Overview of surgical techniques in gender-affirming genital surgery

Chen, Mang L.; Reyblat, Polina; Poh, Melissa; Amanda, C.

doi:10.21037/tau.2019.06.19

Cited by 58 publications

(54 citation statements)

References 66 publications

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“…Furthermore, we found that the use of tubularized vascularized flaps is less prone to stricture and fistulae, likely owing to their robust blood supply and the geometry of the suture line. Variations of the ring technique have been utilized by other centers [9,10] , but to our knowledge this is the first report to describe the technique and report on the outcomes. Indeed, we found that a large majority (87.9%) of patients were able to stand and urinate (primary outcome).…”

Section: Discussionmentioning

confidence: 99%

Metoidioplasty using labial advancement flaps for urethroplasty

Meltzer¹,

Esmonde²

2020

Plast Aesthet Res

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Aim: A variation of the ring metoidioplasty has been performed for masculinizing transgender surgery by the senior surgeon since 2010. It does not require buccal grafts or vaginal wall flaps. An excisional vaginectomy was completed in all patients. We sought to evaluate the urologic outcomes and complications for this technique. Further, we provide a detailed technical description of the technique, including ancillary masculinizing procedures. Methods: This is a retrospective, single surgeon chart review of all patients undergoing metoidioplasty from 2010 to 2020. Demographics, outcomes, and complications are reported. A self-reported patient questionnaire provided data on patient-perceived urologic outcomes. Results: Ninety-one patients were included in the study, with 80 (87.9%) patients reporting ability to stand and void with a strong stream. We observed five strictures (5.5%) and one fistula (1%). Scrotoplasty with tissue expanders and testicular implants were performed in 75 (82.4%) patients, while monsplasty was performed in 54 (59%) patients. Conclusion: Our technique has a low complication rate and patients report a strong urinary stream and the ability to stand in the large majority of cases. Ancillary masculinizing procedures are common. The limitations of metoidioplasty, in general, still persist, which are the small phallus size and variable ability to clear the zipper without lowering the pants to void.

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Section: Discussionmentioning

confidence: 99%

Metoidioplasty using labial advancement flaps for urethroplasty

Meltzer¹,

Esmonde²

2020

Plast Aesthet Res

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“…For more severe cases, revision peritoneal vaginoplasty or visceral interposition vaginoplasty may be required. In some patients, vaginal canal loss is due to inexorable healing of the vaginal cavity over time, despite all dilation efforts, which we hypothesize is more likely in certain patients with a history of exuberant scar formation, superfast healing, or other scarring-related disorders such as urethral stricture (5).…”

Section: Vaginal Stenosismentioning

confidence: 95%

“…Rectovaginal fistulas may occur early or late. Many fistulas are small and heal spontaneously, but fistula repairs may be necessary (5). Reparative surgery involves fecal diversion, resection of the fistula, and revision of the vaginoplasty (3).…”

Section: Rectovaginal Fistulamentioning

confidence: 99%

“…The type of vaginoplasty performed is dependent on every individual's specific needs and surgical goals. Some patients may choose a "zero--depth" vaginoplasty (aka "vulvoplasty") if they do not anticipate to ever want vaginal penetration, or they may have comorbidities that make this a safer option (5). Younger patients in whom puberty has been arrested, may have insufficient penile skin needed for neovaginal cavity augmentation in excess of what is available through standard penile inversion techniques (2).…”

Section: Introductionmentioning

confidence: 99%

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Vaginoplasty tips and tricks

Li¹,

Crane²,

Santucci³

2021

Int. braz j urol.

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Vaginoplasty is a commonly performed surgery for the transfeminine patient. In this review, we discuss how to achieve satisfactory surgical outcomes, and highlight solutions to common complications involved with the surgery, including: wound separation, vaginal stenosis, hematoma, and rectovaginal fistula. Pre-operative evaluation and standard technique are outlined. Goal outcomes regarding aesthetics, creation of a neocavity, urethral management, labial appearance, vaginal packing and clitoral sizing are all described. Peritoneal vaginoplasty technique and visceral interposition technique are detailed as alternatives to the penile inversion technique in case they are needed to be used. Post-operative patient satisfaction, patient care plans, and solutions to common complications are reviewed.

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“…That said, the nearly universal strategy is to use adjacent tissues, sometimes augmented with skin or buccal mucosal grafts, to construct a hairless, epithelial-lined tube from the location of the female urethral orifice to the base of the neophallus. The variations in specific techniques include (1) the degree of clitoral chordee release and resection of clitoral skin performed when repositioning the clitoral body [38,[59][60][61] ; (2) the timing of vaginectomy and the use (or not) of an anterior vaginal myomucosal turnover flap to augment the proximal pars fixa [20,21,62] ; (3) the use (or not) of skin or buccal mucosal grafts to form the dorsal "floor" of the pars fixa [61][62][63][64][65] ; (4) the specifics of labia minora pedicled flaps to construct the ventral "roof " of the pars fixa [60][61][62][63][64][65] ; (5) the timing of pars fixa construction (discussed below); and (6) the use (or not) of a pedicled gracilis muscle or other vascularized flap to augment healing of the multiple anastomotic suture lines necessary [66,67] . These variations have been employed in virtually every combination at various centers.…”

Section: Pars Fixa Urethra (Also Referred To As the Perineal Urethra)mentioning

confidence: 99%

Phalloplasty: understanding the chaos

2020

Plast Aesthet Res

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Wide variation in overall strategies and surgical specifics for masculinizing genital surgery has created a "phalloplasty chaos" that is confusing to both surgeons and patients seeking gender confirming surgery. The purpose of this article is to review masculinizing genital confirming surgery, or "phalloplasty", focusing on specific goals and categorizing each component of the surgical process. Experienced surgeons from several highvolume centers review and categorize the commonly employed strategies and techniques for gender confirming phalloplasty, including the permutations of approaches to cutaneous flap for phallic construction, the sequence and staging of procedures, and strategies for urethral construction. There is no clear advantage or reduction in complications associated with particular sequences of urethral and phallic reconstruction. Because no single technique or staging strategy has proven superior for gender confirming genital surgery, it is paramount that surgeons are knowledgeable of all available options and the associated advantages, disadvantages, and risks.

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Overview of surgical techniques in gender-affirming genital surgery

Cited by 58 publications

References 66 publications

Metoidioplasty using labial advancement flaps for urethroplasty

Metoidioplasty using labial advancement flaps for urethroplasty

Vaginoplasty tips and tricks

Phalloplasty: understanding the chaos

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