A Unique Case of Bulbar Urethroplasty Using Distal Urethral Mucosa Autograft at the Time of Gender-Affirming Vaginoplasty

Y. Wilk Goldsher, Y. M. Qian, Y. Krakowsky, A. L. Millman

Gender Affirming Surgery, Penile Inversion Vaginoplasty, Urethroplasty, Lichen Sclerosis, Transgender, Urethral Stricture

This video presents the first reported case of a combined penile-inversion vaginoplasty (PIV) and bulbar urethroplasty using distal urethral mucosa autograft in a transgender woman with lichen sclerosus–associated urethral stricture disease. The approach repurposes distal urethral tissue normally discarded during PIV as a graft substitute. Operative steps, intraoperative findings, and early outcomes are illustrated. At six months, cystoscopy confirmed urethral patency without recurrence, while vaginal stenosis was noted. The case highlights both the feasibility and challenges of combining complex genital reconstruction with stricture repair in a single stage. These findings underscore the importance of multidisciplinary planning, active postoperative follow-up, and further study of lichen sclerosus manifestations in trans and gender-diverse patients undergoing genital reconstruction.

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