What is a Urethral Stricture?
Urethral stricture is a narrowing or closure of the new urethra caused by scar tissue or hair growth in the urethra (from hair-bearing tissue used to construct the urethra.) Strictures typically develop 6-12 months post-operatively. Symptoms include a weak urine stream and difficulty urinating. If surgical treatment is not pursued, the patient will likely face a lifetime of repeated manual dilations.1
Treatment of a Urethral Stricture
Successfully treating urethral strictures in FTM Phalloplasty patients can be challenging for several reasons:2
- 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 associated with phalloplasty can lead to dense local scar tissue.
There are a number of different treatment options depending on the size and location of the stricture:3
- 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.
Prevention of a Urethral Stricture
Two stage Phalloplasty procedures generally have a lower rate of complications than single stage procedures, and pre-lamination with a full thickness graft can reduce the complication rate.6
1. Dmitriy Nikolavsky. "Urethral Stricture Disease", http://www.uroreconstruction.com/urethral-stricture-disease-2/.
2. 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
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.)
4. Lumen, Nicolaas et al. Urethroplasty for Strictures After Phallic Reconstruction: A Single-Institution Experience.
5. Monstrey SJ, Ceulemans P, Hoebeke P. Sex Reassignment Surgery in the Female-to-Male Transsexual. Seminars in Plastic Surgery. 2011;25(3):229-244. doi:10.1055/s-0031-1281493. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312187/
6. Rashid M, Tamimy MS. Phalloplasty: The dream and the reality. Indian J Plast Surg [serial online] 2013 [cited 2017 Aug 2];46:283-93. http://www.ijps.org/text.asp?2013/46/2/283/118606