What is Urethral Lengthening in Phalloplasty? ~info-doodles!


THIS IS IT!
— the collage —
Info-doodle collection of UL drawings,
based on medical journal articles,
radiology, and operating room photos

The goal in these drawings

How does urethral lengthening work? The language gets full of medical jargon quickly.

There’s a sweet spot of whetting the info appetite I hope this doodle serves. Most trans people considering UL for bottom surgery want to know more than, “We hook up the old to the new” in considering it. But we don’t need operating room notes.

My goal: With as few words as possible, I wanted to sketch the images that helped me understand.

Now, I did not have UL. I don’t have first-hand photos of UL on my own body. So— Sketching allowed me to collage the images on one poster and also to eliminate the component of medical gore.

Limitations

The drawings are not intended to show all techniques. Really, the drawings are just to give a possible context. So, I included an example of variation on staging. I also included variation on which tissue was pedicled (vaginal or labial) to make the hook-up, or the pars fixa.

Complications in healing

There’s a boxed set of drawings on the right-middle of the page. Common complications! Gosh, it’s tough to search for stricture and fistula without seeing a lot of things you… may not have wanted to see. So, if you’re squeamish, these complication doodles are for you.

Feedback?

Did I leave out anything I should have included? I hope the collage gives an introduction to urethral lengthening, for someone considering it.

UL Doodle Collage Components

A few pieces that went into the collage, isolated for another look:

Parts of the urethra given in phalloplasty
(Below) Drawing of urethral stricture based on medical imaging; (Above) Diverticulum
Urethral anatomy for phalloplasty (UL)
The same UL hookup diagram labeled and given a schematic of angles the urine must travel
Phalloplasty with UL, possible complication: fistula. On this individual the skin has opened at the base of the penis, and urine would leak out there. Heal up soon, hon’!
How some surgeons might make the urethral lengthening and hookup from the labia minora. I liked how this set of OR photos also showed me how it was that the natal glans burial could occur at the same time.
To be that avante-garde, I made art of a prior work of medical art. It’s an infinite regress, ha! Here is a Stage 1 – Phalloplasty healing first, with UL hookup coming at a later date for Stage 2.
How neat is this vaginal wall pedicle? This little walnut-shaped (and sized!) zone just beyond the opening of the vagina, where the urethra is also in that depression. That’s where they can flip a section of v. tissue for the hookup. Also it looks like it is sticking its tongue out at me.
(Left) Trans masculine non-op / pre-op, post-T; (Right) Example of post-phallo pelvis with UL, hysto, and vaginectomy. Also shown with an implant in the scrotum. You probably want to focus your attention on how the glans and legs of the dick/clit are still present, as well as the section of mucosal flesh linking the old and new urethra.

Where credit is due!

These are just a few of the physicians whose medical publications provided me context to draw and collage:

Dr. Miro in Serbia, Dr. Chen in California, Dr. Bluebond in NYC, Dr. Coon at Hopkins, and medical artist H. Wilson. I recognized these names, among others, in the articles which helped me get a window into these procedures.

Hope this is useful : )

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