Berli Jens Urs, Ferrin Peter C, Buuck Carter, Cylinder Isabel, Putnam Carley, Dy Geolani W, Peters Blair R, Llado-Farrulla Monica, Sajadi Kamran P, Annen Alvin
From the Division of Plastic and Reconstructive Surgery.
Transgender Health Program.
Plast Reconstr Surg. 2025 Aug 1;156(2):279e-290e. doi: 10.1097/PRS.0000000000012010. Epub 2025 May 7.
There are many ways to construct a urethra in gender-affirming phalloplasty, and comparing outcomes presents challenges because of the diversity of surgical techniques and staging methods in this low-volume procedure. A frequent criticism of phalloplasty is the high rate of urologic complications and associated impact on patient outcomes.
This retrospective, single-surgeon study focuses on long-term outcomes of urethral creation using the Big Ben 2-stage method for urethral lengthening. This study was conducted in 73 patients between December of 2016 and September of 2023, who had at least 6 months' follow-up. Surgical outcomes-specifically, rates of urethral fistulas and strictures-were assessed along with patient-reported outcome measures obtained through distributed surveys.
Seventy-three patients underwent first-stage phalloplasty with the goal of urethral lengthening at the second-stage operation, with 96% achieving standing urination and 4% being converted to a perineal urethrostomy. The total percentage of patients experiencing a urologic complication was 27%. Of the 71 patients who did proceed with the second stage, 8% formed a stricture and 16.4% formed a urethrocutaneous fistula. One patient experiencing a stricture was converted to a perineal urethrostomy. There were no mucoceles or urethral, ureteral, or bowel injuries associated with the colpectomy/colpoclesis. Patient-reported satisfaction was high, with 96% expressing willingness to undergo the procedure again (response rate, 67%).
The Big Ben method demonstrated potential in reducing urethral stricture rates compared with alternative approaches. It further allows mitigation of complication severity and impact on quality of life, and has a high degree of patient satisfaction and ability to achieve the goal of standing urination. It is particularly well suited for a multidisciplinary academic setting.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
在性别肯定性阴茎成形术中，有多种构建尿道的方法，由于该小容量手术中手术技术和分期方法的多样性，比较结果存在挑战。阴茎成形术经常受到的批评是泌尿系统并发症发生率高以及对患者预后的相关影响。
这项回顾性单术者研究聚焦于采用大本钟两阶段法进行尿道延长时尿道构建的长期结果。该研究于2016年12月至2023年9月期间对73例患者进行，这些患者至少有6个月的随访。评估了手术结果，特别是尿道瘘和狭窄的发生率，以及通过分发的调查问卷获得的患者报告的结局指标。
73例患者接受了第一阶段阴茎成形术，目的是在第二阶段手术中延长尿道，96%的患者实现了站立排尿，4%的患者改为会阴尿道造口术。发生泌尿系统并发症的患者总百分比为27%。在继续进行第二阶段手术的7
