Construction of the fixed part of the neourethra in female-to-male transsexuals: experience in 53 patients.

Genital construction in female-to-male transsexuals should ideally involve the creation of a competent neourethra, allowing the patients to void while standing. A short review of the literature on this subject is given. In our hospital, construction of the fixed part of the urethra up to the level of the clitoris has been accomplished using an anterior vaginal flap as described by Thompson and by Bouman in 46 subjects. Initially, serious complications such as vesicovaginal and urethrovaginal fistulas and urinary incontinence were encountered in this series. Subsequently, in experienced hands, this seems to be a technique with few risks. Formation of a urethrocutaneous fistula at the level of the female external urethral orifice can be successfully prevented using this flap. The problem of neourethral urine residue has still to be solved.