Penile Reconstruction and the Role of Surgery in Gender Dysphoria

Lee, Wai Gin; Christopher, Nim; Ralph, David

doi:10.1016/j.euf.2019.03.013

Cited by 9 publications

(6 citation statements)

References 7 publications

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“…'Bottom' surgery Genital GAS encompasses a range of procedures offered to transmasculine individuals. 2 Great care should be taken to tailor the approach to the individual because not all will want, require or qualify for each procedure.…”

Section: Gender Affirmation Surgerymentioning

confidence: 99%

The role of penile reconstruction in gender affirmation surgery

Lee

Ralph

2021

Trends Urol & Men's Health

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Section: Gender Affirmation Surgerymentioning

confidence: 99%

The role of penile reconstruction in gender affirmation surgery

Lee

Ralph

2021

Trends Urol & Men's Health

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“…The aim of masculinising genital GAS is to construct a neophallus (with or without urethra) and scrotum with a male-appearing perineum. 1,2 The female reproductive organs can be removed but not every individual will want, require or qualify for every surgical option that may be available. The flaps used in phalloplasty often do not provide full rigidity as they do not contain native erectile tissue.…”

Section: Introductionmentioning

confidence: 99%

“…Surgical reconstruction is usually staged, with an ideal end result that is aesthetically satisfying, sensate, and allows both micturition whilst standing and penetrative sexual intercourse, if desired. 1 A study demonstrated that out of 1056 individuals who had a phalloplasty, 792 (75%) received a penile prosthesis. 3 Whilst there are malleable (also known as semi-rigid) and inflatable penile prostheses (IPP), the inflatable devices provide a more natural and concealable appearance.…”

Section: Introductionmentioning

confidence: 99%

“…Gender incongruence is associated with rates of self-harm and suicide attempts at least 10-fold higher than the general population. 1 Some patients choose to physically transition to the gender they identify with using a combination of hormonal therapy with or without reconstructive surgery. Gender affirmation surgery (GAS) for transgender and non-binary (TGNB) individuals aims to more closely align the physical body with the individual’s gender identity.…”

Section: Introductionmentioning

confidence: 99%

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Insertion of inflatable penile prosthesis in the neophallus of assigned female at birth individuals: a systematic review of surgical techniques, complications and outcomes

Pang,

Christopher,

Ralph

et al. 2023

Therapeutic Advances in Urology

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Devices such as inflatable penile prostheses (IPP) can be used to achieve erectile rigidity after phalloplasty in assigned female at birth (AFAB) individuals. The approach to inserting an IPP in a neophallus is different and more challenging compared to that of an anatomical penis due to the absence of anatomical structures such as the corpora cavernosa, and the more tenuous blood supply of the neophallus and reconstructed urethra. In addition, the ideal surgical techniques and devices for use in the neophallus have not been defined. This review systematically summarises the literature on the insertion of IPP in the neophallus of individuals AFAB. In particular, the described techniques, types of devices used and peri-operative and patient-reported outcomes are emphasised. An initial search of the PubMed database was performed on 16 September 2022 and an updated search was performed on 26 May 2023. Overall, 185 articles were screened for eligibility and 15 studies fulfilled the inclusion criteria and were included in the analysis. Two studies reported outcomes on the zephyr surgical implant 475 FTM device and the others reported outcomes on the Boston Scientific AMS 600/700TM CX 3-piece inflatable, AMS AmbicorTM 2-piece inflatable, Coloplast Titan® or Dynaflex devices. Overall, 1106 IPPs were analysed. The infection rate was 4.2%–50%, with most studies reporting an infection rate of <30%. Mechanical failure or dysfunction occurred in 1.4%–36.4%, explantation was required in 3.3%–41.6%, and implant revision or replacement was performed in 6%–70%. Overall, 51.4%–90.6% of patients were satisfied and 77%–100% were engaging in sexual intercourse. An IPP in a neophallus is an acceptable option to achieve rigidity for sexual intercourse. However, this challenging procedure has good reports of patient and partner satisfaction despite significant risks of complications.

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“…The reconstruction of the neophallus should be performed as a onestage procedure, yielding sensation (tactile and erogenous), functional neourethra (ability of stand-up voiding), penetrative sexual intercourse, and minimal scarring of the donor site [5,7] . Unfortunately, to this day, there is no single surgical technique to satisfy all these goals of male genitalia reconstruction [8] .…”

Section: Introductionmentioning

confidence: 99%

Metoidioplasty as a one-stage phallic reconstruction in transmen

Bizic¹,

Stojanovic²,

Bencic³

et al. 2020

Plast Aesthet Res

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Gender dysphoria is a condition where there is a discrepancy between the gender assigned at birth and the desired gender, leading the patient to pursue surgical intervention. Reconstruction of the neophallus for transmen is still challenging, even though there are many surgical techniques with satisfying results. The aim of neophallic reconstruction in gender affirmation surgery (GAS) for transmen is to provide stand-up voiding, erotic sensation, orgasm and penetration ability, and acceptable donor site morbidity with minimal scarring and complications. Metoidioplasty as a variant of phalloplasty for transmen is a one-stage procedure that results in male-like external genitals, with minimal scarring, ability of standing micturition, and full erogenous sensation with the ability to achieve orgasm during sexual intercourse. Metoidioplasty is a method of choice for those transmen who wish to have GAS in one procedure without multi-staged procedures to create the adult-male-sized neophallus.

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Penile Reconstruction and the Role of Surgery in Gender Dysphoria

Cited by 9 publications

References 7 publications

The role of penile reconstruction in gender affirmation surgery

The role of penile reconstruction in gender affirmation surgery

Insertion of inflatable penile prosthesis in the neophallus of assigned female at birth individuals: a systematic review of surgical techniques, complications and outcomes

Metoidioplasty as a one-stage phallic reconstruction in transmen

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