ABSTRACT
Objective
To develop an imaging modality for the postoperative phalloplasty urethra. Despite
high urologic complication rates after masculinizing genital surgery, existing methods
for post-surgical evaluation after phalloplasty have drawbacks. Fluoroscopic studies
like the retrograde urethrogram have limitations like user-dependence and meticulous
positioning but also are inadequate for the evaluation of the anatomically distinct
post-phalloplasty urethra. We developed a novel protocol utilizing CT urethrography
with 3D reconstruction using cinematic rendering (3DUG) for neo-urethral imaging.
Materials and Methods
Patients who underwent 3DUG after either phalloplasty, metoidioplasty, or prior to
revision surgery were included. Low-dose imaging protocols were used to avoid any
increases in radiation exposure. The first iteration of our protocol utilized retrograde
contrast administration via the penile urethra, whereas the second iteration of our
protocol utilized an antegrade technique with contrast instillation via the suprapubic
catheter and a voiding scan. Imaging was initially obtained according to symptoms
and then per protocol at 3 weeks after urethral lengthening.
Results
Twenty-six patients were included in the series. Among postoperative phalloplasty
patients imaged for symptoms, urethrocutaneous contrast extravasation/fistula was
identified in five (63%), vaginal remnant in three (38%), and stricture in two (25%)
compared to five (45%), one (9%), and zero respectively for patients imaged routinely.
When intervention was required, operative findings correlated to anatomy on imaging.
Conclusions
We present a new protocol for the use of 3D CT urethrography with cinematic rendering
for neo-urethral reconstruction. This technique has the potential to improve surgical
planning and surveillance of urologic complications in post-phalloplasty patients.
Key words
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References
- Effects of Different Steps in Gender Reassignment Therapy on Psychopathology: A Prospective Study of Persons with a Gender Identity Disorder.J. Sex. Med. 2014; 11 (Available at:): 119-126
- The effect of cross-sex hormonal treatment on gender dysphoria individuals’ mental health: A systematic review.Neuropsychiatr. Dis. Treat. 2016; 12: 1953-1966
- Quality of life improvement after chest wall masculinization in female-to-male transgender patients: A prospective study using the BREAST-Q and Body Uneasiness Test.J. Plast. Reconstr. Aesthetic Surg. 2018; 71 (Available at:): 651-657
- A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen.J. Sex. Med. 2017; 14 (Available at:): 1621-1628
- Urologic Complications After Phalloplasty or Metoidioplasty.Clin. Plast. Surg. 2018; 45 (Available at:): 425-435
- A systematic review of metoidioplasty and radial forearm flap phalloplasty in female-to-male transgender genital reconstruction: Is the “ideal” neophallus an achievable goal?.Plast. Reconstr. Surg. - Glob. Open. 2016; 4: 1-7
- The Surgical Techniques and Outcomes of Secondary Phalloplasty After Metoidioplasty in Transgender Men: An International, Multi-Center Case Series.J. Sex. Med. 2019; 16 (Available at:): 1849-1859
- A new method of urethroplasty for prevention of fistula in female-to-male gender reassignment surgery.Ann. Plast. Surg. 2010; 64: 759-764
- Phalloplasty with urethral lengthening: Addition of a vascularized bulbospongiosus flap from vaginectomy reduces postoperative urethral complications.Plast. Reconstr. Surg. 2017;
- Outcomes of Single Stage Phalloplasty by Pedicled Anterolateral Thigh Flap versus Radial Forearm Free Flap in Gender Confirming Surgery.J. Urol. 2018; 199 (Available at:): 206-214
- Genital Gender-Affirming Surgery Without Urethral Lengthening in Transgender Men—A Clinical Follow-Up Study on the Surgical and Urological Outcomes and Patient Satisfaction.J. Sex. Med. 2020;
- Imaging of urethral stricture disease.Transl. Androl. Urol. 2015; 4: 2-9
- Sonographic staging of anterior urethral strictures.J. Urol. 2000; 163: 1070-1075
- The value of magnetic resonance imaging geometric parameters in pre-assessing the surgical approaches of pelvic fracture urethral injury.Transl. Androl. Urol. 2020; 9: 2596-2605
- Dynamic three-dimensional spiral computed tomographic cysto-urethrography: A novel technique for evaluating post-traumatic posterior urethral defects.BJU Int. 2003;
- CT voiding urethrography and virtual urethroscopy: Preliminary study with 16-MDCT.Am. J. Roentgenol. 2005; 184: 1882-1888
- The application of CT voiding urethrography in the evaluation of urethral stricture associated with fistula: a preliminary report.Int. Urol. Nephrol. 2016; 48: 1267-1273
- Diagnosis of male posterior urethral stricture: Comparison of 64-MDCT urethrography vs. standard urethrography.Abdom. Imaging. 2011; 36: 771-775
- Urethroplasty for strictures after phallic reconstruction: A single-institution experience.Eur. Urol. 2011; 60: 150-158
- Cinematic rendering in CT: A novel, lifelike 3D visualization technique.Am. J. Roentgenol. 2017; 209: 370-379
- Free Flap Phalloplasty For Female To Male Gender Dysphoria.J. Sex. Med. 2016; 13 (Available at): 1942-1947
- CT dose reduction applications: Available tools on the latest generation of CT scanners.J. Am. Coll. Radiol. 2013; 10 (Available at:): 37-41
- CT scan parameters and radiation dose: Practical advice for radiologists.J. Am. Coll. Radiol. 2013; 10 (Available at): 840-846
- Use of 3D reconstruction cloacagrams and 3D printing in cloacal malformations.J. Pediatr. Urol. 2017; 13 (Available at:): 395.e1-395.e6
- Application of IRIS Three-Dimensional Anatomical Models As Preoperative Surgical Planning Tools in the Management of Localized Renal Masses.J. Endourol. 2021; 35 (Available at:): 383-389
- Presenting Complications to a Reconstructive Urologist After Masculinizing Genital Reconstructive Surgery.Urology. 2019; 132 (Available at): 202-206
- Robotic Excision of Vaginal Remnant/Urethral Diverticulum for Relief of Urinary Symptoms Following Phalloplasty in Transgender Men.Urology. 2020; 136: 158-161
Article info
Publication history
Accepted:
January 8,
2023
Received:
September 3,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
