Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium.
Ghent University Hospital, Ghent, Belgium.
Int J Impot Res. 2021 Mar;33(2):178-183. doi: 10.1038/s41443-020-00385-5. Epub 2020 Dec 10.
Phalloplasty is the gold-standard treatment for cis-men with penile insufficiency, which is often secondary to congenital conditions. The study-objective is to evaluate the functional outcomes and surgical complications in this population. A retrospective database comprised of cis-men undergoing a phalloplasty at a tertiary referral center from 2004 to 2019 was created. Phalloplasty was performed with various flaps. The tube-within-tube-technique was used for urethroplasty when possible. Complications <30 days postoperative were categorized according to Clavien-Dindo. Functional outcomes were assessed by bladder emptying and ability to achieve orgasm. Thirty patients were included. Nineteen of them needed urethroplasty, the remaining 11 patients had a catheterizable stoma. Within 30 days postoperative, 3 patients (10%) developed partial-flap necrosis (Clavien-Dindo III), 1 patient (3.3%) developed graft failure (Clavien-Dindo III), 2 patients (6.6%) developed infected hematomas (Clavien-Dindo III) and 1 phalloplasty (3.3%) was complicated by hematuria (Clavien-Dindo II). In the long-term, 10 patients (33%) developed fistulae, 6 (20%) requiring urethroplasty. Seven patients (23%) had urethral strictures, all needing urethroplasty or urethrotomy. Sixteen patients (84%) emptied their bladder per urethra, the three remaining necessitated conversion to perineostomy. Median (IQR) Q on uroflow was 15.7 (11.9-19.2)mL/s with median (IQR) voiding volume of 259 (137-307) mL and median (IQR) residual volume of 11.5 (0-20) ml on ultrasound. All patients but 1 (97%) reported ability to achieve orgasm. RFFA and ALT result in phalli with great ability to achieve orgasm but urethral complications are frequent.
阴茎成形术是治疗因先天性疾病而导致阴茎功能不全的顺性别男性的金标准治疗方法。本研究旨在评估该人群的功能结果和手术并发症。创建了一个回顾性数据库，其中包含 2004 年至 2019 年在三级转诊中心接受阴茎成形术的顺性别男性。阴茎成形术采用了各种皮瓣。当可能时，使用管中管技术进行尿道成形术。术后 30 天内的并发症根据 Clavien-Dindo 进行分类。通过排空膀胱和实现射精的能力来评估功能结果。共纳入 30 例患者。其中 19 例需要尿道成形术，其余 11 例患者有可导管化的造口。术后 30 天内，3 例（10%）出现部分皮瓣坏死（Clavien-Dindo III），1 例（3.3%）出现移植物失败（Clavien-Dindo III），2 例（6.6%）出现感染性血肿（Clavien-Dindo III），1 例阴茎成形术（3.3%）并发血尿（Clavien-Dindo II）。在长期随访中，10 例（33%）患者出现瘘管，6 例（20%）需要尿道成形术。7 例（23%）患者出现尿道狭窄，均需要尿道成形术或尿道切开术。16 例（84%）患者通过尿道排空膀胱，其余 3 例需要改为经会阴造口术。尿流率的中位数（IQR）为 15.7（11.9-19.2）ml/s，平均（IQR）排空量为 259（137-307）ml，平均（IQR）残余量为 11.5（0-20）ml。除 1 例患者（97%）外，所有患者均报告能够达到射精。RFFA 和 ALT 可使阴茎具有很好的射精能力，但尿道并发症较为常见。
