Male-to-Female Genital Reassignment Surgery: A Retrospective Review of Surgical Technique and Complications in 60 Patients

Abstract

Background Patients with male-to-female gender dysphoria (GD) require multidisciplinary assessment and management. Nowadays, more and more patients decide to undergo genital reassignment surgery (GRS) to have aesthetic and functional external female genitalia. Different techniques of this procedure have been described. Orchiectomy, penile disassembly, creation of a neovaginal cavity, repositioning of urethral meatus, and clitorolabioplasty may be identified as the five major steps in all of these techniques. Methods We conducted a retrospective study of 60 patients who underwent genital reassignment procedure for male-to-female GD at our department between November 2008 and August 2013 with a minimum follow-up of 1 year. Data were collected on surgical technique, postoperative dilations protocol, complications, and functional and aesthetic outcomes. We describe and critically evaluate the surgical technique used in our department. Results Follow-up ranged from 14 to 46 months. Two patients developed late neovaginal stricture, and two patients experienced rectovaginal fistulae (one required surgical revision with dermal porcine graft placement). Minor complications occurred in 13 patients and included urethral stenosis, partial wound dehiscence, and minor bleeding. Secondary aesthetic revision surgery was performed in 13 cases. Conclusions GRS can provide good functional and aesthetic outcomes in patients with male-to-female GD. However, despite a careful planning and meticulous surgical technique, secondary procedures are frequently required to improve the function and appearance of the neovagina.

Complications of the neovagina in male‐to‐female transgender surgery: A systematic review and meta‐analysis with discussion of management

“…Prevalence is difficult to establish as data are influenced by accessibility of care, differences in definition of the condition and social climate (Buncamper et al, 2015). Research, however, shows an increase of GD prevalence in more recent cohorts up to 1 in 2,900 genotypic males according to Raigosa et al (2015). The management of patients presenting with male-to-female (MtF) GD is complex and multifactorial.…”

Anatomy of genital reaffirmation surgery (male‐to‐female): Vaginoplasty using penile skin graft with scrotal flaps

“…Once the incision is made, the surgeon begins the process of degloving the penis, which involves dissecting the penile skin from the shaft (Buncamper et al, 2017). The degloved penis is passed through the posterior scrotal opening created by the initial incision at the penile base (Raigosa et al, 2015).…”

“…A section of the penile skin base is used to form the labia minora. It is sutured to the de-epithelialized area of the neoclitoris to form the hood of the neoclitoris (Bizic et al, 2014) and the inferior border of the labia majora (Raigosa et al, 2015). An appropriate amount of scrotal skin is removed (Perovic, 2015) leaving the underlying subcutaneous tissue intact.…”

Histerectomía por laparoscopia en un transexual masculino: reporte de caso y revisión de la literatura

“…Laparoscopic hysterectomy has gained popularity because of several advantages, including smaller access, better visualization of the anatomy, faster recovery and shorter hospital stay, less postoperative pain and no significant scarring (11,12). Reports with the largest number of cases on sex reassignment are found in female transgender individuals (male-to-female), including a retrospective study by Raigosa et al in 60 individuals at Hospital Clinic of Barcelona (13).…”