1
|
Claeys W, Wolff DT, Zachou A, Hoebeke P, Lumen N, Spinoit AF. Variant genital gender-affirming surgery: a systematic review. BJU Int 2024. [PMID: 39209549 DOI: 10.1111/bju.16513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To review the available literature on variant genital gender-affirming surgery (GGAS), including the reasons for performing it, the surgeries themselves and their outcomes. METHODS A systematic review on the performance of variant GGAS was conducted (International Prospective Register of Systematic Reviews [PROSPERO] identifier: CRD42022306684) researching PubMed, Embase, Web of Science and Cochrane databases from inception up to 31 December 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and risk of bias was assessed for each study using the five-criteria quality assessment checklist. RESULTS In total 23 case series were included, of which 17 on masculinising and six on feminising surgeries. Patients mainly choose these surgical procedures out of personal desire to avoid risk of complication or because they do not have dysphoria about certain parts of their genitalia. Complications in masculinising surgeries primarily arose from the extended urethra, which could be mitigated through primary perineal urethrostomy. Both phalloplasty and metoidioplasty carried a higher risk of urethral complications when the vagina was preserved. In feminising surgeries, risk of visceral damage and requirement for lifelong self-dilation could be avoided when vulvoplasty was performed without vaginal canal creation. All studies had a high risk of bias. CONCLUSION This review highlights the importance of variant GGAS and acknowledges the preferences of transgender and gender-diverse individuals. Patients should be informed about the risks and benefits of each step in these procedures.
Collapse
Affiliation(s)
- Wietse Claeys
- Department of Urology, Ghent University Hospital, An ERN eUROGEN Accredited Center, Ghent, Belgium
| | - Dylan T Wolff
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alexandra Zachou
- Department of Urology, Ghent University Hospital, An ERN eUROGEN Accredited Center, Ghent, Belgium
- Department of Urology, Chelsea and Westminster Hospital, London, UK
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, An ERN eUROGEN Accredited Center, Ghent, Belgium
| | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, An ERN eUROGEN Accredited Center, Ghent, Belgium
| | - Anne-Françoise Spinoit
- Department of Urology, Ghent University Hospital, An ERN eUROGEN Accredited Center, Ghent, Belgium
| |
Collapse
|
2
|
Langbroek GB, Ronde EM, Lapid O, Horbach SER, van der Horst CMAM, Breugem CC, Ubbink DT. Healthcare professionals' views on shared decision-making in plastic surgery in the Netherlands. J Plast Reconstr Aesthet Surg 2023; 85:463-472. [PMID: 37597483 DOI: 10.1016/j.bjps.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/18/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND In shared decision-making (SDM), patients and healthcare professionals (HCPs) reach a joint clinical decision based on the best available evidence and the patient's preferences. SDM seems particularly valuable in plastic surgery, as often multiple treatment options are available. This cross-sectional online survey study aimed to assess HCPs' views and knowledge about SDM, identify facilitators and barriers of SDM, and determine specific requirements for SDM within plastic surgery. METHODS Participants were HCPs working in plastic surgery in the Netherlands. Participant characteristics, SDM knowledge, perceived facilitators and barriers, and requirements were assessed using a custom-made online survey. Two researchers thematically analyzed qualitative data. RESULTS We received 124 responses (with a response rate of 23%). Most respondents were attending plastic surgeons (79%), and 60% had more than 10 years of experience. Almost all respondents considered SDM important (91%), and most (78%) indicated that they applied SDM during consultations. However, only 15% of the HCPs showed a comprehensive understanding of the principle of SDM. Sufficient time, available sources of information (on treatment options and SDM), and decision support tools were identified as important requirements for SDM. CONCLUSIONS Despite the positive attitudes toward SDM, there is a clear need for SDM training of HCPs, uniform sources of information and guidelines, and improved awareness and availability of decision support tools. National plastic surgery societies can play a crucial role in improving SDM-related knowledge, the availability of information and decision support tools, and the implementation of SDM in the field of plastic surgery.
Collapse
Affiliation(s)
- Ginger Beau Langbroek
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Elsa M Ronde
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Oren Lapid
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Sophie E R Horbach
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Chantal M A M van der Horst
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Corstiaan C Breugem
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Dirk T Ubbink
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| |
Collapse
|
3
|
Butcher RL, Kinney LM, Blasdel GP, Elwyn G, Myers JB, Boh B, Luck KM, Moses RA. Decision making in metoidioplasty and phalloplasty gender-affirming surgery: a mixed methods study. J Sex Med 2023; 20:1032-1043. [PMID: 37173118 PMCID: PMC10311073 DOI: 10.1093/jsxmed/qdad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/05/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Gender-affirming surgical procedures, such as metoidioplasty and phalloplasty for those assigned female at birth, are complex and multistaged and involve risks. Individuals considering these procedures experience greater uncertainty or decisional conflict, compounded by difficulty finding trustworthy information. AIM (1) To explore the factors contributing to decisional uncertainty and the needs of individuals considering metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) and (2) to inform development of a patient-centered decision aid. METHODS This cross-sectional study was based on mixed methods. Adult transgender men and nonbinary individuals assigned female at birth at various stages of MaPGAS decision making were recruited from 2 study sites in the United States to participate in semistructured interviews and an online gender health survey, which included measures of gender congruence, decisional conflict, urinary health, and quality of life. Trained qualitative researchers conducted all interviews with questions to explore constructs from the Ottawa decision support framework. OUTCOMES Outcomes included goals and priorities for MaPGAS, expectations, knowledge, and decisional needs, as well as variations in decisional conflict by surgical preference, surgical status, and sociodemographic variables. RESULTS We interviewed 26 participants and collected survey data from 39 (24 interviewees, 92%) at various stages of MaPGAS decision making. In surveys and interviews, affirmation of gender identity, standing to urinate, sensation, and the ability to "pass" as male emerged as highly important factors for deciding to undergo MaPGAS. A third of survey respondents reported decisional conflict. Triangulation of data from all sources revealed that conflict emerged most when trying to balance the strong desire to resolve gender dysphoria through surgical transition against the risks and unknowns in urinary and sexual function, appearance, and preservation of sensation post-MaPGAS. Insurance coverage, age, access to surgeons, and health concerns further influenced surgery preferences and timing. CLINICAL IMPLICATIONS The findings add to the understanding of decisional needs and priorities of those considering MaPGAS while revealing new complexities among knowledge, personal factors, and decisional uncertainty. STRENGTHS AND LIMITATIONS This mixed methods study was codeveloped by members of the transgender and nonbinary community and yielded important guidance for providers and individuals considering MaPGAS. The results provide rich qualitative insights for MaPGAS decision making in US contexts. Limitations include low diversity and sample size; both are being addressed in work underway. CONCLUSIONS This study increases understanding of the factors important to MaPGAS decision making, and results are being used to guide development of a patient-centered surgical decision aid and informed survey revision for national distribution.
Collapse
Affiliation(s)
- Rebecca L Butcher
- Center for Program Design and Evaluation, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, United States
| | - Linda M Kinney
- Center for Program Design and Evaluation, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, United States
| | - Gaines P Blasdel
- University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Glyn Elwyn
- Coproduction Laboratory, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, United States
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, UT 84103, United States
| | - Benjamin Boh
- Affirm Endocrinology, Lebanon, NH 03766, United States
| | - Kaylee M Luck
- Section of Urology, Department of Surgery, Dartmouth Health, Lebanon, NH 03756, United States
| | - Rachel A Moses
- Section of Urology, Department of Surgery, Dartmouth Health, Lebanon, NH 03756, United States
- Geisel School of Medicine at Dartmouth, Hanover, NH 03755, United States
| |
Collapse
|
4
|
Gerritse K, Martens C, Bremmer MA, Kreukels BPC, de Vries ALC, Molewijk BC. GenderJourney: Participatory development of an ethics support tool to foster dialogue and reflection on shared decision-making in gender-affirming medical care. PATIENT EDUCATION AND COUNSELING 2023; 114:107854. [PMID: 37356115 DOI: 10.1016/j.pec.2023.107854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 05/19/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To describe and reflect on the development process of GenderJourney: an ethics support tool that seeks to foster (dialogue and reflection on) shared decision-making (SDM) in gender-affirming medical care (GAMC). METHODS Part of a larger project, this study used a participatory design. We included transgender and gender diverse (TGD) clients and healthcare professionals (HCPs) throughout the study in co-creation workshops. In an iterative process, we (1) established stakeholders' needs, (2) reached a consensus on the aims, content, and design, (3) developed and tested successive renditions, and (4) presented the final version of the tool. RESULTS The final tool aims to (A) elucidate the client's care request and corresponding treatment preferences, (B) foster an explicit dialogue between TGD client and HCP about expected/preferred decisional roles and collaboration, (C) stimulate a systematic joint reflection on and handling of SDM-related ethical challenges. CONCLUSION The GenderJourney provides non-directive ethics support to jointly reflect on and foster good SDM, including its inherent ethical challenges. Future studies should focus on its implementation and actual contribution to good SDM. PRACTICE IMPLICATIONS GenderJourney may be used in GAMC to support the dialogue on what good SDM entails and the identification, discussion, and handling of SDM-related ethical challenges.
Collapse
Affiliation(s)
- Karl Gerritse
- Ethics, Law, and Humanities, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands; Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands.
| | - Casper Martens
- Ethics, Law, and Humanities, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands.
| | - Marijke A Bremmer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands; Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands.
| | - Baudewijntje P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands; Medical Psychology, Amsterdam UMC location VUmc, location Vrije Universiteit Amsterdam, the Netherlands.
| | - Annelou L C de Vries
- Center of Expertise on Gender Dysphoria, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands; Child and Adolescent Psychiatry, Amsterdam UMC location University of Amsterdam, the Netherlands.
| | - Bert C Molewijk
- Ethics, Law, and Humanities, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands.
| |
Collapse
|
5
|
Lambert A, Pratt A, Conard LAE, Grigg Dean E, Page E, Vaughn LM, Lipstein EA. Supporting Gender-Related Medical Decision Making for Transgender and Gender-Diverse Individuals: A Scoping Review. Transgend Health 2023; 8:113-123. [PMID: 37013094 PMCID: PMC10066778 DOI: 10.1089/trgh.2021.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Transgender and gender-diverse (TGD) individuals and their families face numerous challenging decisions. To better understand their decision processes, we conducted a scoping review of the existing literature and of decision-support tools in use at pediatric gender-care clinics. Methods We searched PubMed, EMBASE, Scopus CINAHL, PsychINFO, and EBM Reviews for studies that were original research focused on decisions, decision making, or decision support for TGD individuals and/or their families. All studies were reviewed for inclusion by at least two researchers. Additionally, we reviewed clinical tools used to support decision making by TGD youth and their families. Results We retrieved 3306 articles. Thirty-two met criteria for data extraction. Studies focused on three major decisions: gender-confirming surgery, fertility preservation, and gender-affirming hormone therapy. Several themes that cut across clinical topics emerged: decision-making processes, decision-making roles, and sources of decision support. Only three articles focused on decision-support interventions, two of which discussed development of support tools and one evaluated a class designed to help with surgical decision making. None of the clinical tools reviewed met criteria for a decision aid. Conclusions There is a dearth of studies related to decision support interventions, an absence validated by the resources currently in clinical use. This scoping review suggests an opportunity for the development of tools to aid in the decision-making processes for TGD youth and their families.
Collapse
Affiliation(s)
- Amy Lambert
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ashli Pratt
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lee Ann E. Conard
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elaine Grigg Dean
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Erica Page
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa M. Vaughn
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ellen A. Lipstein
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
6
|
van de Grift TC. Masculinizing and defeminizing gender-affirming surgery. Best Pract Res Clin Obstet Gynaecol 2023:102323. [PMID: 36932000 DOI: 10.1016/j.bpobgyn.2023.102323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/24/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
Transmasculine transgender and gender-diverse individuals may request gender-affirming surgery, standalone or in addition to other interventions. The choices and preferred outcomes of surgery can be highly individual. Besides surgeons' technical skills and patient physique, professionals in this field should be able to cooperate with other disciplines and with patients. The most requested surgery is masculinizing chest surgery, aiming to create a masculine chest with minimal scarring. For genital surgery, metoidioplasty refers to the procedure where the hypertrophic clitoris is released and possibly a scrotum is created from local labia flaps, whereas phalloplasty refers to a procedure in which a neophallus is created from a flap. Possible other surgeries include hysterectomy/oophorectomy, colpectomy, and the implants of scrotal or erection prostheses. In order to guide patients and clinicians, standardized outcome measures as well as evidence-based decision aids have been developed. Such aids, in combination with collaborative medical and psychosocial care, may further leverage the long-term outcomes of these surgeries.
Collapse
Affiliation(s)
- Tim C van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands; Amsterdam Public Health Institute, Amsterdam, the Netherlands; Department of Psychiatry and Medical Psychology, Zaans Medical Center, Zaandam, the Netherlands.
| |
Collapse
|
7
|
de Rooij FPW, van der Sluis WB, Ronkes BL, Steensma TD, Al-Tamimi M, van Moorselaar RJA, Bouman MB, Pigot GLS. Comparison of surgical outcomes and urinary functioning after phalloplasty with versus without urethral lengthening in transgender men. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 24:487-498. [PMID: 37901060 PMCID: PMC10601502 DOI: 10.1080/26895269.2022.2110548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Background: Phalloplasty in transgender men is performed with or without Urethral Lengthening (UL). To create clear expectations in the choice of UL, an overview and comparison of outcomes is useful. Aims: To provide and compare surgical outcomes and urinary functioning after phalloplasty with versus without UL in transgender men. Methods: A single-center, retrospective chart review was conducted among transgender men who underwent phalloplasty with or without UL between 01-2013 and 10-2020. Primary outcomes were differences in complication and reoperation rates. Secondary outcomes were end-stages of voiding at last follow-up and differences in voiding analyses pre- and postoperatively. Results: Of 136 men, 91 (67%) underwent phalloplasty with, and 45 (33%) without UL. Wound infection (31 vs. 16%, p = 0.06) and partial flap loss (35 vs. 13%, p = 0.008) were predominately seen after UL. In the UL group, 43% urethral fistulas and 60% urethral strictures were observed, relative to one man without UL who had a urethral fistula (both p < 0.001). Meatal or perineal orifice stenosis was seen in 29% with versus 11% without UL (p = 0.02). Reoperation was needed in 81% with versus 27% without UL (p < 0.001). At follow-up, 80/91 (88%) after UL reached end-stage of voiding, with 60/80 (75%) able to void while standing and 20/80 (25%) having a definitive urethrostomy. The remaining 11/91 (12%) men were awaiting further treatment for urological complications. The men able to void while standing had a median of one reoperation (range 0-6), and a significant decrease in maximum flow rate on postoperative uroflowmetry (21.4 vs. 29.8 mL/s, p < 0.001). After phalloplasty without UL, all men had a definitive perineostomy without changes in voiding analyses. Discussion: The choice for or against UL during phalloplasty has become more relevant over the years. This comparison of surgical outcomes and urinary functioning can be useful in the shared decision-making process to come to the most suitable choice of phalloplasty.
Collapse
Affiliation(s)
- Freek P. W. de Rooij
- Department of Urology, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Wouter B. van der Sluis
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Brechje L. Ronkes
- Department of Urology, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Thomas D. Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Muhammed Al-Tamimi
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | | | - Mark-Bram Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Garry L. S. Pigot
- Department of Urology, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Özer M, Toulabi SP, Fisher AD, T'Sjoen G, Buncamper ME, Monstrey S, Bizic MR, Djordjevic M, Falcone M, Christopher NA, Simon D, Capitán L, Motmans J. ESSM Position Statement "Sexual Wellbeing After Gender Affirming Surgery". Sex Med 2022; 10:100471. [PMID: 34971864 PMCID: PMC8847816 DOI: 10.1016/j.esxm.2021.100471] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/06/2021] [Accepted: 11/09/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Much has been published on the surgical and functional results following Gender Affirming Surgery ('GAS') in trans individuals. Comprehensive results regarding sexual wellbeing following GAS, however, are generally lacking. AIM To review the impact of various GAS on sexual wellbeing in treatment seeking trans individuals, and provide a comprehensive list of clinical recommendations regarding the various surgical options of GAS on behalf of the European Society for Sexual Medicine. METHODS The Medline, Cochrane Library and Embase databases were reviewed on the results of sexual wellbeing after GAS. MAIN OUTCOMES MEASURE The task force established consensus statements regarding the somatic and general requirements before GAS and of GAS: orchiectomy-only, vaginoplasty, breast augmentation, vocal feminization surgery, facial feminization surgery, mastectomy, removal of the female sexual organs, metaidoioplasty, and phalloplasty. Outcomes pertaining to sexual wellbeing- sexual satisfaction, sexual relationship, sexual response, sexual activity, enacted sexual script, sexuality, sexual function, genital function, quality of sex life and sexual pleasure- are provided for each statement separately. RESULTS The present position paper provides clinicians with statements and recommendations for clinical practice, regarding GAS and their effects on sexual wellbeing in trans individuals. These data, are limited and may not be sufficient to make evidence-based recommendations for every surgical option. Findings regarding sexual wellbeing following GAS were mainly positive. There was no data on sexual wellbeing following orchiectomy-only, vocal feminization surgery, facial feminization surgery or the removal of the female sexual organs. The choice for GAS is dependent on patient preference, anatomy and health status, and the surgeon's skills. Trans individuals may benefit from studies focusing exclusively on the effects of GAS on sexual wellbeing. CONCLUSION The available evidence suggests positive results regarding sexual wellbeing following GAS. We advise more studies that underline the evidence regarding sexual wellbeing following GAS. This position statement may aid both clinicians and patients in decision-making process regarding the choice for GAS. Özer M, Toulabi SP, Fisher AD, et al. ESSM Position Statement "Sexual Wellbeing After Gender Affirming Surgery". Sex Med 2022;10:100471.
Collapse
Affiliation(s)
- Müjde Özer
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Sahaand Poor Toulabi
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Alessandra D Fisher
- Andrology, Women's Endocrinology, Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Guy T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Marlon E Buncamper
- Department of Plastic, Reconstructive and Hand Surgery, Ghent University Hospital, Ghent, Belgium
| | - Stan Monstrey
- Department of Plastic, Reconstructive and Hand Surgery, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Marta R Bizic
- Department of Pediatric Urology, University of Belgrade, Belgrade, Serbia
| | | | - Marco Falcone
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Nim A Christopher
- Department of Urology, St Peter's Andrology Centre and The Institute of Urology, London, UK
| | - Daniel Simon
- Facialteam Surgical Group, HC Marbella International Hospital, Marbella, Málaga, Spain
| | - Luis Capitán
- Facialteam Surgical Group, HC Marbella International Hospital, Marbella, Málaga, Spain
| | - Joz Motmans
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
9
|
Parker A, Blasdel G, Kloer C, Kimberly L, Shakir N, Robinson I, Bluebond-Langner R, Zhao LC. "Postulating Penis: What Influences the Interest of Transmasculine Patients in Gender Affirming Penile Reconstruction Techniques?". J Sex Med 2022; 19:385-393. [PMID: 34920952 DOI: 10.1016/j.jsxm.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/15/2021] [Accepted: 10/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The limitations of metoidioplasty and phalloplasty have been reported as deterrents for transgender and other gender expansive individuals (T/GE) desiring gender affirming surgery, and thus penile transplantation, epithesis, and composite tissue engineering (CTE) are being explored as alternative interventions. AIM We aim to understand the acceptability of novel techniques and factors that may influence patient preferences in surgery to best treat this diverse population. METHODS Descriptions of metoidioplasty, phalloplasty, epithesis, CTE, and penile transplant were delivered via online survey from January 2020 to May 2020. Respondents provided ordinal ranking of interest in each intervention from 1 to 5, with 1 representing greatest personal interest. Demographics found to be significant on univariable analysis underwent multivariable ordinal logistic regression to determine independent predictors of interest. OUTCOMES Sexual orientation, gender, and age were independent predictors of interest in interventions. RESULTS There were 965 qualifying respondents. Gay respondents were less likely to be interested in epithesis (OR: 2.282; P = .001) compared to other sexual orientations. Straight individuals were the least likely to be interested in metoidioplasty (OR 3.251; P = .001), and most interested in penile transplantation (OR 0.382; P = .005) and phalloplasty (OR 0.288, P < .001) as potential interventions. Gay and queer respondents showed a significant interest in phalloplasty (Gay: OR 0.472; P = .004; Queer: OR 0.594; P = .017). Those who identify as men were more interested in phalloplasty (OR 0.552; P < .001) than those with differing gender identities. Older age was the only variable associated with a decreased interest in phalloplasty (OR 1.033; P = .001). No demographic analyzed was an independent predictor of interest in CTE. CLINICAL IMPLICATIONS A thorough understanding of patient gender identity, sexual orientation, and sexual behavior should be obtained during consultation for gender affirming penile reconstruction, as these factors influence patient preferences for surgical interventions. STRENGTHS AND LIMITATIONS This study used an anonymous online survey that was distributed through community channels and allowed for the collection of a high quantity of responses throughout the T/GE population that would otherwise be impossible through single-center or in-person means. The community-based methodology minimized barriers to honesty, such as courtesy bias. The survey was only available in English and respondents skewed young and White. CONCLUSION Despite previously reported concerns about the limitations of metoidioplasty, participants ranked it highly, along with CTE, in terms of personal interest, with sexual orientation, gender, and age independently influencing patient preferences, emphasizing their relevance in patient-surgeon consultations. A. Parker, G. Blasdel, C. Kloer et al. "Postulating Penis: What Influences the Interest of Transmasculine Patients in Gender Affirming Penile Reconstruction Techniques?". J Sex Med 2022;19:385-393.
Collapse
Affiliation(s)
- Augustus Parker
- NYU Grossman School of Medicine, NYU Langone Health Systems, New York, NY, USA
| | - Gaines Blasdel
- Department of Urology, New York University Langone Health, New York, NY, USA
| | - Carmen Kloer
- Duke University School of Medicine, Duke Health Systems, Durham, NC, USA; Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Laura Kimberly
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Nabeel Shakir
- Department of Urology, New York University Langone Health, New York, NY, USA
| | - Isabel Robinson
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Rachel Bluebond-Langner
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Lee C Zhao
- Department of Urology, New York University Langone Health, New York, NY, USA.
| |
Collapse
|
10
|
Salgado CJ, Yu K, Lalama MJ. Vaginal and reproductive organ preservation in trans men undergoing gender-affirming phalloplasty: technical considerations. J Surg Case Rep 2021; 2021:rjab553. [PMID: 34987754 PMCID: PMC8714364 DOI: 10.1093/jscr/rjab553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022] Open
Abstract
Gender affirmation surgeries are performed to decrease the patient’s dysphoria and improve quality of life. Preservation of the vaginal canal with reproductive organs is uncommon though becoming increasingly discussed in trans men. This series examines surgical complexities of vaginal and/or reproductive organ preservation in patients undergoing phalloplasty, highlighting considerations for safety and well-being. Two patients who underwent phalloplasty met inclusion and exclusion criteria for the study and were treated in accordance with World Professional Association for Transgender Health standards. We retrospectively reviewed patients’ medical records and extracted demographic data. Phallus and clitoral sensation, ability for penetrative intercourse and treatment of gender incongruence were assessed postoperatively. At an average of 22 months postoperatively, both flaps survived with tactile sensation two-thirds down the shaft, and the clitoris of both maintained erogenous sensation from stimulation. Gender incongruence was described to be reduced, and both patients were able to receive penetrative vaginal intercourse.
Collapse
Affiliation(s)
| | - Kerstin Yu
- Constructive Surgery Associates, Miami, FL 33145, USA
| | | |
Collapse
|
11
|
Fu Y, Zou T, Shen X, Nelson PJ, Li J, Wu C, Yang J, Zheng Y, Bruns C, Zhao Y, Qin L, Dong Q. Lipid metabolism in cancer progression and therapeutic strategies. MedComm (Beijing) 2021; 2:27-59. [PMID: 34766135 PMCID: PMC8491217 DOI: 10.1002/mco2.27] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/17/2020] [Accepted: 07/23/2020] [Indexed: 12/24/2022] Open
Abstract
Dysregulated lipid metabolism represents an important metabolic alteration in cancer. Fatty acids, cholesterol, and phospholipid are the three most prevalent lipids that act as energy producers, signaling molecules, and source material for the biogenesis of cell membranes. The enhanced synthesis, storage, and uptake of lipids contribute to cancer progression. The rewiring of lipid metabolism in cancer has been linked to the activation of oncogenic signaling pathways and cross talk with the tumor microenvironment. The resulting activity favors the survival and proliferation of tumor cells in the harsh conditions within the tumor. Lipid metabolism also plays a vital role in tumor immunogenicity via effects on the function of the noncancer cells within the tumor microenvironment, especially immune‐associated cells. Targeting altered lipid metabolism pathways has shown potential as a promising anticancer therapy. Here, we review recent evidence implicating the contribution of lipid metabolic reprogramming in cancer to cancer progression, and discuss the molecular mechanisms underlying lipid metabolism rewiring in cancer, and potential therapeutic strategies directed toward lipid metabolism in cancer. This review sheds new light to fully understanding of the role of lipid metabolic reprogramming in the context of cancer and provides valuable clues on therapeutic strategies targeting lipid metabolism in cancer.
Collapse
Affiliation(s)
- Yan Fu
- Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute & Institutes of Biomedical Sciences Fudan University Shanghai China
| | - Tiantian Zou
- Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute & Institutes of Biomedical Sciences Fudan University Shanghai China
| | - Xiaotian Shen
- Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute & Institutes of Biomedical Sciences Fudan University Shanghai China
| | - Peter J Nelson
- Medical Clinic and Policlinic IV Ludwig-Maximilian-University (LMU) Munich Germany
| | - Jiahui Li
- General, Visceral and Cancer Surgery University Hospital of Cologne Cologne Germany
| | - Chao Wu
- Department of General Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Jimeng Yang
- Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute & Institutes of Biomedical Sciences Fudan University Shanghai China
| | - Yan Zheng
- Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute & Institutes of Biomedical Sciences Fudan University Shanghai China
| | - Christiane Bruns
- General, Visceral and Cancer Surgery University Hospital of Cologne Cologne Germany
| | - Yue Zhao
- General, Visceral and Cancer Surgery University Hospital of Cologne Cologne Germany
| | - Lunxiu Qin
- Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute & Institutes of Biomedical Sciences Fudan University Shanghai China
| | - Qiongzhu Dong
- Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute & Institutes of Biomedical Sciences Fudan University Shanghai China
| |
Collapse
|
12
|
Pavanello Decaro S, Van Gils S, Van Hoorde B, Baetens K, Heylens G, Elaut E. It Might Take Time: A Study on the Evolution of Quality of Life in Individuals With Gender Incongruence During Gender-Affirming Care. J Sex Med 2021; 18:2045-2055. [PMID: 34666960 DOI: 10.1016/j.jsxm.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The distress caused by gender incongruence has been shown to be reduced with gender-affirming care. The current study follows a cohort of patients that requested gender-affirming care at Ghent University Hospital and examines the outcome of the procedures. METHODS The prospective design with 4 assessment times allows the study to assess the evolution of self-reported quality of life (QoL) and gender incongruence throughout a medical transition process. All the participants (N = 119) received hormone therapy, 52% underwent a separate gonadectomy (N = 62), and 41% vaginoplasty or phalloplasty (N = 49). RESULTS The results suggest that gender incongruence improves after surgery. QoL has slightly different trends for the different gender groups: compared to people who were assigned male at birth (AMAB), people who were assigned female at birth (AFAB) report lower QoL after gonadectomy. Meeting other transgender people facilitate QoL after starting hormone therapy. A higher number of friends after genital surgery are predictive of a better QoL. CLINICAL IMPLICATIONS These results may be useful for clinicians working with transgender patients, as they provide information collected assessing patients soon after surgery and may raise awareness regarding the specific clinical attention that postsurgery patients need. CONCLUSIONS QoL can be compromised after the invasive surgery, while gender incongruence is alleviated throughout the transition. Our results should be confirmed with other prospective study designs that include a longer follow-up period. Pavanello Decaro S, Van Gils S, Van Hoorde B, et al. It Might Take Time: A Study on the Evolution of Quality of Life in Individuals With Gender Incongruence During Gender-Affirming Care. J Sex Med 2021;18:2045-2055.
Collapse
Affiliation(s)
- Sofia Pavanello Decaro
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium; Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Stien Van Gils
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Birgit Van Hoorde
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Kariann Baetens
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Gunter Heylens
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium; Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
| | - Els Elaut
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium; Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
| |
Collapse
|
13
|
Scalia P, Tighe KM, Elwyn G, Bagley PJ, Blunt HB, Boh B, Walters OC, Moses RA. A systematic review of decision aids for gender affirming therapy. Transl Androl Urol 2021; 10:2574-2582. [PMID: 34295744 PMCID: PMC8261453 DOI: 10.21037/tau-20-1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/17/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Transgender and gender diverse (TGD) persons considering gender affirming therapy have to make many complex medical decisions, potentially without understanding the associated harms or benefits of hormonal and surgical interventions. Further, clinicians are often unaware of how best to communicate information to persons seeking gender affirming therapy. Patient decision aids have been developed to provide evidence-based information as a way to help people make decisions in collaboration with their clinicians. It is unclear whether such tools exist for persons seeking gender affirming therapy. The objective of our systematic review is to search for and determine the quality of any existing patient decision aids developed for TGD persons considering gender affirming therapy, and the outcomes associated with their use. METHODS We adapted a search strategy for databases using two key concepts "decision support intervention/patient decision aid" and "transgender". We also conducted a brief online search of Google and abstracts from relevant conferences to identify any tools not published in the academic literature. Following study selection and data extraction, we used the International Patient Decision Aid Standards instrument (IPDASi) to assess the quality of patient decision aids, and the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) checklist to assess the quality of evaluations. RESULTS We identified 762 studies; none were identified from Google or conference content. One tool met our inclusion criteria: an online, pre-encounter patient decision aid for transmasculine genital gender-affirming surgery developed in Amsterdam, translated in English and Dutch. The tool met all the IPDASi qualifying criteria, and scored a 17/28 on the certification criteria, and 57/112 on the quality criteria. The efficacy of the patient decision aid has not been evaluated. CONCLUSIONS Despite multiple decisions required for gender affirming therapies, only one patient decision aid has been developed for transmasculine genital reconstruction. Further research is required to develop patient decision aids for the multiple decision points along the gender affirming journey.
Collapse
Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Katherine M. Tighe
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | | | - Benjamin Boh
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | | |
Collapse
|
14
|
Patient-Reported Outcomes After Genital Gender-Affirming Surgery With Versus Without Urethral Lengthening in Transgender Men. J Sex Med 2021; 18:974-981. [PMID: 33896759 DOI: 10.1016/j.jsxm.2021.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/02/2021] [Accepted: 03/07/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND In our institution, genital Gender-Affirming Surgery (gGAS;phalloplasty or metoidioplasty) in transgender men is offered with or without Urethral Lengthening (UL). AIM The aim of this cross-sectional and retrospective study was to assess the effect of gGAS with or without UL on several Patient-Reported Outcomes (PROs), and to identify predictors of overall patient satisfaction at follow-up. METHODS A self-constructed Patient-Reported Outcome Measure (PROM) was sent to transgender men who were ≥1 year after gGAS. The survey comprises 25 questions divided into 5 domains: type of surgery, satisfaction with the appearance and functionality, quality of life, feelings of masculinity, and sexuality. OUTCOMES Answers to the survey were compared between groups, and a linear regression analysis was conducted to identify predictors of overall patient satisfaction. RESULTS Of 154 eligible transgender men, the PROM was sent to 118 (77%) willing to participate, and 102 (66%) completed the survey. The majority previously underwent phalloplasty (n = 74;73%) compared to metoidioplasty (n = 28;27%). Urethral Lengthening was performed in 56/102 (55%) participants, 51/74 (69%) in phalloplasty, 5/28 (18%) in metoidioplasty. The mean number of complications and reoperations was significantly higher in the UL group (2.7vs1 and 1.6vs0.4 respectively, both P < .001). Most participants were satisfied to very satisfied with life (75%), the appearance (66%), voiding (59%), the effect of surgery on masculinity (82%), and confirmed that the end surgical result matched their expectations (61%), independently of UL. Lowest scores in satisfaction were observed for the sexual functioning of the neophallus, with 34% satisfied to very satisfied participants. Both satisfaction with the appearance of the neophallus (P < .001) and with voiding (P = .02) were positive predictors of overall patient satisfaction at follow-up, in contrast to the complication and reoperation rate postoperatively (P = .48 and P = .95 respectively). CLINICAL IMPLICATIONS Transgender men choosing for gGAS with or without UL can be adequately informed on PROs regarding type of surgery, satisfaction with the appearance and functionality, quality of life, feelings of masculinity, and sexuality. STRENGTHS & LIMITATIONS Study strengths comprise the relatively large cohort, long duration of follow-up, completeness of the data, and innovativeness of the studied outcomes. Limitations are the cross-sectional and retrospective design, possible participation bias and non-validated survey. CONCLUSION No significant differences in several PROs were observed between participants who chose gGAS with or without UL in this retrospective study. Additionally, according to this study, satisfaction with the appearance of the neophallus and with voiding were positive predictors of overall patient satisfaction at follow-up. de Rooij FPW, van de Grift TC, Veerman H, et al. Patient-Reported Outcomes After Genital Gender-Affirming Surgery With Versus Without Urethral Lengthening in Transgender Men. J Sex Med 2020;18:974-981.
Collapse
|
15
|
Neuville P, Carnicelli D, Paparel P, Ruffion A, Morel-Journel N. Metoidioplasty With Implantation of a Specific Semirigid Prosthesis. J Sex Med 2021; 18:830-836. [PMID: 33741289 DOI: 10.1016/j.jsxm.2021.01.177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/23/2020] [Accepted: 01/16/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Metoidioplasty is a possibility for penis reconstruction in transmen that could be enhanced by a semi-rigid prosthesis support. AIM Describe the surgical technique of metoidioplasty with implantation of a specifically designed semi-rigid prosthesis -the ZSI100D4- and analyze preliminary results. METHODS Implantation of semi-rigid prosthesis was proposed to transmen who chose metoidioplasty for genital gender affirming surgery in a specialized university hospital. OUTCOMES Surgical outcomes were collected from medical files. Functional outcomes and satisfaction were collected post-operatively with a questionnaire. RESULTS A total of 15 patients were operated; the mean length of followup was 22 months (SD = 8.7). Median prosthesis size was 8.5 cm (range: 8.5-10). Seven (46.7%) minor complications (Clavien-Dindo grade 2; 5 wound dehiscence and 2 fistula, managed conservatively) and 1 severe (Clavien-Dindo grade 3b) complication (Hematoma that need surgical revision) occurred. Thirteen patients (86.6%) answered the questionnaire; 11 (84.6%) reported being either "very satisfied" or "satisfied" with the appearance of the new genitalia; 10 (76.9%) could void while standing; and 12 patients (92.3%) answered "not at all" to the question "do you have regrets about this surgery ?". CONCLUSION Implantation of a semi-rigid prosthesis in an enlarged clitoris seems to be a valuable option and can be proposed as another possibility for the complex surgical answer to neophallus reconstruction in transmen. Neuville P, Carnicelli D, Paparel P, et al. Metoidioplasty With Implantation of a Specific Semirigid Prosthesis. J Sex Med 2021;18:830-836.
Collapse
Affiliation(s)
- Paul Neuville
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'urologie, Chemin du Grand Revoyet, 69310 Pierre-Benite, France.
| | - Damien Carnicelli
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'urologie, Chemin du Grand Revoyet, 69310 Pierre-Benite, France
| | - Philippe Paparel
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'urologie, Chemin du Grand Revoyet, 69310 Pierre-Benite, France
| | - Alain Ruffion
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'urologie, Chemin du Grand Revoyet, 69310 Pierre-Benite, France
| | - Nicolas Morel-Journel
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'urologie, Chemin du Grand Revoyet, 69310 Pierre-Benite, France
| |
Collapse
|
16
|
Al-Tamimi M, Pigot GL, Ronkes B, de Haseth KB, van de Grift TC, van Moorselaar RJA, Mullender MG, Stojanovic B, van der Sluis WB, Djordjevic M, Bouman MB. The First Experience of Using the Pedicled Labia Minora Flap for Urethral Lengthening in Transgender Men Undergoing Anterolateral Thigh and Superficial Circumflex Iliac Artery Perforator Flap Phalloplasty: A Multicenter Study on Clinical Outcomes. Urology 2020; 138:179-187. [PMID: 31911083 DOI: 10.1016/j.urology.2019.10.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/10/2019] [Accepted: 10/12/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To describe the novel surgical technique of urethral lengthening in anterolateral thigh and superficial circumflex iliac artery perforator flap phalloplasty with a pedicled labia minora flap (PLMF) and report on the clinical outcomes. METHODS Between March 2014 and August 2018, 16 transgender men underwent phalloplasty with a PLMF for urethral lengthening at the Amsterdam UMC (VU university), the Netherlands and the Belgrade University Hospital, Serbia. Patient demographics, surgical characteristics, neourethra characteristics, intra- and postoperative complications, pre-and postoperative voiding evaluation, and the length of hospital stay were retrospectively identified from chart reviews. RESULTS The mean neourethral length was 16.8 ± 2.3 cm, and the pars pendulans 11.7 ± 2.2 cm. The neomeatus was localized on top of the neophallus in 12 (75%) patients. No intraoperative complications occurred. Urethral fistula formation occurred in 4 (25%) patients and strictures in 6 (37.5%) patients. In 3 (18.7%) patients a (temporary) perineostomy had to be performed. Voiding from a standing position was possible in 9 (56.3%) patients. CONCLUSION The PLMF for urethral reconstruction, both pars fixa and pars pendulans, in phalloplasty is a feasible surgical technique in transgender men undergoing anterolateral thigh or superficial circumflex iliac artery perforator flap phalloplasty with sufficient labia minora tissue.
Collapse
Affiliation(s)
- Muhammed Al-Tamimi
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Department of Urology, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands.
| | - Garry L Pigot
- Department of Urology, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Brechje Ronkes
- Department of Urology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Kristin B de Haseth
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Tim C van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | | | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Borko Stojanovic
- Department of Urology, Belgrade University Hospital, Belgrade, Serbia
| | - Wouter B van der Sluis
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | | | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| |
Collapse
|
17
|
Genital Gender-Affirming Surgery in Transgender Men in The Netherlands from 1989 to 2018. Plast Reconstr Surg 2020; 145:153e-161e. [DOI: 10.1097/prs.0000000000006385] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Reply by Authors. J Urol 2018; 200:1321-1322. [DOI: 10.1016/j.juro.2018.07.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
A surgical perspective on the implications of the classification of gender incongruence as a condition related to sexual health by ICD-11. Int J Impot Res 2018; 30:352-354. [PMID: 30368526 DOI: 10.1038/s41443-018-0092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 11/09/2022]
|