Transcystostomal Bladder Tumor Resection in a Transgender Man After Phalloplasty

Area of Science:

• Urology
• Oncology
• Gender-affirming surgery

Background:

• Phalloplasty in transgender men can lead to neourethral strictures, complicating bladder tumor resection.
• Standard transurethral access is often precluded in these patients.
• This case presents the first transcystostomal bladder tumor resection in a transgender man post-radial forearm free flap (RFFF) phalloplasty.

Purpose of the Study:

• To describe a novel transcystostomal approach for bladder tumor resection.
• To demonstrate oncological safety and preservation of function in a transgender man with post-phalloplasty neourethral stricture.

Main Methods:

• A two-stage transcystostomal approach was utilized in a transgender man 23 years after RFFF phalloplasty.
• This involved suprapubic cystostomy (SPC) placement, tract maturation, balloon dilation, and resectoscope insertion.
• A modified Valdivia position facilitated simultaneous transcystostomal and transurethral access with gravity-assisted drainage.

Main Results:

• Complete resection of a 15-mm posterior bladder tumor was achieved without complications.
• Pathology confirmed noninvasive papillary urothelial carcinoma (pTa, low-grade) with negative margins.
• Surveillance revealed no recurrence at 3 and 6 months, preserving standing voiding function.

Conclusions:

• The described two-stage transcystostomal approach is a safe and reproducible option for bladder tumor resection.
• It effectively achieves oncological control while preserving phallic anatomy and voiding function.
• This technique is suitable for patients with inadequate transurethral access post-phalloplasty.