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Volume 24, Issue 6 (November 2022) 24, 570–574; 10.4103/aja2021110

Postphalloplasty urinary function test: an observational study of novel outcome instrument to capture urinary dysfunction and quality of life after phalloplasty

James L Liu1, Lauren Eisenbeis2,3, Stephanie Preston4, Arthur L Burnett1, Heather N DiCarlo1,3, Devin Coon2,3

1 The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
2 Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
3 Johns Hopkins Center for Transgender Health, Johns Hopkins Medicine, Baltimore, MD 21287, USA
4 Department of Surgery, University of Texas Southwestern, Dallas, TX 75370, USA

Correspondence: Dr. D Coon (dcoon@jhmi.edu)

Date of Submission 02-Sep-2021 Date of Acceptance 08-Dec-2021 Date of Web Publication 18-Feb-2022


Due to growing social acceptance, there has been an increasing number of gender-affirmation surgeries performed in North America. Most research in this patient population focuses on surgical outcomes and advancing techniques. However, little work has been done to study functional outcomes. To better evaluate urinary dysfunction in the postphalloplasty trans men patient population, our group developed a novel patient-reported outcome instrument – the postphalloplasty urinary function test (PP UFT) and protocol to measure postvoid urethral volume (PVUR), and we present our preliminary results. We conducted a cross-sectional pilot study in a cohort of 15 adult trans men who had undergone phalloplasty with urethral lengthening surgery between 2018 and 2021. Patients had stable urinary function via the neophallus at the time of survey. Patients filled out the PP UFT and were asked to record their PVUR as per our protocol. The average PP UFT score was 8.9 out of 40 and the average quality-of-life (QOL) score was 2.6. Postvoid dribbling constituted the major complaint and on average comprised 63.2% of the reported PP UFT score. The average PVUR was 2.2 ml (range: 0.5–5.6 ml). There was a positive correlation between higher PP UFT and worse-reported quality of life (P < 0.01; R2 = 0.4). Current questionnaires accepted in cis-male urology have limitations for accurately capturing urinary dysfunction in this specific patient group. The combination of PP UFT and PVUR measurement offers potential for quantifying urinary function and quality of life in patients who undergo phalloplasty. Future studies will validate these instruments.

Keywords: gender affirmation; gender surgery; phalloplasty; postvoid urethral residual; urethral lengthening; urinary dysfunction

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