Turns out, the complications differ in reconstruction surgery for male-to-female and cis-male transgender patients. A new study has found that risks of penile reconstruction surgery, also known as phalloplasty, appear higher in female-to-male transgender (trans-male) patients, compared to the risks posed by native male (cis-male) patients undergoing surgery.

Jeffrey B. Friedrich, MD, of University of Washington, Seattle, conducted the study with colleagues from American Society of Plastic Surgeons (ASPS). According to Dr. Friedrich, complications are also less frequent when reconstruction of the urethra (urethroplasty) is done as a single-stage procedure. He noted, “Our results provide useful information for surgeons and patients to consider when discussing options, risks, and expected outcomes of phalloplasty”.

The study also focused on increased phalloplasty risks for trans-male patients and with staged-urethral surgery. The team of researchers analysed the findings of 50 previous studies related to phalloplasty. Incidentally, 19 of these studies reported phalloplasty on 869 trans-male patients and 32 reported phalloplasty on 482 cis-male patients.

The results showed some important differences in outcome between the two groups. The overall rate of complications related to the urethra was 39.4 percent in trans-male patients compared to 24.8 percent in cis-male patients. Rates of complications involving the tissue flaps used for penile reconstruction were also higher in trans-male patients – 10.8 versus 8.1 percent.

Outcomes were also affected by the approach used to reconstruct the urethra – 23 studies including 723 patients used a single-step (primary) approach to urethroplasty, while 13 studies including 201 patients used multiple-step (staged) procedures.

The rate of tissue flap-related complications was also lower with primary urethroplasty: 8.6 percent, compared to 16.7 percent for staged procedures. In addition to fewer complications, single-stage urethral reconstruction was associated with improvement in key outcomes, for both trans-male and cis-male patients.

Ability to urinate while standing, sexual functioning, and patient satisfaction were all better with primary versus staged urethroplasty. The study is published in the medical journal of the American Society of Plastic Surgeons.