Review of the literature on construction of a neourethra in female-to-male transsexuals.

Voiding in a male fashion has priority for most female-to-male transsexuals. For that reason, lengthening of the urethra has been attempted by various surgeons. Because constructing a neourethra has frequently led to fistulas and strictures, some authorities abandoned their attempts. In this report, a review of the literature on the construction of a pars pendulans and a pars fixa urethrae in phalloplasty is given. The techniques used in our institute are mentioned. The use of local tissue for lengthening of the fixed part of the urethra can be successful in case a vaginal flap is incorporated. In phalloplasty, the free flap technique is a useful alternative to the use of pedicled flaps. The techniques necessitating opening the abdomen and viscera are too elaborate and too risky to be used as routine procedures. The use of external devices for urination as suggested by some investigators is not only unsatisfactory to the patient, it also carries the risk of urinary duct infection and trauma.