Monopolar Resection Of Anastomotic Urethral Polyps After Excision And Primary Anastomosis In Radial Free Forearm Flap Total Phallic Reconstruction Patients

Abstract

Introduction Following phalloplasty, urological problems, such as urethral fistula and urethral stricture, are frequent. Even in the best hands, an "all cause" urological complication rate of 36% is observed. There are no reports in literature regarding urethral polyps after excision and primary anastomosis in cases of Total Phallic Reconstruction. Methods Retrospective study that identified patients who previously had Radial Free Forearm Flap Total Phallic Reconstruction (Phalloplasty) and underwent monopolar resection of anastomotic urethral polyps after excision & primary anastomosis urethroplasty between August 2020 and August 2022 in Department of Urology, Kasr Al-Ainy-Cairo University hospitals. Results A total of 3 patients were identified with anastomotic urethral polyp, median age was 25 years. Monopolar endoscopic resection of urethral polyps was done. All patients voided freely with good flow (Median Q-Max 34.4 ml/s, range 26.0-54.1 ml/s) after catheter removal and residual urine volume by ultrasound was insignificant. During follow up, one patient suffered from recurrent anastomotic urethral stricture while the other two cases continued to void freely with no urinary obstructive symptoms or significant residual urine. Median follow up was 12 months (range 6-24 months). Discussion Urethral complications after phalloplasty are frequent but treatment recommendations are lacking in the literature. Studies concerning urethroplasty after phalloplasty are scarce in the literature. While reviewing the literature, no case reports were found regarding urethral polyps after anastomotic urethroplasty in patients who had underwent Total Phallic Reconstruction. Conclusion Urethral polyp excision using monoploar energy is feasible and can be safe to use in patients after Total Phallic Reconstruction, but due to the lack of similar cases in literature no recommendation can be made regarding this approach and further research is still required.