Photo Credit: Nadzeya Haroshka
The following is a summary of “Urethroplasty Outcomes for Pars Fixa Urethral Strictures Following Gender-affirming Phalloplasty and Metoidioplasty: A Retrospective Study,” published in the December 2023 issue of Urology by Jung, et al.
For a study, researchers sought to assess the outcomes of three urethroplasty techniques for pars fixa (PF) urethral strictures and propose a treatment algorithm based on stricture characteristics. The PF region is crucial in constructing the neourethra during gender-affirming phalloplasty and metoidioplasty, presenting unique challenges due to its anatomy and vascularization.
Data from 41 urethroplasties performed on 41 patients between March 2018 and June 2021 were reviewed from two surgical centers. When the urethral segments were mobile, the Heineke-Mikulicz (HM) repair was employed for strictures under 20 mm. Substituting urethroplasty with ventral onlay buccal mucosal graft was used for strictures under 40 mm, which are unsuitable for HM repair. Complex or long (≥40 mm) strictures underwent two-stage Johansen urethroplasty. Success was defined as a minimum 12-month follow-up without requiring further intervention.
The mean follow-up was 30.2 months (12.4-52.0 months), with a mean stricture length of 16.9 mm (range: 2-55 mm). Most strictures (46%) were distal to the PF. HM urethroplasty achieved a success rate of 44% (n = 16), while substitution urethroplasty had a success rate of 92% (n = 13). Two-stage Johansen urethroplasty had a success rate of 75% (n = 12).
Success rates for PF urethral stricture repair varied from 44% to 92% depending on the surgical approach, with the optimal procedure determined by stricture length, severity, and local tissue mobility.
Reference: goldjournal.net/article/S0090-4295(23)00598-8/abstract