Surgery inquiry: urethraplasty in meta prior to phallo

Thank you for your advice and for letting me know about your experience with Hysto. It really helped put me at ease. I got my hysto and I didn’t feel much pain at all. I’m planning on having meta next because it’s funded by my insurance but I have a few things that I was hoping you could answer as you’ve gone through phallo. I want MLD in the future but I’m unable to afford it at the moment. I figure I’ll get the meta 1st but I’m struggling on whether I should get urinary hook up. I am not sure if I should get the meta with urinary hook up if I am planning on getting phallo in the future. With your phalloplasty, does the urethra go through your original “glans” (the little guy) ? I’m a bit confused about that part and the placement of it under the constructed phallus? And in your opinion would you personally recommend that I get the Urinary lengthening or should I just get the clitoral release? I was hoping for a second opinion on what would be a better choice as a step before phalloplasty. Thank you very much for your help!

You’re very welcome 🙂 Congrats on hysto!

I nearly did that between hysto and phallo. I had no access to insurance at the time so out of pocket I could afford a release and scrotoplasty. I toyed getting u hook-up with the release and decided against it because it doubled the cost of getting the release and I could not justify forking that much money over for a temporary solution. I could justify the release because on its own it was relatively cheap and the scroto because that was the same whether phallo or meta is done. But getting urethral lengthening done for meta, can increase the risk of stricture and fistula for a subsequent urethral lengthening in phallo. Plus urethraplasty for meta with the surgeon I was considering cost as much as the release and scroto combined. In the end I went directly with phallo without another surgeon because public health insurance coverage changed in my province.

The area most prone to stricture and fistula in urethral lengthening is where the already existing urethra ends, and the extension is added. In the case of urethraplasty in a meta, it’s from where the natal urethra ends, and the extension begins. Fistulas can arise all along the extension, but strictures are rarer. Fistulas further along the extension tends to self-resolve, meaning, with a little post-op care, most will close up without surgical intervention. But fistulas at the point of connection are more likely to require surgical intervention. Getting urethraplasty done inside a phalloplasty following urethral lengthening into a meta means adding scar tissue from the 2nd urethraplasty next to where there’s already some from the 1st one.  I don’t have figures from research to share, but anecdotally, a lot of guys who got meta and then phallo, both with urethraplasty, report having strictures at that juncture.

Is it a reason to avoid doing this at all cost? I would say that depends on your personal circumstances, including your history of scarring (are you prone to hypertrophic or keloid scarring?) how long you expect there to be between meta and phallo (the longer the better as the scar tissue will soften over the first give years, which will make subsequent surgery easier), and so on.

[Picture by Jakob Owens from Unsplash. Description: a person waving a candle randomly in all directions. The pattern of the movement is captured as a line of light by a slow shudder.]

The other thing to look into is if your insurance will cover you getting both. More and more insurances will offer to cover either, but not phallo if meta was done first. Increasingly we are asked to be more certain about our choice, and only get one of the two procedures covered. This may not apply to your insurance plan, I’m just recommending you check the fine print. And then ask whichever surgeon(s) you’re considering for their feelings on doing urethraplasty to a previous urethral extension at your consult(s).

Best of luck to you, whatever you decide. I hope you have as smooth and quick a recovery as possible.

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