
(5) There is considerable variation among centers in reported rates of minor and major urethral
complications, even those using nearly identical techniques. Most importantly, there are no data at present
demonstrating that any given staging of procedures, or that any of many variations in surgical specifics for
urethral construction result in consistent reductions in subsequent rates of urethral strictures or fistulas.
(6) The placement of erectile prostheses in transmasculine patients after phalloplasty will be guided by the
expertise, philosophy, and outcomes of each surgical team. However, all phalloplasty patients should be
informed in advance that the majority of long-term studies report high rates of infection and extrusion of
erectile devices.

Despite this phalloplasty chaos, we emphasize that masculinizing genital GCS is medically necessary
with well-demonstrated health benefits for properly selected patients. With an increased volume of these
[78]
procedures being performed , and with further research in all domains, we anticipate continual advances
in this difficult and challenging area of surgery.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception, design and intellectual content of this article, provided
administrative, technical, and material support: Lane M, Sluiter EC, Morrison SD, Coon D, Gast KM, Berli
JU, Kuzon WM

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Written informed consent was obtained for publication of patient images used in this manuscript. Consent
for use in publication was obtained by Dr. Berli.

Copyright
© The Author(s) 2020.

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