Forearm Technique

Constructing a New Urethra for Transgender Men

In the complex surgical landscape of gender transition from female to male, creating a new urethra represents a significant challenge.

This procedure is crucial for those seeking to achieve urinary functions aligned with their gender identity, allowing for urination in a standing position.

Despite the advancements in surgical techniques, complications such as urethral leakage and stricture remain prevalent, posing additional challenges for patients and medical practitioners alike.

Global Trends and Surgical Innovations

The pursuit of constructing a functional urethra has seen various innovations, particularly the “vaginectomy and abdominal phalloplasty” method, recognized for its efficacy in forming a male genitalia that meets size, shape, urination function, sensation, and the ability to accommodate erectile devices.

This article delves into the forearm technique for urethra construction, highlighting the procedural intricacies, patient preparation, and post-operative considerations.

Surgical Techniques for Urethra Extension

The extension of the urethra involves the meticulous creation of a longer urinary tract to facilitate forward urination, a characteristic feature of male physiology.

This process typically includes the transformation of the vaginal canal’s anterior wall into an extended urethral segment.

The surgical approach for this procedure involves detailed preparation steps, including a thorough physical examination, laboratory testing for pre-operative anomalies, and the temporary cessation of hormone therapy to reduce surgical bleeding risks.

The Forearm Technique: An Overview

The forearm technique for urethra construction involves using tissue from the patient’s forearm to form a new urinary channel.

This method addresses the significant issue of urethral complications by utilizing tissue from alternative body areas, notably the lower buttocks, which offers concealment and size adjustability, thus reducing the risk of stricture.

Pre-Surgical Preparations

Patients undergoing this procedure must undergo comprehensive physical examinations and laboratory tests to ensure overall health and surgical readiness.

Specific considerations include evaluating the non-dominant arm for tissue harvesting and preparing the patient for the implications of scarring and the post-operative care required for the newly constructed urethra.

Surgical Process and Patient Journey

The surgical creation of a new urethra involves harvesting a strip of skin from the lower buttocks, removing fatty and glandular tissues to prevent future hair growth within the urethra.

This skin strip is then meticulously crafted around a catheter to form the new urethral channel, which is subsequently implanted into the forearm, allowing for vascular integration and healing.

Post-Surgical Care and Recovery

Following the surgery, patients embark on a recovery phase that includes wound care and monitoring for complications such as bleeding or infection.

The catheter serves as a temporary urethral axis during this period, requiring meticulous cleaning and maintenance to ensure proper healing and functionality of the new urethra.

Addressing Surgical Risks and Complications

While the forearm technique presents a promising solution to urethral construction, it is not devoid of challenges.

Potential complications include scarring, tissue damage, and the psychological impact of the procedure on the patient.

It is imperative for medical practitioners to provide comprehensive counseling and support throughout the surgical journey, addressing any concerns and managing expectations.


The construction of a new urethra using forearm tissue represents a significant advancement in gender transition surgeries, offering transgender men the opportunity to achieve a crucial aspect of their physical transition.

Despite the complexities and potential risks associated with the procedure, careful planning, skilled surgical execution, and dedicated post-operative care can lead to successful outcomes, enabling patients to live their lives more aligned with their gender identity.

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