Surgical repair of urethral complications after metoidioplasty for genital gender affirming surgery

Metoidioplasty as form of genital gender affirming surgery (GGAS) is frequently complicated by urethral fistulas and/or strictures. Knowledge on how to treat these complications is scarce. This series aims to describe the techniques used to treat urethral fistulas and strictures and will report the outcomes of these techniques. For this purpose, a retrospective analysis was done of a database containing 74 transmen who underwent metoidioplasty and retrieved 26 patients who underwent surgical treatment for a urethral complication. Four patients suffered both a stricture and fistula after metoidioplasty. Fistula repair was done by 3-layer closure in 18 patients and failed in 7 (39%) cases after a median follow-up of 27 months. Urethroplasty was done by different techniques according to the type of stricture and failed in 4 (33%) out of 12 cases after a median follow-up of 15 months. No high-grade complications (Dindo-Clavien >= grade 3) were reported after fistula repair or urethroplasty. This series highlights that fistulas and strictures are frequent after metoidioplasty, but can be successfully treated by respectively 3-layer closure and urethroplasty in about 2 out of 3 cases.