OBJECTIVE: To describe the novel surgical technique of urethral lengthening in anterolateral thigh (ALT) and superficial circumflex iliac artery perforator flap (SCIP) phalloplasty with a pedicled labia minora flap (PLMF) and report on the clinical outcomes.
METHODS: Between March 2014 and August 2018, 16 transgender men underwent phalloplasty with a PLMF for urethral lengthening at the Amsterdam UMC (VU university), the Netherlands and the Belgrade University Hospital, Serbia. Patient demographics, surgical characteristics, neo-urethra characteristics, intra- and postoperative complications, pre-and postoperative voiding evaluation and the length of hospital stay were retrospectively identified from chart reviews.
RESULTS: The mean neo-urethral length was 16.8±2.3 centimeter, and the pars pendulans 11.7 ±2.2 centimeter. The neo-meatus was localized on top of the neophallus in 12 (75%) patients. No intraoperative complications occurred. Urethral fistula formation occurred in four (25%) patients and strictures in six (37.5%) patients. In three (18.7%) patients a (temporary) perineostomy had to be performed. Voiding from a standing position was possible in 9 (56.3%) patients.
CONCLUSION: The pedicled labia minora flap for urethral reconstruction, both pars fixa and pars pendulans, in phalloplasty is a feasible surgical technique in transgender men undergoing ALT or SCIP phalloplasty with sufficient labia minora tissue.