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Djordjevic ML. Treatment of Urethral Stricture Disease by Internal Urethrotomy, Dilation, or Stenting. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.eursup.2015.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kurbatov D, Stojanovic B, Dubskiy S, Lepetukhin A, Djordjevic ML. Buccal mucosa graft urethroplasty in a case of urethral amyloidosis presenting with long anterior urethral stricture. Can Urol Assoc J 2015; 9:E830-3. [PMID: 26600896 DOI: 10.5489/cuaj.2957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Urethral amyloidosis is a rare condition, but clinically relevant because it can mimic urothelial carcinoma. We report a case of localized urethral amyloidosis presenting with a long anterior urethral stricture. We used extensive grafts of buccal mucosa for standard augmentation urethroplasty, with a successful outcome at the 2-year follow-up.
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Stojanovic B, Djordjevic ML. Anatomy of the clitoris and its impact on neophalloplasty (metoidioplasty) in female transgenders. Clin Anat 2015; 28:368-75. [PMID: 25740576 DOI: 10.1002/ca.22525] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 01/20/2015] [Indexed: 11/09/2022]
Abstract
The current management of female to male transgender surgery is based on the advances in neophalloplasty, perioperative care and the knowledge of the female genital anatomy, as well as the changes that occur to this anatomy with preoperative hormonal changes in transgender population. Since the clitoris plays the main role in female sexual satisfaction, its impact on the outcome in female to male transgender surgery is predictable. Although female genital anatomy was poorly described in majority of anatomical textbooks, recent studies have provided a better insight in important details such as neurovascular supply, ligaments, body configuration, and relationship with urethral/vaginal complex. This article aims to review current state of knowledge of the clitoral anatomy as well its impact on clitoral reconstruction in female to male sex reassignment surgery.
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Abstract
Surgical treatment of long urethral stricture disease remains one of the most challenging problems in urology. In recent years there has been continuous discussion with regard to the etiology, location, length, and management of extensive urethral stricture disease. Various tissues such as genital and extragenital skin, buccal mucosa, lingual mucosa, small intestinal submucosa, and bladder mucosa have been proposed for urethral reconstruction. The most frequent questions pertain to the optimal technique for urethroplasty and the optimal graft for substitution urethroplasty, as judged by both patient satisfaction and outcome success. We review the recent literature with respect to any new information on graft urethroplasty for extensive urethral stricture.
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Djordjevic ML. Surgery: Treating urotrauma--new guidelines to aid decisions. Nat Rev Urol 2014; 11:495-6. [PMID: 25112858 DOI: 10.1038/nrurol.2014.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Djordjevic ML, Bizic MR, Martins F, Kojovic V, Krstic Z. Treatment for Failed Epispadias Repair Presenting in Adults. J Urol 2013; 190:165-70. [DOI: 10.1016/j.juro.2013.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 01/11/2013] [Indexed: 11/25/2022]
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Djordjevic ML, Bizic MR. Comparison of Two Different Methods for Urethral Lengthening in Female to Male (Metoidioplasty) Surgery. J Sex Med 2013; 10:1431-8. [DOI: 10.1111/jsm.12108] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bizic MR, Majstorovic MJ, Vukadinovic V, Korac G, Krstic Z, Radojicic Z, Ducic S, Djordjevic ML. Fast-track surgery concepts for congenital urogenital anomalies. Ann Ital Chir 2013; 84:61-66. [PMID: 23449169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM To investigate the possibility of fast-track surgery concepts in pediatric urology department as a single center study model of a developing country. MATERIAL OF STUDY The study included 1620 patients surgically treated at the pediatric urology department, from 2009 to 2011. According to the congenital anomalies, all patients were classified in one of four groups: I - testicular anomalies (197 patients); II - external genital anomalies (453); III - upper urinary tract anomalies (801) and IV - associated anomalies (169). We analyzed the total duration of stay in the hospital of all patients among all treating doctors concerning the anomaly. RESULTS Statistically significant difference in total length of hospitalization of all patients in Group I was noted in Doctors 1 and 5 (F=10.36** for F0.05;5;12=3.11 and F0.01;5;12=5.06), as well as in the Group II (F=17.01** for F0.05;5;12=3.11 and F0.01;5;12=5.06). Statistical analysis was not possible to be performed in groups III and IV because of lack of the patients. DISCUSSION Analyzing the length of hospitalization of the patients treated at the urology department, all doctors showed the tendency to shorten the total length of hospitalization in patients of all groups. Majority of the studies carried out on pediatric urology departments in developed countries, showed that over 50% of children were successfully treated using fast-track surgery concept. CONCLUSIONS Modern methods of surgical management and anesthesia allow decrease of hospitalization length, financial savings to the healthcare system and better comfort for patients.
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Nikolic DV, Djordjevic ML, Granic M, Nikolic AT, Stanimirovic VV, Zdravkovic D, Jelic S. Importance of revealing a rare case of breast cancer in a female to male transsexual after bilateral mastectomy. World J Surg Oncol 2012; 10:280. [PMID: 23273269 PMCID: PMC3554459 DOI: 10.1186/1477-7819-10-280] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 11/26/2012] [Indexed: 12/20/2022] Open
Abstract
The incidence of breast carcinoma following prophylactic mastectomy is probably less than 2%. We present a 43-year-old female to male transsexual who developed breast cancer 1 year after bilateral nipple- sparing subcutaneous mastectomy as part of female to male gender reassignment surgery. In addition to gender reassignment surgery, total abdominal hysterectomy with bilateral salpingo-oophorectomy (to avoid the patient from entering menopause and to eliminate any subsequent risk of iatrogenic endometrial carcinoma), colpocleisys, metoidioplasty, phalloplasty, urethroplasty together with scrotoplasty/placement of testicular prosthesis and perineoplasty were also performed. Before the sex change surgery, the following diagnostic procedures were performed: breast ultrasound and mammography (which were normal), lung radiography (also normal) together with abdominal ultrasound examination, biochemical analysis of the blood and hormonal status. According to medical literature, in the last 50 years only three papers have been published with four cases of breast cancer in transsexual female to male patients. All hormonal pathways included in this complex hormonal and surgical procedure of transgender surgery have important implications for women undergoing prophylactic mastectomy because of a high risk of possible breast cancer.
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Djordjevic ML, Stanojevic DS, Bizic MR. Rectosigmoid Vaginoplasty: Clinical Experience and Outcomes in 86 Cases. J Sex Med 2011; 8:3487-94. [DOI: 10.1111/j.1743-6109.2011.02494.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Djordjevic ML, Kojovic V, Bizic M, Majstorovic M, Vukadinovic V, Korac G. "Hanging" of the buccal mucosal graft for urethral stricture repair after failed hypospadias. J Urol 2011; 185:2479-82. [PMID: 21527203 DOI: 10.1016/j.juro.2011.01.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE Urethral stricture is the second most common complication of hypospadias repair after urethrocutaneous fistula. Usually more than 1 procedure is needed for correction due to a lack of available tissue after previous repairs. We evaluated 1-stage urethral stricture management after hypospadias repair using a ventral buccal mucosal graft. We describe the importance of graft hanging and coverage. MATERIALS AND METHODS From August 2004 to April 2009, 15 patients 9 to 17 years old underwent urethral stricture repair after failed hypospadias surgery. Mean time after primary surgery was 7.2 years (range 4 to 13). Vascularized periurethral tissue around the stenotic part of the neourethra was dissected. The urethra was opened ventrally and a buccal mucosal graft of appropriate size was inserted to allow urethral augmentation. Using several U stitches the graft was anchored to the surrounding periurethral tissue to prevent its folding and retraction. Recurrent chordee in 12 patients and secondary vesicoureteral reflux in 3 were also corrected at this time. RESULTS Mean followup was 37 months (range 17 to 73). Successful results were confirmed in all patients by urethrography and uroflowmetry. One urethral fistula was corrected 3 months later by minor surgery. Recurvature did not develop in this group. There was no recurrent reflux in endoscopically treated patients. CONCLUSIONS Ventral buccal mucosal grafting is a simple, safe option for urethral stricture repair. Hanging the graft to periurethral tissue is important for its survival and to prevent postoperative folding and retraction.
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Labus LD, Djordjevic ML, Stanojevic DS, Bizic MR, Stojanovic BZ, Cavic TM. Rectosigmoid vaginoplasty in patients with vaginal agenesis: sexual and psychosocial outcomes. Sex Health 2011; 8:427-30. [DOI: 10.1071/sh10105] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 02/10/2011] [Indexed: 11/23/2022]
Abstract
Background
The main goal in women with Mayer–Rokitansky–Küster–Hauser syndrome (vaginal agenesis) is creation of a neovagina that will satisfy the patient’s desire. We evaluated sexual and psychosocial adjustment in patients who underwent rectosigmoid vaginoplasty because of vaginal agenesis. Methods: A total of 36 women, aged 21 to 38 years (mean = 26) who underwent rectosigmoid vaginoplasty from 1997 to 2006 were evaluated. Sexual and psychosocial appraisal included the Female Sexual Function Index (FSFI), Beck’s Depression Inventory (BDI), and standardised questionnaires about postoperative satisfaction, social and sexual adjustment. Results: Mean FSFI score was 28.9 (range = 11.5–35.7) with a cut-off score of 26.55 for sexual dysfunction. Out of the 36 women, 10 (27, 8%) had sexual dysfunction. Mean BDI score was 7.55 (cut-off score = 0–9 for non-depression). Twenty-eight women (77.8%) were without symptoms of depression, six women (BDI range = 10–29) had moderate and two women had severe depression (BDI = 42). There were a significant number of patients (P < 0.01) with a high satisfaction score in FSFI and low BDI results. Thirty-two (88.9%) of the patients believed that surgery was done at the right time and the main postoperative support came from their family. Thirty-four (94.4%) of the patients reported satisfactory femininity, with a heterosexual orientation. Thirty patients (83. 3%) were very satisfied with the surgery, while 34 considered surgery as the best treatment. Conclusions: The sexual function and psychosocial status of these patients should be followed long-term to estimate their quality of life.
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Djordjevic ML, Santucci R. In Memory of Sava V. Perović (1937-2010). Urology 2010. [DOI: 10.1016/j.urology.2010.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Djordjevic ML, Stanojevic D, Kojovic V, Ducic S, Joksic I, Pavicevic P, Smoljanic Z, Bizic M, Majstorovic MJ. Complete bladder duplication with severe urogenital malformations: embryological and clinical aspects. Eur J Pediatr Surg 2009; 19:410-2. [PMID: 19452442 DOI: 10.1055/s-0029-1202254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Djordjevic ML, Stanojevic D, Bizic M, Kojovic V, Majstorovic M, Vujovic S, Milosevic A, Korac G, Perovic SV. ORIGINAL RESEARCH–INTERSEX AND GENDER IDENTITY DISORDERS: Metoidioplasty as a Single Stage Sex Reassignment Surgery in Female Transsexuals: Belgrade Experience. J Sex Med 2009; 6:1306-1313. [DOI: 10.1111/j.1743-6109.2008.01065.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Perovic SV, Djinovic RP, Bumbasirevic MZ, Santucci RA, Djordjevic ML, Kourbatov D. Severe penile injuries: a problem of severity and reconstruction. BJU Int 2009; 104:676-87. [PMID: 19154493 DOI: 10.1111/j.1464-410x.2008.08343.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To report our experience of treating severe penile injuries with different causes and treatments, as penile trauma presents a difficult physical and psychological problem, and the type and extent of injury varies from mild to severe, sometimes even with total amputation. PATIENTS AND METHODS We analysed retrospectively 43 patients (mean age 28 years, range 5-52 years) with severe penile injuries referred to us from March 1999 to August 2007. The causes of penile injuries differed, including iatrogenic trauma (20), traffic accidents (11), burns (three), self-amputation (two), ritual circumcision (two), penile fracture (two), gunshot trauma (two) and electrocution (one). The management required a wide variety of surgical techniques tailored to each patient depending on the type and extent of injury. RESULTS The mean (range) follow-up was 47 (10-108) months. The aesthetic and functional results, including satisfactory sexual intercourse were good in 35 patients. There were complications in seven patients; infection after implanting an inflatable penile prosthesis in one, protrusion of a semirigid prosthesis in one, urethral complications (one stenosis and two fistulae) in three and partial skin flap necrosis in two. CONCLUSIONS Severe penile injuries should be treated on an individual basis, applying different techniques. However, treatment can be effective and safe only in specialized centres.
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Djordjevic ML, Majstorovic M, Stanojevic D, Bizic M, Ducic S, Kojovic V, Vukadinovic V, Korac G, Perovic S. One-stage repair of severe hypospadias using combined buccal mucosa graft and longitudinal dorsal skin flap. Eur J Pediatr Surg 2008; 18:427-30. [PMID: 19039736 DOI: 10.1055/s-2008-1038929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM OF THE STUDY Urethral reconstruction in severe hypospadias presents a great challenge. We evaluated a method of combining longitudinal dorsal island skin flap and buccal mucosa graft to create a neourethra in the most severe hypospadias. Our aim was to repair the most difficult cases in a one-stage procedure. METHODS Between January 2003 and July 2007, 23 patients (aged from 9 to 26 months) underwent repair of severe hypospadias (18 penoscrotal and 5 scrotal forms). The short urethral plate is divided in all cases and the remaining curvature was repaired by dorsal plication. The buccal mucosa graft is harvested and fixed to the ventral side of corpora cavernosa to form the first half of the neourethra. A longitudinal dorsal island skin flap is created and buttonholed ventrally. It is sutured to the buccal mucosa graft to form the neourethra. An abundant flap pedicle is fixed laterally to cover all the suture lines of the neourethra. Penile skin reconstruction is done using available penile skin. RESULTS The mean follow-up was 27 (range 11-66) months. Satisfactory results were achieved in 20 patients. There were two urethral fistula and one temporary distal urethral stricture. CONCLUSION A combined longitudinal island skin flap and buccal mucosa graft could be a good choice for single-stage urethral reconstruction in the repair of the most severe hypospadias.
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Djordjevic ML, Majstorovic M, Stanojevic D, Bizic M, Kojovic V, Vukadinovic V, Korac G, Krstic Z, Perovic SV. Combined buccal mucosa graft and dorsal penile skin flap for repair of severe hypospadias. Urology 2008; 71:821-5. [PMID: 18336884 DOI: 10.1016/j.urology.2007.12.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Revised: 11/21/2007] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Urethral reconstruction in severe hypospadias presents a great challenge. We have designed a method of combining a longitudinal dorsal island skin flap and buccal mucosa graft to create a neourethra in most severe hypospadias. METHODS Between January 2003 and March 2007, 17 patients (aged from 9 to 23 months) underwent severe hypospadias repair (13 penoscrotal and 4 scrotal hypospadias). Short urethral plate was divided in all cases and remaining curvature repaired by dorsal plication. We harvested and fixed a buccal mucosa graft to the ventral side of corpora cavernosa to be the first half of a neourethra. A longitudinal dorsal island skin flap was created and buttonholed ventrally. We sutured it together with the buccal mucosa graft to form the neourethra. We fixed the abundant flap pedicle laterally to cover all suture lines of the neourethra. We performed penile skin reconstruction using available penile skin. RESULTS The mean (range) follow-up was 25 (7 to 58) months. We achieved satisfactory, functional, and aesthetic results in 14 patients. In 3 cases urethral fistula (2) and distal stricture (1) required secondary treatment. CONCLUSIONS Combined longitudinal island skin flap and buccal mucosa graft could be a good choice for urethral reconstruction in most severe hypospadias repairs.
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Djordjevic ML, Bumbasirevic MZ, Vukovic PM, Sansalone S, Perovic SV. Musculocutaneous latissimus dorsi free transfer flap for total phalloplasty in children. J Pediatr Urol 2006; 2:333-9. [PMID: 18947632 DOI: 10.1016/j.jpurol.2006.05.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Accepted: 05/02/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Total phalloplasty is rarely performed in children due to the mutilation involved and the dilemma concerning neophallic size in children. We present a musculocutaneous latissimus dorsi free transfer flap for total phalloplasty in children with difficult psychological problems. MATERIALS AND METHODS Total phalloplasty was performed in eight boys aged between 10 and 15 years. Indications were small penis after failed epispadias repair (4), micropenis (3) and intersexuality (1). A musculocutaneous latissimus dorsi free flap was harvested with thoracodorsal artery, vein and nerve. The flap was transferred to the pubic region and anastomosed to the femoral artery, saphenous vein and ilioinguinal nerve. Two-staged urethroplasty was performed in five patients using buccal mucosa, while in the remaining three a Mitrofanoff channel had been created previously. An inflatable penile prosthesis was implanted in two cases after puberty. RESULTS Follow-up was from 6 to 53 months (mean: 29 months). Penile size varied from 13 to 16 cm in length and from 10 to 12 cm in circumference. No flap necrosis, either partial or total, was noted. The donor site healed acceptably in four cases while in the remaining four moderate scarring occurred. Function of the penile prostheses is satisfactory. Psychological status is significantly improved in all children. CONCLUSION Phalloplasty in childhood is indicated to prevent profound psychological problems related to body dysmorphia. The musculocutaneous latissimus dorsi flap is a possible choice for phalloplasty in children that enables good neophallic size as in adults. We recommend this surgery to be performed before puberty to ensure optimal psychosexual pubertal development.
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Djordjevic ML, Perovic SV, Slavkovic Z, Djakovic N. Longitudinal dorsal dartos flap for prevention of fistula after a Snodgrass hypospadias procedure. Eur Urol 2006; 50:53-7. [PMID: 16707207 DOI: 10.1016/j.eururo.2006.04.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Accepted: 04/20/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The Snodgrass technique presents the procedure of choice for distal hypospadias. Fistula formation is the most common complication with various rates. We evaluated the importance of a urethral covering using vascularized dorsal subcutaneous tissue for fistula prevention. METHODS Our study included 126 patients, aged 10 months to 16 years, who underwent hypospadias repair from April 1998 through June 2005. Of the patients, 89 had distal, 30 had midshaft and 7 had penoscrotal hypospadias. All patients underwent standard tubularized incised plate urethroplasty, which was followed by reconstruction of new surrounding urethral tissue. A longitudinal dorsal dartos flap was harvested and transposed to the ventral side by the buttonhole manoeuvre. The flap was sutured to the glans and the corpora cavernosa to completely cover the neourethra with well-vascularized subcutaneous tissue. RESULTS Mean follow-up was 32 (6-87) months. A successful result without fistula was achieved in all 126 patients. In six patients, temporary stenosis of the glandular urethra occurred and was solved by dilation. CONCLUSIONS A urethral covering should be performed as part of the Snodgrass procedure. A dorsal well-vascularized dartos flap that is buttonholed ventrally represents a good choice for fistula prevention. Redundancy of the flap and its excellent vascularization depend on the harvesting technique.
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Perovic SV, Byun JS, Scheplev P, Djordjevic ML, Kim JH, Bubanj T. New Perspectives of Penile Enhancement Surgery: Tissue Engineering with Biodegradable Scaffolds. Eur Urol 2006; 49:139-47. [PMID: 16310926 DOI: 10.1016/j.eururo.2005.08.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Accepted: 08/25/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate in a multicenter, prospective study preliminary aesthetic and functional results of autologous ex-vivo tissue engineering for penile girth enhancement. METHODS From July 1999 to January 2004, 204 men of mean age 26.77 (range 19-54 years) underwent this procedure. Indications for penile girth enhancement were penile dysmorphic disorder and previous failed surgery for penile girth enhancement. Fibroblast cells harvested from 1 cc of biopsied scrotal dermal tissue were expanded in culture until the total cell number of at least 2x10(7) was reached. Suspended cells in culture medium were then seeded on pretreated tube-shaped PLGA scaffolds and incubated for 24 hours. After penile degloving, scaffolds were shape adjusted and transplanted between dartos and Buck's fascia when the skin was compliant or under the neurovascular bundle when the skin was not compliant. RESULTS A total of 84 randomly selected patients were followed 1 to 5 years postoperatively (median 24 months). The gain in girth ranged from 1.9 to 4.1cm (mean 3.15 cm). Postoperative complications occurred as infection in three, penile skin pressure necrosis in two and seroma formation in five patients and were all treated conservatively. Surgical intervention was appraised by patients on a scale from 1 to 5 as follows: the best mark (5) was given by 44.05%, very good (4) by 36.90%, good (3) by 19.05% and only one patient gave the mark 2 judging general penile appearance as dissatisfactory; mean score was 4.25. CONCLUSION Autologous tissue engineering by using biodegradable scaffolds as a carrier is a new and safe therapeutic approach for penile girth enhancement. The outcome of this study points out the necessity for its expanded clinical applicability in the future.
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Djordjevic ML, Perovic SV, Vukadinovic VM. Dorsal dartos flap for preventing fistula in the Snodgrass hypospadias repair. BJU Int 2005; 95:1303-9. [DOI: 10.1111/j.1464-410x.2005.05500.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE To describe metoidioplasty, a technique for creating a neophallus from an enlarged clitoris in female transsexuals, without needing the complex, multi-staged surgical construction of a large phallus, as this reconstruction is one of the most difficult in female transsexuals. PATIENTS AND METHODS From September 1995 to April 2002 metoidioplasty was used in 22 patients (aged 18-33 years). The technique is based on the repair of the most severe form of hypospadias and intersex. The 'urethral plate' and urethra are completely dissected from the clitoral corporeal bodies, then divided at the level of the glanular corona, and the clitoris straightened and lengthened. A longitudinal vascularized island flap is designed and harvested from the dorsal skin of the clitoris, transposed to the ventral side, tubularized and anastomosed with the native urethra. The new urethral meatus is brought to the top of the neophallus, and the skin of the neophallus and scrotum reconstructed using labia minora and majora flaps. RESULTS The mean (range) follow-up was 3.9 (0.5-6) years; the neophallus was 5.7 (4-10) cm, considered satisfactory in 17 patients but the remaining five required additional phalloplasty. The complications were urethral stenosis in two and fistula in three patients. CONCLUSIONS Metoidioplasty is an alternative to phalloplasty, allowing voiding while standing. In patients who desire a larger phallus, various techniques of phalloplasty can also be used.
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