Abstract
Urethral complications following urethral lengthening in transgender men, such as strictures and fistulas, are common and frequently necessitate secondary surgical interventions. These surgeries vary significantly in their techniques and are evaluated with considerable heterogeneity, making a synthesized presentation of their outcomes valuable for guiding clinical management. This systematic review included 14 studies selected through a database search (Medline, Embase, Web of Science) that reported urethral complications after urethral lengthening. Among the 595 patients considered, 76% underwent phalloplasty and 24% underwent metoidioplasty. Our findings highlight that staged urethroplasty techniques demonstrated the lowest recurrence rates (0-25%), particularly in the management of long strictures in the pendulous urethra. In contrast, one-stage urethroplasties-especially those performed without augmentation-were associated with high recurrence rates, reaching approximately 50%, even when buccal mucosa grafts were used for augmentation. Patient-reported outcomes were documented in only one-third of the included studies, underscoring the limited functional evaluation of urethroplasty outcomes following phalloplasty. The considerable variability in urethroplasty techniques, types of genital reconstruction, and reporting standards highlights the need for more comprehensive and standardized outcome assessments. Future studies will be essential in advancing our understanding and optimizing the management of these complex cases.