[Subsequent procedures after masculinizing surgery: neourethra and prosthetics]

The goal of masculinizing genital surgery, which is usually performed over several planned operative stages, is to construct a genital that is both aesthetically and functionally satisfactory. It aims to create a phallus with the best possible sensitivity, a long-term stable neourethra for voiding in a standing position, and to enable penetrative sexual intercourse by means of erectile prostheses. Whether all of these steps are required depends on the individual needs of the trans man. Due to anatomical peculiarities (the absence of stable tissue types designed for the relevant function), both urethral surgery and penile prosthesis implantation differ significantly from those performed on cisgender male patients and result in higher complication rates. Since the neourethra is usually constructed from several tissue types not designed for contact with urine-such as the labia minora, vaginal mucosa, and formerly hair-bearing dermis-the main complications include urethral fistulas, strictures, and diverticulum formation, as well as hair growth within the neourethra with or without stone formation and consequent impaired urinary outflow. The most common complications of prosthesis implantation in trans men are infection, erosion, dislocation, and (premature) mechanical failure, which frequently necessitates further revisions and subsequent operations. The available evidence is predominantly based on retrospective data with small case numbers and is characterized by considerable heterogeneity regarding the definition of endpoints and the assessment of patient-reported outcomes. Despite these methodological limitations, the published studies overall show a high rate of functional satisfaction.