Surgical outcomes and proposal for a treatment algorithm for urethral strictures in transgender men
| Autor: | Femke R. M. Peters, R. Jeroen A. van Moorselaar, Mark-Bram Bouman, Garry L.S. Pigot, Wouter B. van der Sluis, Muhammed Al-Tamimi, Brechje L. Ronkes, Freek P. W. de Rooij |
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| Přispěvatelé: | Urology, APH - Quality of Care, Plastic, Reconstructive and Hand Surgery, APH - Personalized Medicine, APH - Methodology, Other Research |
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Adult
Male Reoperation Urethral stricture Urology 030232 urology & nephrology Urination Metoidioplasty Transgender Persons 03 medical and health sciences Young Adult 0302 clinical medicine Urethra Interquartile range Transgender medicine Sex Reassignment Surgery Humans Urethrostomy Retrospective Studies Urethral Stricture business.industry Anastomosis Surgical Retrospective cohort study Pedicled Flap medicine.disease Urodynamics Treatment Outcome 030220 oncology & carcinogenesis Female Phalloplasty business Algorithm Algorithms Follow-Up Studies Penis |
| Zdroj: | BJU International, 129(1), 63-71. Wiley-Blackwell de Rooij, F P W, Peters, F R M, Ronkes, B L, van der Sluis, W B, Al-Tamimi, M, van Moorselaar, R J A, Bouman, M-B & Pigot, G L S 2022, ' Surgical outcomes and proposal for a treatment algorithm for urethral strictures in transgender men ', BJU International, vol. 129, no. 1, pp. 63-71 . https://doi.org/10.1111/bju.15500 |
| ISSN: | 1464-4096 |
| Popis: | Objectives To assess our results of surgical treatment for urethral strictures in transgender men, and to provide a surgical treatment algorithm. Patients and methods A single centre, retrospective cohort study was conducted of transgender men who underwent surgical correction of their urethral stricture(s) between January 2013 and March 2020. The medical charts of 72 transgender men with 147 urethral strictures were reviewed. The primary outcomes were the success and recurrence rates after surgical treatment for urethral strictures. Results The median (interquartile range [IQR]) follow-up was 61 (25-202) months. At last follow-up, 50/72 (69%) were able to void while standing (after one [60%], two [20%], three [6%], four [8%], five [4%], or seven [2%] procedures), 10/72 (14%) await further treatment, two of the 72 (3%) sat to void despite good urodynamic function, and 10/72 (14%) had a definitive urethrostomy. Of 104 surgical treatments included in separate success rate analysis, 65 (63%) were successful (43/75 [57%] after phalloplasty, 22/29 [76%] after metoidioplasty). The highest success rates in short urethral strictures were seen after a Heineke-Mikulicz procedure (six of seven cases), and in longer or more complicated urethral strictures after two-stage with graft (four of six), two-stage without graft (10/12), pedicled flap (11/15, 73%), and single-stage graft (seven of seven) urethroplasties. Grafts used were buccal mucosa or full-thickness skin grafts. Success rates improved over time, with success rates of 38% and 36% in 2013 and 2014, to 71% and 73% in 2018 and 2019, respectively. We concluded with a surgical treatment algorithm based on previous literature, stricture characteristics, and our surgical outcomes. Conclusion The highest success rates were seen after a Heineke-Mikulicz procedure in short urethral strictures; and after graft, pedicled flap, or two-stage urethroplasties in longer or more complicated urethral strictures. Finally, most of the transgender men were able to void while standing, although in some multiple surgical procedures were necessary to accomplish this. |
| Databáze: | OpenAIRE |
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