One of the primary goals of the phalloplasty for female-to-male transsexuals is to gain the voiding ability in the standing position. However, achieving the competence of urethra, sensation and rigidity of the neophallus is still a significant challenge. Serious complications such as urethral fistula, obstruction and stricture were encountered in this surgery. In experienced hands, this seems to be associated with urethroplasty technique.

The authors performed phalloplasty with radial forearm osteocutaneous free flap method in 70 patients of female-to-male transsexuals. In 38 cases which were enrolled before 2001, we had carried out the urethroplasty by our own method, but since 2001, we have applied the modified method of urethroplasty to reduce the incidence of urethrocutaneous fistula. Thirty-four cases have undergone a new modified method of ours. For construction of the urethra, an anteriorly based vaginal wall flap and labium minoral flaps were used in this technique.

In our new method series, 1 case (1.4%) of flap loss occurred after phalloplasty. The incidence of urethrocutaneous fistula was 30%. Before the year 2001, of 38 patients, there were 14 cases (36.8%) who developed urethrocutaneous fistula. On the other hand, 7 of 32 patients (21.9%) who underwent urethroplasty by the modified labium minoral flap and anteriorly based vaginal flap had urethrocutaneous fistula after 2001.

One-stage total phalloplasty and urethroplasty is associated with a significant increase of urethral fistula and obstruction. However, the urethrocutaneous fistula at the level of the female external urethral orifice can be successfully reduced using this new method.

Abstract

Authors: Kim, Seok-Kwun MD, PhD; Moon, Joo-Bong MD; Heo, Jeong MD; Kwon, Yong-Seok MD; Lee, Keun-Cheol MD, PhD
Source: Annals of Plastic Surgery: June 2010 – Volume 64 – Issue 6 – pp 759-764

British Columbia’s Medical Services Plan currently covers male-to-female gender reassignment surgery, as well as female-to-male top surgery (mastectomy) and chest re-contouring. However, the province does not currently fund bottom-surgery for FTM citizens. Urge the British Columbia Ministry of Health to join the ranks of Ontario and Quebec in performing the surgery, and also to start including this surgery in their MSP guidelines.

Take Action! Sign the Petition.

Earlier this year, an article in the British Columbia newspaper, the Victoria Times Colonist, called for provincial funding for trans male bottom surgery. The article singled out phalloplasty and had no mention of metoidioplasty, a procedure that’s presumably more in-demand by transgender men. But is that presumption correct? To find out, we surveyed trans men interested in bottom surgery and asked: “If money were no object, would you choose to have a metoidioplasty or a phalloplasty?”

View the survey results »