Neuville Paul, Madec François-Xavier, Vetterlein Malte W, Adamowicz Jan, Białek Łukasz, Campos-Juanatey Felix, Chierigo Francesco, Cocci Andrea, Frankiewicz Mikołaj, Klemm Jakob, Mantica Guglielmo, Oszczudłowski Maciej, Redmond Elaine J, Rosenbaum Clemens M, Verla Wesley, Waterloos Marjan, Carnicelli Damien, Morel-Journel Nicolas
Department of Urology, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France.
Claude Bernard University Lyon 1, Lyon, France.
Int J Impot Res. 2025 Aug 19. doi: 10.1038/s41443-025-01132-4.
Urethral complications following urethral lengthening in transgender men, such as strictures and fistulas, are common and frequently necessitate secondary surgical interventions. These surgeries vary significantly in their techniques and are evaluated with considerable heterogeneity, making a synthesized presentation of their outcomes valuable for guiding clinical management. This systematic review included 14 studies selected through a database search (Medline, Embase, Web of Science) that reported urethral complications after urethral lengthening. Among the 595 patients considered, 76% underwent phalloplasty and 24% underwent metoidioplasty. Our findings highlight that staged urethroplasty techniques demonstrated the lowest recurrence rates (0-25%), particularly in the management of long strictures in the pendulous urethra. In contrast, one-stage urethroplasties-especially those performed without augmentation-were associated with high recurrence rates, reaching approximately 50%, even when buccal mucosa grafts were used for augmentation. Patient-reported outcomes were documented in only one-third of the included studies, underscoring the limited functional evaluation of urethroplasty outcomes following phalloplasty. The considerable variability in urethroplasty techniques, types of genital reconstruction, and reporting standards highlights the need for more comprehensive and standardized outcome assessments. Future studies will be essential in advancing our understanding and optimizing the management of these complex cases.
跨性别男性尿道延长术后的尿道并发症，如尿道狭窄和瘘管，很常见，且常常需要二次手术干预。这些手术的技术差异很大，评估结果也存在很大异质性，因此综合呈现其结果对于指导临床管理很有价值。这项系统评价纳入了通过数据库检索（Medline、Embase、Web of Science）选出的14项研究，这些研究报告了尿道延长术后的尿道并发症。在纳入的595例患者中，76%接受了阴茎成形术，24%接受了阴蒂成形术。我们的研究结果表明，分期尿道成形术技术的复发率最低（0 - 25%），尤其是在处理悬垂部尿道的长段狭窄时。相比之下，一期尿道成形术——尤其是那些未进行扩大手术的——复发率较高，即使使用颊黏膜移植进行扩大手术，复发率仍可达约50%。在纳入的研究中，只有三分之一记录了患者报告的结局，这凸显了阴茎成形术后尿道成形术结局的功能评估有限。尿道成形术技术、生殖器重建类型和报告标准的显著差异表明，需要更全面和标准化的结局评估。未来的研究对于增进我们对这些复杂病例的理解和优化管理至关重要。
