Urethroplasty Methods for Stricture Repair After Gender Affirming Phalloplasty: High Failure Rates in a Hostile Surgical Field.

OBJECTIVE: To report our experience with 71 postphalloplasty urethral strictures in order to discuss the performance characteristics of different urethroplasty techniques in urethral stricture after phalloplasty. METHODS: We conducted a retrospective chart review of 85 urethroplasties performed for stricture repair in 71 patients with phalloplasty for gender affirmation between August 2017 and May 2020. Stricture location, urethroplasty type, complication rate, and recurrence rate were recorded. RESULTS: The most common stricture type was distal anastomotic (40/71, 56%). The most common initial repair type was excision and primary anastomosis (EPA) (33/85, 39%), followed by first-stage Johanson urethroplasty (32/85, 38%). The stricture recurrence rate after initial repair of all types was 52% (44/85). The recurrence rate of stricture after EPA was 58% (19/33). The recurrence rate after staged urethroplasty was 25% (2/8) for patients who successfully completed a first and second stage. 30% (3/10) of patients who completed a first stage and opted out of a second stage required a revision to achieve successful lifetime voiding from the surgical urethrostomy. CONCLUSION: EPA after phalloplasty has a high failure rate. Nontransecting anastomotic urethroplasty has slightly lower failure rate, and staged Johanson-type surgeries have the highest success rates after phalloplasty.

Lack of Gender Diversity Among Systematic Reviews Authors in the Urological Literature (1998-2021).

PURPOSE: Gender equity is a key performance metric in research, including systematic reviews, and is increasingly noted in publications. We performed this study to assess gender parity in scientific authorship of systematic reviews published in the urological literature. MATERIALS AND METHODS: We identified all published systematic reviews addressing questions of therapy/prevention in 5 major urological journals (The Journal of Urology®, European Urology, Urology, BJU International, and World Journal of Urology) from 1998 to 2021. We determined gender of first, second, corresponding, and any author as a binary variable (woman or man) using a predefined algorithm. RESULTS: We included 523 systematic reviews. The main journal contributors were European Urology (32.6%), BJU International (22.0%), and The Journal of Urology (19.5%). Slightly more than half (51.8%) of reviews included at least 1 woman coauthor, 37.5% did not, and in 10.7% it was unclear. First, second, and corresponding authors were women in 13.7%, 12.4%, and 4.7%, respectively, and the median number of women contributors was 1 (interquartile range 0-2). Women-first authorship for the time period 1998-2012 was 13.0% (P = .139), and senior authorship was 5.0% (P = .270). In 2013-2016 it was 11.0% and 4.1%, and in 2017-2021 it increased somewhat to 16.5% and 5.1% (P = .270), respectively. CONCLUSIONS: The number of women involved in systematic reviews is low and has not improved over time. Since scientific authorship is important for academic advancement, this finding may contribute to the underrepresentation of women in academic leadership positions. Efforts to improve gender diversity in urology should include more collaboration across genders.