title: Buccal mucosal graft urethroplasty for the treatment of urethral stricture in the neophallus.
abstract: OBJECTIVE
  To present our operative approach and outcomes with buccal mucosal graft urethroplasty for anastomic stricture in the neophallus.
  
  
  METHODS
  All patients who underwent buccal mucosal graft urethroplasty by a single surgeon for urethral stricture in a neophallus between March 1998 and June 2013 were identified. Urethroplasties were performed using 1-stage ventral onlay buccal mucosal graft after incision of the stricture.
  
  
  RESULTS
  Ten patients were included in analysis. One patient underwent creation of neophallus after trauma, whereas all others were performed as gender reassignment. In all patients, strictures were located at the anastomosis between the native and the neourethra. Mean age was 39 years (range, 26-56 years). Mean stricture length was 3.6 cm (range, 2-6 cm). Median follow-up was 9.5 months (range, 2.7-84 months). At last follow-up, all the first 3 patients had stricture recurrence, whereas 5 of the next 7 patients remained free of stricture (overall success rate, 50%). A total of 11 follow-up procedures were performed for recurrent strictures in these patients, including 8 internal urethrotomies, 1 suprapubic tube placement, and 2 repeat urethroplasties. The only perioperative complication was a patient who experienced mild rhabdomyolysis, which resolved with supportive measures.
  
  
  CONCLUSIONS
  Experience with urethral strictures in the neophallus is limited, and management is complex. Buccal mucosal graft urethroplasty may be more effective than endoscopic management, but failure remains common. Modifications in surgical approach and experience may improve outcomes.
authors: Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL. Electronic address: pariserj@gmail.com.
authors: Joseph J
authors: JJ
authors: Pariser
authors: Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL.
authors: Joshua A
authors: JA
authors: Cohn
authors: Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL.
authors: Lawrence J
authors: LJ
authors: Gottlieb
authors: Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL.
authors: Gregory T
authors: GT
authors: Bales
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D010413:Penis / Q000293:injuries / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D057830:Gender-Affirming Surgery / Q000009:adverse effects; D019738:Surgically-Created Structures / Q000009:adverse effects*; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology / Q000601:surgery*