V857 OPTIMIZED TRANSGENDER SURGERY MALE TO FEMALE
2011-04-01

You have accessJournal of UrologyReconstruction, Transitional Cell Carcinoma & Adrenal1 Apr 2011V857 OPTIMIZED TRANSGENDER SURGERY MALE TO FEMALE Bastian Amend, Joerg Seibold, Arnulf Stenzl, and Karl-Dietrich Sievert Bastian AmendBastian Amend Tuebingen, Germany , Joerg SeiboldJoerg Seibold Tuebingen, Germany , Arnulf StenzlArnulf Stenzl Tuebingen, Germany , and Karl-Dietrich SievertKarl-Dietrich Sievert Tuebingen, Germany View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.679AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Different techniques have been described for neovaginal and clitoral gender reassignment. Major problems after neovaginal reconstruction are vaginal stenosis and insufficient size resulting in patient dissatisfaction. Perovic et al. described the incorporation of an excessive penile urethra into the neovaginal circumference. We demonstrate our technique in regard to optimized postoperative outcome and reduction of typical risks such as compartment syndrome, thrombosis and peroneal paralysis caused by prolonged lithotomy position. METHODS From October 2006 to October 2010 26 patients underwent gender reassignment using the following technique: Dorsal position was used for penile disassembly and orchiectomy. After repositioning to lithotomy position with additional pneumatic stockings, both corpora cavernosa were resected and the neovagina was constructed using penile skin w/o foreskin including the penile urethra. Before the neovagina is inserted into the blunt-dissected rectoprostatic space and fixed to the sacrospinous ligament, the size-reduced vascularized and innervated glans is used to create the neoclitoris. The medial scrotal skin is used to form the labia majora and minora and the subcutaneous fat is rotated to shape the mons pubis. A unique approach to move the skin resulted in reduced skin incisions. RESULTS 26 patients received transgender surgery with the described technique. One intraoperative complication (rectal injury with primary closure without colostomy) occurred without any consequences. No transfusions were needed. All patients reported satisfaction concerning neovaginal length and width. In addition to two urethral strictures treated by meatoplasty, no neovaginal strictures were reported. Patients were offered a second intervention for aesthetic aspects of the labia and mons pubis; it performed in two-thirds of the cases. 25 patients reported the possibility of clitoric orgasm and sensibility. CONCLUSIONS The incorporation of vascularized distal urethra for the creation of neovagina results in an optimal functional size with regard to depth and width; in addition the glans was transformed into the neoclitoris. The two-step positioning of the patients reduced operating time and postoperative complications. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e344 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bastian Amend Tuebingen, Germany More articles by this author Joerg Seibold Tuebingen, Germany More articles by this author Arnulf Stenzl Tuebingen, Germany More articles by this author Karl-Dietrich Sievert Tuebingen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...