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Post-Operative Use of Furosemide Is Associated with Decreased Urinary Complications after Transgender Free Radial Forearm Phalloplasty

Miller, Travis J. MD; Chen, Mang L. MD; Watt, Andrew J. MD; Buntic, Rudolf F. MD, FACS; Safa, Bauback MD; Lin, Walter C. MD

Plastic and Reconstructive Surgery – Global Open: July 2019 - Volume 7 - Issue 7S - p 1
doi: 10.1097/01.GOX.0000579784.10831.6e
Mountain West 2019 Abstract Supplement

The Buncke Clinic, San Francisco, CA

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

PURPOSE: Phalloplasty with a double-tubed radial forearm free flap (RF) is commonly performed for masculinizing gender-affirmation surgery. Previous studies have compared complication rates among differing techniques, but risk factors for complications remain unclear. We thus undertook a case-control study evaluating patient and perioperative risk factors for complications in single-stage RF phalloplasty patients. We hypothesized that fluid management factors would affect outcomes with higher complication rates among those requiring diuretics perioperatively.

METHODS: A single-center, prospective analysis of patients undergoing single-stage double-tubed RF phalloplasty with full-length urethroplasty was performed from October 2017 to December 2018. Univariate analysis was performed using input variables including age, body mass index, prior childbirth, primary glansplasty, primary scrotoplasty, number of venous microanastomoses, American Society of Anesthesiologists (ASA) score, operating time, intraoperative fluid volume, and postoperative furosemide treatment. Output variables included flap-related complications, urethral complications, and scroto/perineal complications.

RESULTS: Forty-six consecutive patients underwent RF phalloplasty reconstruction over 14 months. Intraoperative fluids ranged from 1 to 4.1 liters. Fifteen patients (32.6%) received furosemide due to flap edema; two (4.3%) additionally required flap decompression. There were no incidences of partial or total flap loss. Overall complication rate was 50%. Furosemide in the acute perioperative period was associated with a decreased risk of urethral complications (OR =0.14, p = 0.03).

CONCLUSIONS: Contrary to our hypothesis, use of perioperative furosemide was associated with fewer phalloplasty urethral complications, possibly by accelerating fluid mobilization and decreasing flap edema. Further study is necessary to confirm this mechanism and determine whether diuretics should be routinely administered perioperatively.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.