GenitoUrinary Reconstructive Surgeon
San Francisco, CA
Joined October 2019
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Nomenclature: Johanson Urethroplasty
- derives from Swedish urologist Bror Johanson, who described the original two-stage urethroplasty for urethral strictures
- common mispelling: Johansson, Johansen, Johannson
Ring Metoidioplasty: Outcomes & Technical Analysis
Technique:
- Labia minora ring flap for UL
- Ghent method for scrotoplasty
➡️ 94 pts (44m follow-up)
➡️ 14% fistulas (6 repaired), 4% strictures
➡️ 9% urethral revision rate | <5% scrotal necrosis
ovid.com/jnls/ijoru/fulltext…
Pedicled Labia Minora Flap for Urethral Lengthening in Phalloplasty
➔ 16 patients (ALT/SCIP)
➔ Fistula 25%, Stricture 37.5%, Perineal urethrostomy 18.7%
➔ Standing voiding: 56.3%
Feasible but high stricture/fistula rates
DOI: 10.1016/j.urology.2019.10.041
Anterolateral Thigh Phalloplasty With Staged Skin Graft Urethroplasty
→ 24 patients, 3-stage ALT phalloplasty
→ Standing micturition achieved: 87.5%
→ Urologic complications: fistula 33.3%, stricture 20.8%
→ Staged STSG urethroplasty offers a viable path to standing micturition with manageable revisions.
DOI: 10.1016/j.urology.2023.03.038
Long-term outcomes for primary IPP insertion after phalloplasty (London 2026)
N=694; 9/2001 to 7/2024
▶️RF phallus 506/694
▶️Infection: 69/694
▶️Mech fail: Boston 30%, Coloplast 12%
▶️Overall revision: 40% 5 yrs; 56% 10yrs; 65% 15yrs
bjui-journals.onlinelibrary.…
Perioperative Antimicrobial Strategies in Inflatable Penile Prosthesis Surgery
Multicenter retrospective study 5261 patients
▶️Infection rate 1.9%
▶️Antifungal use lowers risk
▶️Postop abx > 24 hrs no benefit
⏩Use antifungal; question postop abx > 24 hrs
pubmed.ncbi.nlm.nih.gov/4077…
Multicenter Analysis of Long-Term Outcomes of AUS After Urethroplasty
▶️178 patients (17 surgeons)
▶️Complications: explant, erosion, infection, atrophy, mech failure
▶️Prior transecting Uplasty 56% | nontransecting 24%
⏩AUS risk higher in patients who had transecting urethroplasty
auajournals.org/doi/10.1097/…
Rates of infection of hydrophilic IPPs (inflatable penile prostheses) using 0.05% CHG (chlorhexidine gluconate)
▶️14 institutions, 2150 IPPs
▶️Infections: CHG 4.6%, Abx 2.1%
⏩CHG use increases infection risk of hydrophilic IPPs
pubmed.ncbi.nlm.nih.gov/4126…
ZSI475 (IPP) and ZSI100 (MPP) outcomes (Amsterdam 2025)
▶️50 patients, 85 implants (66 IPPs; 19 MPPs)
▶️Median followup 26mos IPPs, 32mos MPPs
▶️Infection: IPP 15%, MPP 11%
▶️Revision 56%
⏩Poor 3-yr complication free survival: 39% IPPs and 31% MPPs
pubmed.ncbi.nlm.nih.gov/4089…
London Staging of RFFF phalloplasty:
▶️ Stage 1: RFFF phallus, pars pendulans (PP) from RFFF matured to labial skin after resection of minora projection
▶️Stage 2: pars fixa (PF) from vaginal + labial flaps | PF-PP anastomosis | glansplasty | scrotoplasty | vaginectomy
London Staged RFFF phalloplasty urethral outcomes 2010
▶️ N = 115: 3 phallus loss | 84 PF and PP urethroplasty |
▶️31 PP urethroplasty only
▶️Median followup 26 months (1998-2008)
▶️Fistulas 20
▶️Strictures 9
⏩Revisions 29/84 (35%)
pubmed.ncbi.nlm.nih.gov/1947…