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Dr. Karl Coutinho
Reconstructive Urologist Specializing in Phalloplasty Complications and Urethral Reconstruction
Dr. Karl Coutinho, MD is a board-certified urologist with advanced training in reconstructive urology who plays a key role in gender-affirming surgical care—especially for patients navigating urinary complications after Phalloplasty. As a key member of the GAMMA (Gender Affirming Medical and Microsurgical Associates) team, Dr. Coutinho collaborates closely with Dr. Jonathan Keith and Dr. Drew Marano to support urethral reconstruction, complication repair, and implant procedures.
For many people seeking phalloplasty, the ability to urinate comfortably and confidently through the phallus is a central goal of surgery. When complications arise, they can be physically exhausting and emotionally devastating. Dr. Coutinho’s work is centered on helping patients regain function, comfort, and quality of life through advanced reconstructive urology care.
Education, Training and Memberships
- Undergraduate degree in Biology and Economics, New York University
- Medical degree, New Jersey Medical School (2010)
- Internship in General Surgery
- Residency in Urology, Mount Sinai Hospital (New York City)
- Fellowship training in genitourinary trauma and reconstruction, Northwestern Memorial Hospital (Chicago) and University Hospitals (Cleveland)
- Additional training in genitourinary prosthetics and reconstruction through Perito Urology (Miami)
- Visiting fellow, Kulkarni Endosurgery Institute (Pune, India)
- Founding member, Society of Gender Surgeons
- Fellow of the American College of Surgeons
Relevant Research
Dr. Coutinho has published widely and presented at national medical conferences in urologic reconstruction, military medicine, pediatric urology, kidney transplant, and genitourinary prosthetics. He has also served as a principal investigator and co-investigator on multiple FDA clinical trials, including research on the Optilume drug-coated balloon—an advanced, minimally invasive treatment option for certain urethral strictures.
Phalloplasty Complication Repairs
Two of the most common urinary complications after Phalloplasty are urethral strictures and urethral fistulas.
A urethral stricture occurs when scar tissue causes the urethra (the tube that carries urine out of the body) to narrow. This can lead to a weak stream, spraying, painful urination, urinary retention, repeated urinary tract infections, and in severe cases, the inability to urinate without catheterization. Strictures are not only physically painful—they can interfere with daily life, work, travel, intimacy, and emotional wellbeing.
Optilume is designed to treat strictures by combining two approaches in one procedure: mechanical dilation of the narrowed area using a balloon, and delivery of a medication (paclitaxel) directly to the urethral tissue to help reduce scar regrowth. For select patients with shorter or less complex strictures, this can offer a less invasive alternative to repeat dilations or more extensive reconstructive surgery. However, treatment recommendations depend on the location, length, and severity of the stricture, as well as a patient’s prior surgical history.
Another common urinary complication following phalloplasty is a urethral fistula. A urethral fistula is an abnormal opening that allows urine to leak out of the urethra before it reaches the tip of the phallus. Patients may notice urine coming from a second opening, wetness after urination, skin irritation, or difficulty healing. Fistulas can be particularly distressing because they often require long periods of wound care, activity restrictions, and in some cases additional surgery.
Strictures and fistulas can sometimes occur together, and one complication may increase the risk of the other, making expert evaluation by a reconstructive urologist who specializes in urethral repair especially important.
Dr. Coutinho’s fellowship training in genitourinary trauma and reconstruction is directly applicable to the complex urethral repairs sometimes required after Phalloplasty. He treats stricture and fistula complications with a reconstructive approach that is individualized to each patient’s anatomy, surgical history, and goals. Depending on the situation, treatment may include minimally invasive options such as Optilume, as well as more advanced reconstructive techniques for complex strictures, fistulas, and scar-related urinary issues.
Implant Surgeries
In addition to complication repair, Dr. Coutinho supports later-stage masculinizing genital surgery by performing implant procedures that help patients achieve both aesthetic and functional goals after Phalloplasty. His implant services include placement of testicular implants and/or erectile implants (inflatable penile prosthesis).
Practice Locations
Dr. Coutinho operates with the GAMMA surgical team in New Jersey and New York City. He is affiliated with Cooperman Barnabas Medical Center (Livingston, New Jersey), University Hospital (Newark, New Jersey) and Lenox Hill Hospital (New York City).
Referrals
While Dr. Coutinho most often sees patients in coordination with Dr. Keith and Dr. Marano, he may also evaluate select referrals for revision or repair surgery following procedures performed at other institutions. To learn more about referrals or consultation pathways, contact the GAMMA team.