Stanford, Calif.; Seattle, Wash.; New York, N.Y.; and Rochester, Minn.
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine; and the Department of Plastic Surgery, Mayo Clinic.
Plast Reconstr Surg. 2018 Feb;141(2):220e-229e. doi: 10.1097/PRS.0000000000004061.
BACKGROUND: Phalloplasty is associated with improved quality-of-life in those with penile defects, and in female-to-male transgender (transmale) patients seeking gender-confirming surgery. However, aggregate complication and outcome data are sparse. This study compares phalloplasty outcomes between transmale and cismale patients and between those with primary versus staged urethroplasty. METHODS: A comprehensive literature search of PubMed, MEDLINE, and Google Scholar databases was conducted for studies relating to phalloplasty. Data on techniques, complications, outcomes, and patient demographics were collected. Analysis using the random-effects model with subgroup analyses was performed. RESULTS: A total of 50 studies (1351 patients) were included: 19 studies (869 patients) for transmale patients and 31 studies (482 patients) for cismale patients. The urethral complication rate in the transmale group was 39.4 percent (95 percent CI, 30.6 to 48.9 percent; p = 0.028) compared to 24.8 percent (95 percent CI, 16.5 to 35.4 percent; p < 0.001) in the cismale group. The overall flap complication rates for transmale and cismale patients were 10.8 percent (95 percent CI, 7.0 to 16.2 percent; p < 0.001) and 8.1 percent (95 percent CI, 5.5 to 11.7 percent; p < 0.001), respectively. Twenty-three studies (723 patients) used primary urethroplasty and 13 studies (210 patients) performed staged urethroplasty procedures. Flap complication rates of primary and staged urethroplasty were 8.6 percent (95 percent CI, 5.3 to 13.8 percent; p < 0.001) and 16.7 percent (95 percent CI, 10.7 to 24.9 percent; p < 0.001), respectively. Primary urethroplasty had superior outcomes of voiding while standing, sexual function, and patient satisfaction compared with staged urethroplasty. CONCLUSIONS: Cismale patients undergoing phalloplasty had lower urethral and flap complication rates compared with transmale patients. Staged urethroplasty had more flap complications, and worse outcomes and patient satisfaction compared with primary urethroplasty.
背景：阴茎成形术可改善有阴茎缺陷的患者和寻求性别确认手术的女性转男性（跨性别男性）患者的生活质量。然而，综合并发症和结果数据仍然很少。本研究比较了跨性别男性和顺性别男性患者以及初次与分期尿道成形术患者的阴茎成形术结果。
方法：对 PubMed、MEDLINE 和 Google Scholar 数据库进行了全面的文献检索，以查找与阴茎成形术相关的研究。收集了技术、并发症、结果和患者人口统计学数据。使用随机效应模型进行分析，并进行亚组分析。
结果：共纳入 50 项研究（1351 例患者）：19 项研究（869 例患者）为跨性别男性患者，31 项研究（482 例患者）为顺性别男性患者。跨性别男性组的尿道并发症发生率为 39.4%（95%CI，30.6%至 48.9%；p=0.028），而顺性别男性组为 24.8%（95%CI，16.5%至 35.4%；p<0.001）。跨性别男性和顺性别男性患者的总体皮瓣并发症发生率分别为 10.8%（95%CI，7.0%至 16.2%；p<0.001）和 8.1%（95%CI，5.5%至 11.7%；p<0.001）。23 项研究（723 例患者）采用初次尿道成形术，13 项研究（210 例患者）行分期尿道成形术。初次和分期尿道成形术的皮瓣并发症发生率分别为 8.6%（95%CI，5.3%至 13.8%；p<0.001）和 16.7%（95%CI，10.7%至 24.9%；p<0.001）。与分期尿道成形术相比，初次尿道成形术在站立排尿、性功能和患者满意度方面具有更好的效果。
结论：与跨性别男性患者相比，行阴茎成形术的顺性别男性患者的尿道和皮瓣并发症发生率更低。分期尿道成形术的皮瓣并发症更多，且结果和患者满意度更差。
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