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Fewer phalloplasty complications reported in cismale vs. transmale patients

Cismale patients undergoing phalloplasty experienced fewer urethral and flap complications than transmale patients, according to recent findings.

The researchers noted that improved quality of life has been reported with phalloplasty among cismale patients being treated for penile defects and transmale — female-to-male — patients seeking gender-conforming surgery. However, few data sets have examined complication rates associated with this procedure.

Researchers compared complications in cismale and transmale phalloplasty recipients, along with complications for primary and staged urethroplasty.

The review of PubMed, MEDLINE, and Google Scholar databases yielded 50 studies comprising 1,351 patients. There were 19 studies involving 869 transmale individuals and 31 studies involving 482 cismale individuals.

Urethral complications occurred in 39.4% (P = .028) of transmale phalloplasty recipients and 24.8% (P < .001) of cismales. Similarly, 10.8% (P < .001) of transmales and 8.1% (P < .001) of cismales experienced flap complications.

Primary urethroplasty was used in 23 studies involving 723 patients, while 210 patients in 13 studies experienced staged procedures.

In staged procedures, flap complications occurred in 8.6% (P < .001) of the primary urethroplasty group and 16.7% (P < .001) of the staged urethroplasty group.

Voiding while standing was improved in the primary urethroplasty group compared with the staged procedure group. Sexual function and patient satisfaction also were improved with primary procedures compared with staged procedures.

“Thorough discussions regarding the complications of penile reconstruction are necessary prior to undertaking these procedures,” the researchers concluded. “It is imperative we strive to develop standardized and reliable patient-reported outcomes for our transgender patients, as changes in post-operative quality-of-life and gender dysphoria are the metrics by which these surgeries should be judged.” – by Rob Volansky

Disclosure: The researchers report no relevant financial disclosures.