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

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;R?=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.

Modified malleable prosthesis with a fixed mesh:case series for the Ghattas technique

Penile prosthetic implantation represents a cornerstone for patients with organic erectile dysfunction(ED)that is refractory,unsatisfactory,or contra-indicated for other approved medical or mechanical options.In this study,we introduce the“Ghattas technique,”wherein we constructed a polypropylene mesh sheath that surrounds and is fixed to a 13-mm malleable prosthesis cylinder,which can increase the cylinder diameter for cases that need a larger prosthesis.All patients underwent preoperative evaluation and completed the five-item International Index of Erectile Function questionnaire(IIEF-5).Postoperative outcomes were evaluated by IIEF-5 and Erectile Dysfunction Inventory of Treatment Satisfaction(EDITS)questionnaires at final follow-up.The mean age of the 23 included patients was 57.9(standard deviation[s.d.]:11.4)years and the mean duration of ED was 8.5(s.d.:7.9)years.Erection improvement was determined by comparing mean preoperative and postoperative IIEF-5 scores(8.3[s.d.:3.9]vs 24.6[s.d.:0.6],P<0.001).High treatment satisfaction was determined according to a mean EDITS score of 94.9(s.d.:9.9).The proposed Ghattas technique was safe and effective in our patients,and provides opportunity for cases that need a diameter larger than 13 mm.Further studies are needed to confirm these results.