Waterschoot Mieke, Claeys Wietse, Hoebeke Piet, Verla Wesley, Waterloos Marjan, Wirtz Michel, Buncamper Marlon, Lumen Nicolaas
Department of Urology, Ghent University Hospital, 9000 Gent, Belgium.
Department of Plastic and Reconstructive Surgery, Ghent University Hospital, 9000 Gent, Belgium.
J Clin Med. 2021 Aug 30;10(17):3912. doi: 10.3390/jcm10173912.
Urethral strictures are a common complication after genital gender-affirming surgery (GGAS) in transmasculine patients. Studies that specifically focus on the management of urethral strictures are scarce. The aim of this systematic review is to collect all available evidence on the management of urethral strictures in transmasculine patients who underwent urethral lengthening.
We performed a systematic review of the management of urethral strictures in transmasculine patients after phalloplasty or metoidioplasty (PROSPERO, CRD42021215811) with literature from PubMed, Embase, Web of Science and Cochrane. Preferred Reporting Items for Systematic reviews and Meta-Analysis-(PRISMA) guidelines were followed, and risk of bias was assessed for every individual study using the 5-criterion quality appraisal checklist.
Eight case series were included with a total of 179 transmasculine patients. Only one study discussed the management of urethral strictures after metoidioplasty. Urethral strictures were most often seen at the anastomosis between the fixed and pendulous urethra. For each stricture location, different techniques have been reported. All studies were at a high risk of bias. The current evidence is insufficient to favor one technique over another.
Different techniques have been described for the different clinical scenarios of urethral stricture disease after GGAS. In the absence of comparative studies, however, it is impossible to advocate for one technique over another. This calls for additional research, ideally well-designed prospective randomized controlled trials (RCTs), focusing on both surgical and functional outcome parameters.
尿道狭窄是经男性化生殖器性别确认手术（GGAS）后跨性别男性患者的常见并发症。专门关注尿道狭窄治疗的研究很少。本系统评价的目的是收集所有关于接受尿道延长术的跨性别男性患者尿道狭窄治疗的现有证据。
我们对阴茎成形术或阴囊成形术后跨性别男性患者尿道狭窄的治疗进行了系统评价（PROSPERO，CRD42021215811），检索了PubMed、Embase、科学网和Cochrane的文献。遵循系统评价和Meta分析的首选报告项目（PRISMA）指南，并使用5项标准质量评估清单对每项研究的偏倚风险进行评估。
纳入了8个病例系列，共179例跨性别男性患者。只有一项研究讨论了阴囊成形术后尿道狭窄的治疗。尿道狭窄最常出现在固定尿道和悬垂尿道的吻合处。对于每个狭窄部位，已报道了不同的技术。所有研究都有较高的偏倚风险。目前的证据不足以支持一种技术优于另一种技术。
对于GGAS后尿道狭窄疾病的不同临床情况，已经描述了不同的技术。然而，在缺乏比较研究的情况下，不可能主张一种技术优于另一种技术。这需要更多的研究，理想情况下是设计良好的前瞻性随机对照试验（RCT），关注手术和功能结果参数。
