Background: Primary phalloplasty in transgender men can be performed using a single or double free or pedicled flap to reconstruct the shaft and, if desired, the urethra. Vascular complications may result in total or partial loss of the used flap(s). Surgical management after flap loss in primary phalloplasty presents a challenge to the reconstructive surgeon.
Aim: To describe our experience with surgical reconstructive management after primary phalloplasty flap loss in transgender men and report on the clinical and participant-reported outcomes.
Methods: All transgender men who underwent a secondary reconstructive procedure after failure of the primary procedure between January 1989 and December 2023, at our institution, were identified. A retrospective chart review was conducted, recording relevant demographic and clinical data. In addition, participants were invited to complete a non-validated questionnaire consisting of questions regarding surgical outcomes, (sexual) functionality, and sexuality.
Outcomes: Surgical outcomes, flap failure, and self-reported outcomes.
Results: Eighteen individuals were included in this study, who underwent flap reconstruction of the phalloplasty shaft (n = 7), the urethra (n = 4), or both (n = 7). Primary phalloplasty was performed with urethral lengthening (UL) in 16 (89%) and without in 2 (11%). There were no redo phalloplasty flap failures. In those with UL 13/16 (81%) were able to void while standing. Eleven individuals completed the follow-up questionnaire. Most participants were "satisfied" (45%) or "very satisfied" (27%) with the appearance of their penis. All participants (strongly) agreed that when looking back, they would undergo the surgery all over again.
Clinical Implications: Practical surgical tips, deducted from our experiences, are provided for gender surgeons performing (revision) phalloplasty and urethroplasty.
Strengths And Limitations: Strengths are the unique set of surgical reconstruction cases that has taught us valuable lessons. Data from this study can be used to optimize pre-operative counseling regarding flap loss complications and the outcomes of the subsequent management. Weaknesses comprise the retrospective nature, the low number of included individuals, and use of non-validated questionnaires for self-reported outcomes.
Conclusion: Flap loss after primary phalloplasty in transgender men is a serious complication. Successful secondary reconstruction of the phalloplasty can be performed using a new pedicled or free flap.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1093/jsxmed/qdae119 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Recruitment of Young Gay, Bisexual, and Other Men Who Have Sex With Men for a Web-Based Human Papillomavirus Vaccination Intervention: Differences in Participant Characteristics and Study Engagement by Recruitment Source in a Randomized Controlled Trial.
J Med Internet Res
January 2025
College of Public Health, The Ohio State University, Columbus, OH, United States.
Background: Young gay, bisexual, and other men who have sex with men have been referred to as a "hard-to-reach" or "hidden" community in terms of recruiting for research studies. With widespread internet use among this group and young adults in general, web-based avenues represent an important approach for reaching and recruiting members of this community. However, little is known about how participants recruited from various web-based sources may differ from one another.
View Article and Find Full Text PDFValidating a Case Definition for Transgender Adults Using Administrative Data.
JAMA Netw Open
January 2025
Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Importance: Administrative health data serve as promising data sources to study transgender health at a population level in the absence of self-reported gender identity.
Objective: To develop and validate case definitions identifying transgender adults in administrative data compared with the reference standard of self-reported gender identity in a universal health care setting.
Design, Setting, And Participants: In this cohort study conducted in Alberta, Canada, data from provincial administrative health data sources including inpatient hospitalizations, emergency department encounters, primary care visits, prescription drug dispensations, and the provincial health insurance registry were linked and used to develop 15 case definitions (9 for transgender women and 6 for transgender men).
Cross-Sectional Evaluation of State-Level Protections, Medical Debt, and Deferred Care Among Sexual and Gender Minority People.
J Gen Intern Med
January 2025
Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.
Background: Millions of Americans have medical debt and/or defer care due to cost. Few studies have examined the association of such health-related financial problems with sexual orientation or gender identity, and whether state-level policies protecting sexual and gender minority (SGM) people affect disparities in such problems.
Objective: To examine the relationships between SGM status, state-level SGM protections, and health-related financial problems.
Influence of androgen receptor on bone health in transgender adults: insights from the COMET study.
J Endocrinol Invest
January 2025
Regional Reference Center for Gender Incongruence (CRRIG) of the Veneto Region, University Hospital of Padova, Padua, Italy.
Purpose: Previous studies show that transgender and gender-diverse (TGD) individuals, especially those assigned male at birth (AMAB), often have low bone mineral density (BMD) before beginning gender-affirming hormone therapy (GAHT). The reasons for this are not fully understood, and the potential role of androgen receptor (AR) polymorphisms - known to affect bone density in the general population - has not been explored. This study aims to assess the impact of AR polymorphisms on bone health in the TGD population.
View Article and Find Full Text PDFThe Digital Transformation and the Right to Health of Young Adults in Bangladesh and Colombia: A Community-Engaged Study.
Health Hum Rights
December 2024
In her 2023 report to the United Nations Human Rights Council on digital innovation, technology, and the right to health, the Special Rapporteur on the right to health underscored the positive impact of the digital transformation on young people, but also noted serious concerns, calling for greater efforts to consult and engage with youth and civil society. In our study, early-career researchers from Bangladesh and Colombia collaborated within a broader international research and advocacy project to investigate how diverse young adults experience digital health and to invite their recommendations and collaborative advocacy. Researchers held focus group discussions and interviews with young adults aged 18-30 (in Bangladesh, predominantly men; in Colombia, people living with HIV, gay men, and transgender women).
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!