Richard A. Santucci

Background: Construction of the glans is an important aspect of gender-affirming phalloplasty. In these surgeries, the glans ridge is commonly constructed using the Norfolk technique or a similar technique. In cases of glans ridge flattening after creation, we generally recommend a redo/revision glansplasty, which is often curative. However, in situations when the glans ridge flattens again, we developed a silicone glans implant technique in an effort to create a satisfactory and lasting glans ridge. Methods: We conducted a pilot study of our first 12 glans implant cases. A retrospective chart review and brief, ad-hoc patient survey measured patient demographics, implant status, and patient satisfaction. Results: A total of 12 patients received a silicone glans implant between November 2017 and February 2020. One patient had the glans implant removed before the survey, and also could not be contacted. Three patients did not respond to the survey. Of the eight patients who responded, only five (5/8, 63%) patients still had the silicone implant at the time of the survey. The average satisfaction score was 3.25 (range 1 = very satisfied and 5 = very dissatisfied). Common complaints cited included dissatisfaction with implant appearance, as well as infection, discomfort, and pain. Conclusions: Patients and surgeons should be aware of the possibility of a novel silicone implant technique to create a glansplasty in those with failed/flattened previous glansplasty surgery. However, the technique is in development: patient satisfaction remains spotty and complication rates are high, although technical improvements may increase future success rates.

Radial forearm free flap phalloplasty (RFFP) is the current standard of care for most FTM gender confirmation surgeries. This procedure is associated with a rate of urethral stricture as high as 51%, which falls only to 23–35% even among the most experienced contemporary surgeons. While some modifications have been proposed to combat this high complication rate, it still remains a major source of lasting morbidity. The method involves literature review of RFFP literature. Lowest stricture rates are found when neourethra is made with a long, meticulously constructed tube of well‐vascularized perivaginal/periurethral and labia minora tissue. In cases of urethral stricture, urethroplasty is required in 94–96% of patients. Surgery should be delayed until all acute inflammation has subsided. Urethroplasty is technically challenging and fails in up to 50% of cases. Repeated surgery or salvage urethral exteriorization procedures, which can leave the patient with lifelong perineal urethrostomy, are often required. Patient and physician knowledge regarding the high burden and poor treatment options for urethral stricture after phalloplasty is incomplete, and patient acceptance of this reality is crucial for honest understanding of the potential complications of this increasingly common but extremely complex surgery. Clin. Anat. 31:187–190, 2018.

This is the recent Société Internationale d’Urologie/International Consultation on Urological Diseases (SIU/ICUD) consultation for evaluation and follow-up of urethral stricture disease, a narrowing of the urethra in men that has a significant impact on health and quality of life. Management of urethral strictures/stenosis is complex and requires careful evaluation. Looking at the quality of the evidence and expert opinion, the authors reviewed all available published data regarding anterior urethral stricture or posterior urethral stenosis evaluation and follow-up before making their recommendations. Urethrography and cystoscopy remain the main forms of assessment, with adjunct methodologies being available as more non-invasive options when required. This Recommendation is of an article referenced in an F1000 Faculty Review also written by Maxx A. Gallegos and Richard A. Santucci.

Bladder neck contractures most commonly occur after transurethral resection of the prostate (TURP) and are distinct from post prostatectomy anastomotic stenosis. The incidence is between 0.9% and 17% {1-3}. These contractures are often initially managed with dilation or urethrotomy and even with transurethral resection (TURBNC). When they are recurrent, one study found that radial urethrotomy and the injection of mitomycin C (MMC)...

Bladder neck contractures most commonly occur after transurethral resection of the prostate (TURP) and are distinct from post prostatectomy anastomotic stenosis. The incidence is between 0.9% and 17% {1-3}. These contractures are often initially managed with dilation or urethrotomy and even with transurethral resection (TURBNC). When they are recurrent, radial urethrotomy and the injection of mitomycin C (MMC) has been shown to yield a long-term success rate of 72% for one treatment and 89% after two treatments {4}, while similar success rates have been reported for initial treatment when using bipolar incisions when compared to “cold” urethrotomy {5}. Ali et al. found that the use of MMC decreased the stricture recurrence and increased the time to recurrence in urethral strictures after direct visualization internal urethrotomy (DVIU) {6}. Interestingly, this study—which reports the results from the Trauma and Urologic Reconstruction Network of Surgeons (TURNS)—has similar success rates (~75%), but also reports severe complications in 7% of patients. However, in this series, the dose of MMC was not standardized and often much higher doses than suggested by Buckley et al. {4}. This Recommendation is of an article referenced in an F1000 Faculty Review also written by Maxx A. Gallegos and Richard A. Santucci.

This article provides a good guide to the different techniques used to treat bulbar urethral strictures. The authors discuss the pros and cons associated with the various methods. This Recommendation is of an article referenced in an F1000 Faculty Review also written by Maxx A. Gallegos and Richard A. Santucci.