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Arteaga R, Dryden K, Blasdel G. Patient education and surgical decision-making in genital gender-affirming surgery. Curr Opin Urol 2024; 34:308-313. [PMID: 38932497 DOI: 10.1097/mou.0000000000001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW An update on the latest advances in surgical decision-making for genital gender-affirming surgery (GGAS), with an emphasis on patient education from three perspectives: surgeon-team perspectives, patient perspectives, and educational resources available to the public on social media. RECENT FINDINGS Transgender, nonbinary, and other culturally specific gender identities (TGNB) patients overwhelmingly desire an active role in the decision-making process. New developments in patient-engagement strategies help mitigate the harm of historical gatekeeping practices by centering the needs and experiences of TGNB patients to create a prioritized research agenda for GGAS effectiveness. Patient educational resources play an integral role in navigating the complexity of GGAS-surgical options, informing patients of the technical and logistical knowledge required for GGAS surgical decision-making. Peer support experiences are a critical facilitator for patient surgical decision-making, both for informed decision-making and for psychosocial support. SUMMARY Several developments have been made in examining shared-decision making, educational resources from the perspectives of both the surgical team and patients, and the role of social media in GGAS. Surgeons must continue to initiate robust conversations of patient goals, GGAS surgical options, the possible risk and benefit profiles of each option, and aftercare requirements, all while prioritizing patient-engagement strategies.
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Affiliation(s)
- Rebecca Arteaga
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kim Dryden
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Gaines Blasdel
- University of Michigan Medical School, Ann Arbor, Michigan, USA
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2
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Schoenbrunner A, Cripps C. Sexual Function in Post-surgical Transgender and Gender Diverse Individuals. Obstet Gynecol Clin North Am 2024; 51:425-435. [PMID: 38777493 DOI: 10.1016/j.ogc.2024.03.005] [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] [Indexed: 05/25/2024]
Abstract
Surgical treatment for gender dysphoria consists of facial, chest, and genital surgery. Chest and genital gender affirmation surgeries alter the form and function of the native organs. This can have a profound impact on sexual function for transgender and gender- diverse individuals. In this article, the authors will discuss the impacts that chest and genital gender affirmation surgeries can have on sexual function.
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Affiliation(s)
- Anna Schoenbrunner
- Department of Plastic and Reconstructive Surgery, The Ohio State University, 915 Olentangy River Road, Suite 2140, Columbus, OH 43212, USA.
| | - Courtney Cripps
- Department of Surgery, Section of Plastic and Reconstructive Surgery, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
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Sun HH, Gupta S, Chen ML. Urethral Outcomes of the Labia Minora Ring Flap for Metoidioplasty and Phalloplasty. Urology 2024; 188:156-161. [PMID: 38670276 DOI: 10.1016/j.urology.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE To determine urethral outcomes of single-stage metoidioplasty and radial forearm free flap (RFFF) phalloplasty using the labia minora ring flap for urethral lengthening (UL). METHODS A retrospective review was performed of patients undergoing single-stage metoidioplasty and RFFF phalloplasty utilizing the labia minora ring flap technique. The ring flap consists of endodermal labia minora tissue ventral to the clitoris and surrounding the vaginal introitus. During metoidioplasty, the ring flap accounts for the entirety of UL. During RFFF phalloplasty, the ring flap becomes the pars fixa (PF) urethra. The primary outcomes measured were rates of fistula, stricture, and surgical revision. RESULTS Between November 2017 and August 2023, 311 patients underwent metoidioplasty or RFFF phalloplasty (mean follow-up 37 months). Of the 69 metoidioplasties, urethrocutaneous fistulas developed in 11 patients (16%); strictures occurred in 4 (6%). Of the 242 phalloplasty patients, there were 71 fistulas (29%), 56 of which resolved spontaneously. Strictures developed in 44 patients (18%). Twenty-five patients (10%) developed both a stricture and fistula. Surgical repair was required in 8/69 (12%) metoidioplasty patients and in 46/242 (19%) RFFF phalloplasty patients for an overall revision rate of 17%. CONCLUSION UL during metoidioplasty or RFFF phalloplasty can be accomplished in a single stage using the labia minora ring flap with comparable surgical revision rates to previously described techniques. This approach can also be applied to other phalloplasty techniques. Many fistulas of the PF urethra resolve spontaneously. Higher urethral revision rates were seen in phalloplasty compared to metoidioplasty.
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Affiliation(s)
- Helen H Sun
- Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH.
| | - Shubham Gupta
- Case Western Reserve University/University Hospitals of Cleveland, Cleveland, OH
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Zhang TR, Harel D, Rivera A, Shahnawaz S, Qian Y, Berry C, Zhao LC, Radix A, Bluebond-Langner R, Mmonu NA. Incidence, Complications, and Long-term Outcomes of Gender-affirming Phalloplasty: Analysis of a Large Statewide Population-based Dataset. Urology 2024; 185:27-33. [PMID: 38340965 DOI: 10.1016/j.urology.2023.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/26/2023] [Accepted: 10/16/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To evaluate the incidence of gender-affirming phalloplasty and postoperative complications in a large population-based dataset. METHODS Retrospective cohort study was done using the California Department of Health Care Access and Information datasets which include patient-level data from all licensed hospitals, emergency departments, and ambulatory surgery facilities in California. Adult patients 18 years or older undergoing gender-affirming phalloplasty in California from January 1, 2009 to December 31, 2019 were included. We examined phalloplasty-related complications using International Classification of Disease diagnosis and procedure codes and Current Procedural Terminology codes. Unique record linkage number identifiers were used to follow patients longitudinally. Statistical analysis included Kaplan-Meier survival analysis and Cox proportional hazards analysis. RESULTS We identified 766 patients who underwent gender-affirming phalloplasty in 23 facilities. Of 475 patients with record linkage numbers, 253 (55.3%) had subsequent re-presentations to the inpatient, emergency department, and ambulatory surgery settings related to phalloplasty complications. Survival analysis indicated that 50% of patients re-presented by 1year post-phalloplasty. Asian/Pacific Islander patients had lower risk of complications, and California residents had higher risk of complications. CONCLUSION This population-based study confirms that gender-affirming phalloplasty has a high complication rate, and demonstrates for the first time an association with high rates of return to hospitals, emergency departments, and ambulatory surgery centers. These findings provide additional higher-level evidence that may aid patient counseling, shared surgical decision-making, and institutional and government policy.
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Affiliation(s)
- Tenny R Zhang
- Department of Urology, NYU Langone Medical Center, New York, NY; Department of Urology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - Daphna Harel
- Department of Applied Statistics, Social Science, and Humanities, New York University, New York, NY
| | - Adrian Rivera
- Department of Biostatistics, New York University, New York, NY
| | - Samia Shahnawaz
- Department of Biostatistics, New York University, New York, NY
| | - Yingzhi Qian
- Department of Biostatistics, New York University, New York, NY
| | - Carolyn Berry
- Department of Population Health, NYU Langone Medical Center, New York, NY
| | - Lee C Zhao
- Department of Urology, NYU Langone Medical Center, New York, NY
| | - Asa Radix
- Department of Medicine, NYU Langone Medical Center, New York, NY; Callen-Lorde Community Health Center, New York, NY
| | | | - Nnenaya A Mmonu
- Department of Urology, NYU Langone Medical Center, New York, NY; Department of Population Health, NYU Langone Medical Center, New York, NY.
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Küenzlen L, Wallmichrath JC, Küntscher MV, Rothenberger J, Laback C, Schaefer DJ, Schaff J, Bozkurt A, Djedovic G, Langer S, Hirsch T, Rieger U. [Choice of flaps for phalloplasty: what is the contemporary standard? Consensus Statement of the German-Speaking Society for Microsurgery of Peripheral Nerves and Vessels]. HANDCHIR MIKROCHIR P 2023; 55:427-436. [PMID: 37783212 DOI: 10.1055/a-2134-5891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
The ever-expanding number of transmen as well as their surgeons share an increasing interest in the construction of a neophallus. While the indication for surgery and the positive effect of a phalloplasty on the quality of life, mental health and sexual function has already been thoroughly analysed, there is a lack of data comparing and evaluating the surgical steps. During the consensus conference on the "choice of flaps for phalloplasty" at the annual meeting of the German-Speaking Society for Microsurgery of Peripheral Nerves and Vessels, the current literature was discussed and a consensus on the surgical technique of a phalloplasty was reached. This manuscript publishes jointly developed recommendations on the following topics: choice of flaps for phalloplasty, preoperative diagnostic tests before phalloplasty, urethral construction in the radial forearm flap and anterior lateral thigh flap, preformation of the urethra at the forearm or thigh, venous drainage of the radial forearm flap, innervation of the phallus, staged phalloplasty, coronaplasty and managing the donor site of a radial forearm flap.
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Affiliation(s)
- Lara Küenzlen
- Klinik für Plastische und Ästhetische Chirurgie, Wiederherstellungs- und Handchirurgie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | | | - Markus V Küntscher
- Plastische Chirurgie, Privatpraxis für Plastische & Ästhetische Chirurgie, Hohen Neuendorf, Germany
| | - Jens Rothenberger
- Klinik für Plastische und Ästhetische Chirurgie, Wiederherstellungs- und Handchirurgie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Christian Laback
- Klinische Abteilung für plastische, ästhetische und rekonstruktive Chirurgie, Medizinische Universität Graz, Graz, Austria
| | | | | | - Ahmet Bozkurt
- Klinik für Plastische, Ästhetische und Handchirurgie , HELIOS Universitatsklinikum Wuppertal, Wuppertal, Germany
| | - Gabriel Djedovic
- Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Stefan Langer
- Sektion Plastische, Ästhetische und Spezielle Handchirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Tobias Hirsch
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Fachklinik Hornheide eV, Munster, Germany
- Abteilung für Plastische Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirugie, Universitätsklinikum Münster, Munster, Germany
| | - Ulrich Rieger
- Klinik für Plastische und Ästhetische Chirurgie, Wiederherstellungs- und Handchirurgie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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Koehler A, Strauß B, Briken P, Fisch M, Riechardt S, Nieder TO. (De-)centralized health care delivery, surgical outcome, and psychosocial health of transgender and gender-diverse people undergoing vaginoplasty: results of a retrospective, single-center study. World J Urol 2023; 41:1775-1783. [PMID: 36961526 PMCID: PMC10352146 DOI: 10.1007/s00345-023-04348-5] [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: 11/25/2022] [Accepted: 02/23/2023] [Indexed: 03/25/2023] Open
Abstract
PURPOSE Previous research on genital gender-affirming surgery lacked to build a framework that took various surrounding factors into account. E.g., transgender health care services are delivered in both centralized (by one interdisciplinary institution) and decentralized settings (by different medical institutions spread over several locations). The present study investigated the effects of different structural and clinical aspects of gender-affirming genital surgery on psychosocial outcomes. METHODS We surveyed former transgender and gender-diverse people who completed a vaginoplasty between 2014 and 2018. 45 participants were included in the study. We calculated hierarchical linear regression analyses to assess the relationship between psychosocial outcome measures (gender congruence, mental health, quality of life) and different aspects of gender-affirming genital surgery (e.g., setting of service delivery). To address shortcomings regarding the small sample size, we applied a rigorous statistical approach (e.g., Bonferroni correction) to ensure that we only identify predictors that are actually related to the outcomes. RESULTS A non-responder analysis revealed no systematic bias in the recruitment procedure. Treatment satisfaction was a significant predictor for gender congruence. Moreover, we found the setting of service delivery (centralized, decentralized) to predict psychological health and the physical health dimension of quality of life. The effect sizes of our models were moderate to high, and models explained up to 26% of the total variance with a power up to 0.83. CONCLUSION The present study is an exploratory attempt into the manifold relationships between treatment-related factors (e.g., aesthetic outcome), the setting of service delivery, and their effects on gender-affirming genital surgery.
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Affiliation(s)
- Andreas Koehler
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernhard Strauß
- Institute of Psychosocial Medicine, Psychotherapy, and Psycho-Oncology, University Hospital Jena, Jena, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Riechardt
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Timo O Nieder
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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7
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Bond SM, Fouche T, Smith JR, Garza RM. Review of Health Insurance Policy Inclusivity of Gender Nonconforming and Nonbinary Individuals Seeking Gender-Affirming Health Care. Transgend Health 2022; 7:484-496. [PMID: 36644124 PMCID: PMC9829125 DOI: 10.1089/trgh.2020.0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background An increasing number of individuals who present to health care professionals identify as transgender, gender nonconforming (GNC), and gender nonbinary (NB). GNC/NB individuals experience higher rates of discrimination in health care settings compared with their binary (e.g., trans male and trans female) counterparts. Outdated language excludes the nuances of gender identity. The goal of this study was to evaluate whether current terminology found in health insurance policies may be a barrier to gender-affirming health care for GNC/NB individuals. Methods Health insurance policies for a diverse subset of government (n=4) and private (n=6) payers were obtained in May 2020. Policies were reviewed independently by two members of the research team to determine whether each was supportive or unsupportive to GNC/NB individuals. An arbitrary scoring system was designed that allowed the reviewers to assign a specific number of points to each policy based on the aggregation of mention, coverage, and inclusivity. Results Most policies performed poorly as indicated by a support score less than zero. It was also noted that most policies used binary, gendered language, and terminology that excludes the unique gender identities of many GNC/NB individuals. Conclusions Most policies currently failed to provide clear, inclusive coverage to GNC/NB individuals for relevant and important aspects of their care. In their current state, these policies are a source of confusion, uncertainty, and discouragement for these individuals, which can present as a barrier to accessing quality, inclusive, gender-affirming health care.
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Affiliation(s)
- Stephanie M. Bond
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medicine & Biological Sciences, Chicago, Illinois, USA
| | - Tom Fouche
- Pritzker School of Medicine, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Jesse R. Smith
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medicine & Biological Sciences, Chicago, Illinois, USA
| | - Rebecca M. Garza
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medicine & Biological Sciences, Chicago, Illinois, USA
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Legislations Mandating Insurance Coverage Are Highly Effective in Delivering Surgical Care of Transgender Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4496. [PMID: 36061492 PMCID: PMC9433082 DOI: 10.1097/gox.0000000000004496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022]
Abstract
Although gender-affirming surgery is increasingly performed, few studies have examined any temporal correlation between legislations mandating transgender care and the actuation of such surgical care.
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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.
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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
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Bonapace-Potvin M, Lorange E, Ma X, Medor MC, Bensimon É, Brassard P, Bélanger M. The Montréal Classification of urethral lengthening for phalloplasty in transmasculine patients-surgical techniques and urethral complications. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 24:461-468. [PMID: 37901062 PMCID: PMC10601514 DOI: 10.1080/26895269.2022.2104418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Introduction Phalloplasties are one of the most performed genital surgeries in the treatment of gender dysphoria for transmasculine patients. Urethral lengthening is an essential component of phalloplasties. Few techniques have been described for the creation of this pars fixa urethra. The purpose of this article is to present the Montréal Classification for pars fixa urethral lengthening, to detail the surgical techniques and to report on clinical outcomes. Materials and methods All patients undergoing phalloplasty from November 2016 to February 2019 were included in this study. Patient demographics, type of surgery and urological complications were recorded. Statistics were performed using student's T-test, Chi-squared test, Fisher's exact test and One-way ANOVA. Patients underwent either type 1, type 2, or type 3 urethral reconstruction. Results Of the 84 total patients, 45 underwent type 1 lengthening, 28 type 2, and 11 type 3. Eighteen and 33 patients underwent single-stage and two stage anastomosis of the pars fixa to the pars pendulans neourethra, respectively. Thirty-three patients have not had any additional surgeries to date. Post-operative urological complications for immediate anastomosis and two-stage anastomosis were reported in 77.7% and 18.2% of patients, respectively. Conclusions We propose a classification as well as a description of three types of urethral lengthening techniques. Over the last few years, we have shifted away from single-stage anastomosis and have adopted a two-stage anastomosis technique. Our experience allows us to classify urethral lengthening and to standardize care depending on patient characteristics, leading to excellent results.
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Affiliation(s)
- Michelle Bonapace-Potvin
- Plastic Surgery Department, Centre Métropolitain de Chirurgie, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
| | - Elisabeth Lorange
- Plastic Surgery Department, Centre Métropolitain de Chirurgie, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
| | - Xiya Ma
- Plastic Surgery Department, Centre Métropolitain de Chirurgie, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
| | - Maria Cassandre Medor
- Plastic Surgery Department, Centre Métropolitain de Chirurgie, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
| | - Éric Bensimon
- Plastic Surgery Department, Centre Métropolitain de Chirurgie, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
| | - Pierre Brassard
- Plastic Surgery Department, Centre Métropolitain de Chirurgie, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
| | - Maud Bélanger
- Plastic Surgery Department, Centre Métropolitain de Chirurgie, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
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11
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Gümüşsoy S, Hortu İ, Dönmez S, Alp Dal N, Ergenoğlu AM. Investigation of body image perception, self-esteem, and self-confidence in female-to-male transsexuals before and after sex reassignment surgery. Perspect Psychiatr Care 2022; 58:961-967. [PMID: 34085294 DOI: 10.1111/ppc.12883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The study was aimed at investigatting the changes in body image perception, self-esteem, and self-confidence of female-to-male transsexuals (FtM) after sex reassignment surgery (SRS). DESIGN AND METHODS The quasi-experimental study was conducted with the female individuals who undergo FtM SRS between May 2018 and May 2019. The study data were collected using the Personal Information Form, Body Image Scale, Coopersmith Self-Esteem Inventory, and Self-Confidence Scale. FINDINGS It was observed that the patients' postoperative body image perception, self-esteem, and self-confidence improved. As their postoperative body image perception was higher than was their preoperative body image perception, their postoperative self-esteem and self-confidence levels were also higher. In addition, as their self-esteem increased, so did their self-confidence. PRACTICE IMPLICATIONS It was found that the patients' postoperative body image perception, self-esteem, and self-confidence improved.
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Affiliation(s)
- Süreyya Gümüşsoy
- Atatürk Health Care Vocational School, Ege University, Bornova, Izmir, Turkey
| | - İsmet Hortu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Sevgül Dönmez
- Department of Nursing, Institute of Health Sciences, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Nursel Alp Dal
- Midwifery Department, Faculty of Health Sciences, Munzur University Aktuluk Campus, Tunceli, Turkey
| | - Ahmet M Ergenoğlu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
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12
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Briles BL, Middleton RY, Celtik KE, Crane CN, Safir M, Santucci RA. Penile Prosthesis Placement by a Dedicated Transgender Surgery Unit: A Retrospective Analysis of Complications. J Sex Med 2022; 19:641-649. [PMID: 35241370 DOI: 10.1016/j.jsxm.2022.01.518] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/21/2021] [Accepted: 01/31/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Penile prostheses may be used as a component of genital gender affirmation surgery for the purpose of achieving penile rigidity after phalloplasty, and transgender individuals experience higher complication rates than cisgender individuals. AIM To observe complications with transmasculine penile prosthesis surgery over time and across surgical conditions. METHODS Retrospective chart review of all transmasculine patients with phalloplasty undergoing penile prosthesis placement between 4/14/2017 and 2/11/2020 (80 patients). OUTCOMES Independent variables include implant type, previous genital surgeries, and simultaneous genital surgeries. Dependent variables include prosthesis infection and mechanical complication (device malfunction, dislodgement, erosion). RESULTS There was an overall complication requiring surgery rate of 36% and infection rate of 20% (15/67 for inflatable prostheses and 1/13 for semirigid), with 14% (11/80) experiencing infection requiring removal. Differences in infection rates appeared insignificant across categories of previous surgery or with simultaneous surgery, but we did notice a markedly lower rate for semirigid prostheses compared to inflatable. There was a significant relationship between infection and case number, with the probability of infection decreasing over time. Device loss at 9 months was 21% overall. Preoperative conditions of the neophallus such as prior stricture correction and perioperative factors such as simultaneous clean and clean-contaminated procedures seemed to pose no additional increase in complication rates. CLINICAL IMPLICATIONS Type and number of prior and simultaneous non-prosthetic surgeries should not be considered as a risk factor for penile prosthesis after phalloplasty for transmasculine patients, even those that are clean-contaminated STRENGTHS & LIMITATIONS: Our cohort size is large compared to currently available studies, although not large enough to generate sufficient power for group comparisons. We have reported every genital surgical step between phalloplasty and penile prosthesis placement and recorded complications with subsequent devices after failure. Patient-reported outcomes were not collected. CONCLUSION We demonstrate that preoperative conditions of the neophallus, such as prior stricture correction, and perioperative factors, such as simultaneous clean and clean-contaminated procedures, seem to pose no additional increase in complication rates. Our data suggest that surgical experience may further decrease complications over time. B. L. Briles, R. Y. Middleton, K. E. Celtik, et al. Penile Prosthesis Placement by a Dedicated Transgender Surgery Unit: A Retrospective Analysis of Complications. J Sex Med 2022;19:641-649.
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Affiliation(s)
| | - Ravyn Y Middleton
- Long School of Medicine, UT Health San Antonio; San Antonio, TX, USA
| | - Kenan E Celtik
- Department of Urology, Houston Methodist Hospital; Houston, TX, USA
| | | | - Michael Safir
- Crane Center for Transgender Surgery; Austin, TX, USA
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Wu CA, Jolly D, Boskey ER, Ganor O. A Systematic Review of Staging and Flap Choice in Gender-Affirming Phalloplasty. JOURNAL OF RECONSTRUCTIVE MICROSURGERY OPEN 2022. [DOI: 10.1055/s-0042-1748884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Background As phalloplasty becomes more routinely performed, there is a growing need for an evidence base to guide surgical decision-making. Recent reviews have suggested that flap type and number of stages may affect the high rates of urethral complications seen with phalloplasty, but no rigorous comparison of both has been performed.
Methods A systematic review was conducted across PubMed, Google Scholar, and ScienceDirect (PROSPERO #158722). All included studies examined urethral complications following gender-affirming phalloplasty in transgender men. Data were extracted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations system. All searches, extractions, and grading were completed by two authors.
Results Twenty-five studies were included with a total of 1,674 patients. Identified flap types included radial forearm, anterolateral thigh, abdominal, and fibular flaps. Surgical techniques varied widely within the flap types. Number of stages ranged from one to four. Stricture and fistula were the most frequently reported complications with considerable variation in the reported rates between studies, even within singular flap types. Data extraction indicated serious quality issues with the published literature, with the majority of studies at high risk of bias due to short follow-up times, inconsistent and incomplete reporting of outcomes, and inconsistent reporting of surgical technique.
Conclusion To date, there is insufficient data to support a preferred flap type to minimize the urethral complication rates of phalloplasty. Further high-quality literature is required to determine the impact of potential factors affecting complications of gender-affirming phalloplasty. Improved literature quality may be facilitated by a standardized set of reporting guidelines.
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Affiliation(s)
| | - Divya Jolly
- Department of Plastic and Oral Surgery, Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Elizabeth R. Boskey
- Department of Plastic and Oral Surgery, Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Oren Ganor
- Department of Plastic and Oral Surgery, Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
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14
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Callegari M, Pettigrew G, MacLean J, Mishra K, Khouri JS, Gupta S. Gender Affirmation Surgery for the Transmasculine Patient. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2022. [DOI: 10.1007/s13669-022-00330-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Wu SH, Shen BH, Perng CK, Wang TH, Shih YC, Ma H, Wu HY. Complications of free-flap procedures for phalloplasty in female-to-male transgender surgery: 25-year experience a single medical center. J Chin Med Assoc 2022; 85:341-345. [PMID: 35259134 DOI: 10.1097/jcma.0000000000000677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To present the complications of free-flap phalloplasty in three-staged female-to-male transgender surgery. METHODS This retrospective study included patients who underwent a three-staged free-flap phalloplasty for female-to-male transgender surgery between January 1988 and December 2013. Data regarding demographics, operative techniques, and complications were collected and analyzed. RESULTS A total of 101 patients with a mean age of 30.2 years were included. Phalloplasty with traditional free forearm tube-in-tube fasciocutaneous flap was performed in 25 (24.8%) patients, free forearm fasciocutaneous flap with vaginal mucosa for a prefabricated urethra in 30 (29.7%) patients, free radial forearm osteocutaneous flap with vaginal mucosa for a prefabricated urethra in 22 (21.8%) patients, and free fibula osteocutaneous flap with vaginal mucosa for a prefabricated urethra in 24 (23.8%) patients. Complication rates of partial flap loss, urethrocutaneous fistula, urethral stricture, and hair or stone formation were 12.9%, 49.5%, 24.8%, and 5.0%, respectively. Patients receiving fibula osteocutaneous flap phalloplasty had the lowest overall complication rate (33.3%), followed by those with radial forearm osteocutaneous flap (40.9%), forearm fasciocutaneous flap (43.3%), and forearm tube-in-tube fasciocutaneous flap (80.0%). Forearm tube-in-tube fasciocutaneous flap procedure was associated with significantly higher rates of overall complications (p = 0.05), urethrocutaneous fistula (p = 0.005), and hair or stone formation (p = 0.002) compared with the other three types of procedures. Rates of all complications did not significantly differ among fibula osteocutaneous flap, radial forearm osteocutaneous flap, and forearm fasciocutaneous flap procedures. CONCLUSION In free-flap phalloplasty for female-to-male transgender surgery, utilization of free fibula osteocutaneous flap with vaginal mucosa for a prefabricated urethra resulted in the lowest complication rate. Further comparisons among different procedures of phalloplasty are warranted.
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Affiliation(s)
- Szu-Hsien Wu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Bing-Hwei Shen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Cherng-Kang Perng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Tien-Hsiang Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Chung Shih
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsu Ma
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ho-Yu Wu
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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16
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Martin SA, Morrison SD, Patel V, Capitán-Cañadas F, Sánchez-García A, Rodríguez-Conesa M, Bellinga RJ, Simon D, Capitán L, Satterwhite T, Nazerali R. Social Perception of Facial Feminization Surgery Outcomes: Does Gender Identity Alter Gaze? Aesthet Surg J 2021; 41:1207-1215. [PMID: 33336697 DOI: 10.1093/asj/sjaa377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The evaluation of gender-affirming facial feminization surgery (FFS) outcomes can be highly subjective, which has resulted in a limited understanding of the social perception of favorable gender and aesthetic facial appearance following FFS. Eye-tracking technology has introduced an objective measure of viewer subconscious gaze. OBJECTIVES The aim of this study was to use eye-tracking technology to measure attention and perception of surgery-naive cisgender female and feminized transgender faces, based on viewer gender identity. METHODS Thirty-two participants (18 cisgender and 14 transgender) were enrolled and shown 5 photographs each of surgery-naive cisgender female and feminized transgender faces. Gaze was captured with a Tobii Pro X2-60 eye-tracking device (Tobii, Stockholm, Sweden) and participants rated the gender and aesthetic appearance of each face on Likert-type scales. RESULTS Total image gaze fixation time did not differ by participant gender identity (6.00 vs 6.04 seconds, P = 0.889); however, transgender participants spent more time evaluating the forehead/brow, buccal/mandibular regions, and chin (P < 0.001). Multivariate regression analysis showed significant associations between viewer gender identity, age, race, and education, and the time spent evaluating gender salient facial features. Feminized faces were rated as more masculine with poorer aesthetic appearance than surgery-naive cisgender female faces; however, there was no significant difference in the distribution of gender appearance ratings assigned to each photograph by cisgender and transgender participants. CONCLUSIONS These results demonstrate that gender identity influences subconscious attention and gaze on female faces. Nevertheless, differences in gaze distribution did not correspond to subjective rated gender appearance for either surgery-naive cisgender female or feminized transgender faces, further illustrating the complexity of evaluating social perception of favorable FFS outcomes.
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Affiliation(s)
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Viren Patel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Anabel Sánchez-García
- FACIALTEAM Surgical Group, HC Marbella International Hospital, Marbella, Málaga, Spain
| | | | - Raúl J Bellinga
- FACIALTEAM Surgical Group, HC Marbella International Hospital, Marbella, Málaga, Spain
| | - Daniel Simon
- FACIALTEAM Surgical Group, HC Marbella International Hospital, Marbella, Málaga, Spain
| | - Luis Capitán
- FACIALTEAM Surgical Group, HC Marbella International Hospital, Marbella, Málaga, Spain
| | | | - Rahim Nazerali
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, CA, USA
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17
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Miller TJ, Lin WC, Safa B, Watt AJ, Chen ML. Transgender Scrotoplasty and Perineal Reconstruction With Labia Majora Flaps: Technique and Outcomes From 147 Consecutive Cases. Ann Plast Surg 2021; 87:324-330. [PMID: 34397521 DOI: 10.1097/sap.0000000000002602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Labia majora, the embryologic homologs of the scrotum, are ideal donor tissue for transgender scrotoplasty. The technique is detailed, and surgical outcomes are assessed for scrotoplasty using labia majora rotational advancement flaps. METHODS We retrospectively reviewed the outcomes of phalloplasty patients who underwent either primary or secondary labia majora flap scrotoplasty and perineal reconstruction from October 1, 2017, to December 1, 2019. Bilateral elevation and rotational flap advancement from the posterior to anterior position formed a pouch-like scrotum. Perineal reconstruction involved multilayered closure with apposition of the inner thigh skin. RESULTS The mean follow-up was 12.5 months (0.5-26 months). One hundred forty-seven scrotoplasties were performed. Of the 147 total scrotoplasty patients, 133 had labia majora flap scrotoplasty and perineal reconstruction with single-stage phalloplasty. Distal flap necrosis occurred in 6 patients (4.1%); 5 were ipsilateral to the groin dissection required for phalloplasty. Large (>1 cm diameter) perineoscrotal junction dehiscence occurred in 7 patients (4.7%). All wounds were managed conservatively except for 3 patients who developed urethrocutaneous fistulas at the perineoscrotal junction. All 3 patients required fistula repair. Two (1.4%) scrotal hematomas and 3 (2.0%) perineal hematomas were seen; all required operative intervention. CONCLUSIONS Labia majora flap scrotoplasty via the bilateral rotational advancement technique and perineal reconstruction can be safely performed during phalloplasty. Minor wound complications are common and frequently heal with conservative management. Wounds that do not heal may be associated with urethral complications. Hematomas are rare but usually require operative intervention.
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18
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Harris J, Premaratne ID, Spector JA. Facial Masculinization from Procedures to Payment: A Review. LGBT Health 2021; 8:444-453. [PMID: 34403627 DOI: 10.1089/lgbt.2020.0128] [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
As the demand for gender-affirming procedures continues to increase, patients and providers have a greater imperative to understand the current state of facial masculinization. Facial reconstruction for transgender women has been shown to treat gender dysphoria effectively and reduce rates of discrimination and victimization. Although facial masculinization surgery for transgender men is less common, there are multiple surgical and nonsurgical options to supplement the effect of hormone therapy on facial appearance, including but not limited to: receding the hair line, flattening the forehead, expanding the supraorbital ridge, increasing the dorsal nasal projection, squaring the jaw, and augmenting the chin. This review aims to summarize these techniques for providers who wish to inform transgender male patients about their options and discuss them in the context of patient satisfaction and availability of insurance coverage.
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Affiliation(s)
- Jason Harris
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Ishani D Premaratne
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Jason A Spector
- Laboratory of Bioregenerative Medicine and Surgery, Division of Plastic Surgery, Weill Cornell Medical College, New York, New York, USA.,Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
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19
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Beamer MR, Schardein J, Shakir N, Jun MS, Bluebond-Langner R, Zhao LC, Nikolavsky D. One or Two Stage Buccal Augmented Urethroplasty has a High Success Rate in Treating Post Phalloplasty Anastomotic Urethral Stricture. Urology 2021; 156:271-278. [PMID: 34119502 DOI: 10.1016/j.urology.2021.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe the outcomes of single-stage and staged repairs in properly selected patients with phalloplasty anastomotic strictures. METHODS A bi-institutional retrospective review was performed of all patients who underwent anastomotic stricture repairs between 7/2014-8/2020. Those who had prior augmented urethroplasties or poorly vascularized tissue underwent two-stage repairs (Group-2), all others underwent single-stage repair with a double-face (dorsal inlay and ventral onlay) buccal mucosal graft urethroplasty (Group-1). Postoperatively, urethral patency and patient reported outcome measures (PROMs) were assessed. RESULTS Twenty-three patients with anastomotic strictures were identified. Fourteen patients met inclusion criteria and had 1-year follow-up (9 in Group-1; 5 in Group-2). Nine patients (64%) had prior failed interventions (56% Group-1; 80% Group-2). At a mean follow-up of 33.9 (Group-1) and 35.2 months (Group-2) there were two stricture recurrences in Group-1 (22%) and none in Group-2. PROMs were completed by 12 patients. All patients reported the ability to void standing. Post-void dribbling was present in the majority of patients (7/7 Group-1; 2/4 in Group-2). Mean IPSS was 3.9 (0-14) for Group-1 and 1 (0-3) for Group-2. All reported at least a moderate improvement in their condition on GRA (Group-1 +3 71%, +2 29%; Group-2 +3 100%). CONCLUSION Single-stage repairs are feasible for patients with anastomotic strictures who have well vascularized tissue and no prior single-stage buccal mucosa augmented urethroplasty failures. Staged repairs are feasible for patients with poor tissue quality. Proper patient selection is important for successful reconstruction.
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Affiliation(s)
- Matthew R Beamer
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY
| | - Jessica Schardein
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY
| | - Nabeel Shakir
- Department of Urology, New York University Langone Health, New York, NY
| | - Min Suk Jun
- Department of Urology, New York University Langone Health, New York, NY
| | - Rachel Bluebond-Langner
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - Lee C Zhao
- Department of Urology, New York University Langone Health, New York, NY
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20
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Huayllani MT, Boczar D, Saleem HY, Cinotto G, Avila FR, Manrique OJ, Ciudad P, Rinker BD, Forte AJ. Single versus two-stage phalloplasty for transgender female-to-male patients: a systematic review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:608. [PMID: 33987306 DOI: 10.21037/atm-20-3514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Phalloplasty is the main treatment for gender dysphoria disorder. It is difficult to ascertain if staging of phalloplasty influences the rate of complications. We aim to describe and compare the rates of complication between single versus two-stage phalloplasty for transgender female-to-male patients. PubMed, Ovid Medline, EMBASE and SCOPUS databases were queried for studies reporting complications of female-to-male transgender patients who underwent phalloplasty. The keywords "phalloplasty", "female to male", "outcome", "complication" and synonyms in different combinations were used for the search. Only studies that could identify whether phallic shaft creation was performed in a single or two-stage procedure were included. From a total of 336 articles, 20 met the inclusion criteria. Sixteen studies reported complications associated with a single-stage phalloplasty and seven studies identified complications after a two-stage procedure. The most common complications found for both groups of staging were fistula, stricture and total/partial flap necrosis. Patients who underwent two-stage phalloplasty had higher complication rates (partial or total flap necrosis and fistulas), compared with the single-stage procedure (P<0.05). In conclusion, this systematic review identified the impact of staging in the rate of complications related to phalloplasty for transgender female-to-male patients; a two-stage phalloplasty has a higher rate of complications.
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Affiliation(s)
- Maria T Huayllani
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Daniel Boczar
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Humza Y Saleem
- Department of Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Gabriela Cinotto
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Oscar J Manrique
- Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Pedro Ciudad
- Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
| | - Brian D Rinker
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA
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21
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Terrier M, Morel-Journel N, Carnicelli D, Ruffion A, Terrier JE, Maucort-Boulch D, Paganelli L, Neuville P. Suprapubic phalloplasty in transmen: surgical results and critical review. Int J Impot Res 2021; 33:754-761. [PMID: 33727691 DOI: 10.1038/s41443-021-00426-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/07/2020] [Accepted: 03/02/2021] [Indexed: 11/09/2022]
Abstract
This article presents the surgical outcomes of a consecutive series of 71 transmen undergoing pre-expanded suprapubic phalloplasty (SPP) in a specialized center. The median [IQR] duration to finalize this three-stage phalloplasty procedure was 7 months [6-7]. Median [IQR] follow-up was 39.4 months [19.7-81.2]. Among those included, 25 (35.2%) had a urethroplasty, and 40 (56.3%) a penile prosthesis as additional procedures. Complications were the result of disorders of wound healing (dehiscence, infection, partial necrosis) or tissue expander (migration, infection). Sixty patients (84.5%) experienced at least one complication during the phalloplasty procedure, mostly minor complications Clavien < IIIa (81.8%). Among these, 16 (22.5%) underwent at least one reintervention, 2 of whom underwent two reinterventions (18 reinterventions in total for Clavien ≥ IIIa complication). There was no loss of phalloplasty. Among the wide variety of techniques developed for phalloplasty, the suprapubic technique seems to be a valuable option for transmen on the path to genital gender affirming surgery.
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Affiliation(s)
- Manon Terrier
- Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France.
| | - Nicolas Morel-Journel
- Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France
| | - Damien Carnicelli
- Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France
| | - Alain Ruffion
- Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France
| | - Jean-Etienne Terrier
- Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France
| | | | - Lena Paganelli
- Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France
| | - Paul Neuville
- Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France
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Patel V, Nolan IT, Card E, Morrison SD, Bared A. Facial Hair Transplantation for Transgender Patients: A Literature Review and Guidelines for Practice. Aesthet Surg J 2021; 41:NP42-NP51. [PMID: 33565575 DOI: 10.1093/asj/sjaa430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Facial hair transplantation has become an increasingly popular modality to create a more masculine appearance for transmasculine patients. OBJECTIVES This aim of this study was to review the current literature regarding facial hair transplantation and provide recommendations and best practices for transgender patients. METHODS A comprehensive literature search of the PubMed, MEDLINE, and Embase databases was conducted for studies published through April 2020 for publications discussing facial hair transplant in transmasculine patients, in addition to the nontransgender population. Data extracted include patient demographics, techniques, outcomes, complications, and patient satisfaction. RESULTS We identified 2 articles discussing facial hair transplantation in transmasculine patients. Due to the paucity of publications describing facial hair transplantation in transmasculine patients, data regarding facial hair transplant from the cisgender population were utilized to augment our review and recommendations. CONCLUSIONS Facial hair transplant is a safe and effective means of promoting a masculine appearance for transgender patients. Nevertheless, facial hair transplantation should be deferred until at least 1 year after the initiation of testosterone therapy to allow surgeons to more accurately identify regions that would benefit the most from transplantation. Additionally, providers should engage patients in discussions about any plans to undergo facial masculinization surgery because this can alter the position of transplanted hairs. Currently, follicular unit extraction from the occipital scalp is the preferred technique, with use of the temporal scalp if additional grafts are needed. Patients should be advised that a secondary grafting procedure may be needed a year after initial transplant to achieve desired density. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Viren Patel
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ian T Nolan
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Elizabeth Card
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
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Alexander GM, John K, Hammond T, Lahey J. Living Up to a Name: Gender Role Behavior Varies With Forename Gender Typicality. Front Psychol 2021; 11:604848. [PMID: 33551916 PMCID: PMC7862123 DOI: 10.3389/fpsyg.2020.604848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
Forenames serve as proxies for gender labels that activate gender stereotypes and gender socialization. Unlike rigid binary gender categories, they differ in the degree to which they are perceived as "masculine" or "feminine." We examined the novel hypothesis that the ability of a forename to signal gender is associated with gender role behavior in women (n = 215) and men (n = 127; M = 19.32, SD = 2.11) as part of a larger study evaluating forenames used in resume research. Compared to individuals endorsing a "gender-strong" forename, those perceiving their forename as relatively "gender-weak" reported less gender-typical childhood social behavior and a weaker expression of gender-linked personality traits. Our findings suggest that forenames strengthen or weaken gender socialization, gender identification, and so contribute to the variable expression of gender role behavior within binary gender groups.
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Affiliation(s)
- Gerianne M Alexander
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Kendall John
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, United States
| | - Tracy Hammond
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX, United States
| | - Joanna Lahey
- Bush School of Government and Public Service, Texas A&M University, College Station, TX, United States
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Fernandez-Crespo RE, Buscaino K, Parker J, Carrion R. Current Status for Semirigid Penile Prosthetic Devices. Curr Urol Rep 2021; 22:7. [PMID: 33420928 DOI: 10.1007/s11934-020-01028-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper was to evaluate the current use of semirigid penile prosthesis (SRPP), surgical techniques for insertion of SRPP, and how to prevent and approach surgical complications. RECENT FINDINGS SRPP is a valid option for those who are refractory to medical therapy for erectile dysfunction (ED) and even more appropriate for specific subsets of patient populations. It is important for urologists to know which patient population SRPP is preferred for. Several studies have shown good patient outcomes and patient satisfaction with those who underwent SRPP.
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Affiliation(s)
- Raul E Fernandez-Crespo
- Tampa General Hospital, 1 Tampa General Circle, Tampa, FL, 33606, USA. .,University of South Florida, Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
| | - Kristina Buscaino
- Tampa General Hospital, 1 Tampa General Circle, Tampa, FL, 33606, USA.,University of South Florida, Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Justin Parker
- Tampa General Hospital, 1 Tampa General Circle, Tampa, FL, 33606, USA.,University of South Florida, Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Rafael Carrion
- Tampa General Hospital, 1 Tampa General Circle, Tampa, FL, 33606, USA.,University of South Florida, Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
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25
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Köhler A, Strauß B, Briken P, Riechardt S, Fisch M, Nieder TO. [Feminizing Genital Gender-affirmative Surgery in Centralized and Decentralized Health Care Settings - The Hamburg TransCare study]. Psychother Psychosom Med Psychol 2020; 71:132-140. [PMID: 33063307 DOI: 10.1055/a-1243-0715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Gender Dysphoria (GD, formerly known as transsexualism) describes distress and impairment in an individual caused by the incongruence between the experienced gender and the sex assigned at birth (Gender Incongruence: GI). Transgender health care focusses on gender-affirmative treatments (e. g., hormone therapy) and associated needs (e. g., psychotherapy). Moreover, genital surgery is considered an effective treatment to reduce GI/GD and improve mental health and quality of life. Interdisciplinary cooperation between the associated medical facilities is regarded as evidence-based health care. OBJECTIVES To date, THC is delivered in zwei different health care settings: interdisciplinary and centralized from one medical institution vs. decentralized, spread over several medical institutions. In Germany, individuals with GI/GD access health care mostly in decentralized structures. The consequences of feminizing genital surgery carried out in centralized and decentralized health care structures in terms of quality and effectiveness have not been investigated so far. The goal of the TransCare study is to prospectively examine individuals with GI/GD seeking feminizing genital surgery regarding demographics and clinical characteristics as well as to analyze the influence of centralized and decentralized health care settings on the psychosocial and clinical outcome. MATERIALS AND METHODS To recruit a valid and comprehensive sample, participants were questioned prospectively. RESULTS The results of the study should help gain new insights into the influence of centralized and decentralized health care settings carrying out feminizing genital surgery on psychosocial and clinical outcomes for the patients. CONCLUSION Based on the TransCare study, we suggest that health care should be improved according to individual patient needs.
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Affiliation(s)
- Andreas Köhler
- Institut für Sexualforschung, Sexualmedizin und Forensische Psychiatrie, Universitätsklinikum Hamburg-Eppendorf
| | - Bernhard Strauß
- Institut für Psychosoziale Medizin und Psychotherapie, Universitätsklinikum Jena
| | - Peer Briken
- Institut für Sexualforschung, Sexualmedizin und Forensische Psychiatrie, Universitätsklinikum Hamburg-Eppendorf
| | - Silke Riechardt
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf
| | - Margit Fisch
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf
| | - Timo O Nieder
- Institut für Sexualforschung, Sexualmedizin und Forensische Psychiatrie, Universitätsklinikum Hamburg-Eppendorf
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Marschalek J, Pietrowski D, Dekan S, Marschalek ML, Brandstetter M, Ott J. Markers of vitality in ovaries of transmen after long-term androgen treatment: a prospective cohort study. Mol Med 2020; 26:83. [PMID: 32891132 PMCID: PMC7487795 DOI: 10.1186/s10020-020-00214-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gender-affirming hormone therapy has been hypothesized to reduce the patient's reproductive potential in transmen, although the exact long-term effects on future fertility are unknown. METHODS In this prospective cohort study we aimed to evaluate ovaries of 20 transmen by using hormone serum levels, histomorphological analysis and fluorescence activated cells sorting (FACS) analysis - in order to assess the amount of vital cells. RESULTS The median total number of follicles per field of view was 39 (IQR 12-122). Of all follicles (n = 1661), the vast majority was primordial (n = 1505, 90.6%), followed by primary (n = 76, 4.6%), abnormal (n = 63, 3.8%) and secondary follicles (n = 17, 1.0%). FACS analysis was available for 13 samples (65.0%) and the median frequency of vital cells was 87.5% (IQR, 77.7-95.4%). Both a higher age (p = 0.032) and a lower BMI (p = 0.003) were significantly associated with a higher frequency of vital cells. CONCLUSION The majority of ovarian cells after long-term androgen treatment were vital in FACS analysis and histomorphological evaluation revealed a normal cortical follicle distribution. These results are currently exploratory, but might be promising for issues on fertility preservation. TRIAL REGISTRATION The study was approved by the ethics committee of the Medical University of Vienna (EK 2240/2016) and was retrospectively registered in the Current Controlled Trials Register (registration number NCT03649087 , date of registration: 28.08.2018).
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Affiliation(s)
- Julian Marschalek
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Detlef Pietrowski
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Sabine Dekan
- Clinical Institute of Pathology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Marie-Louise Marschalek
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Maximilian Brandstetter
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Johannes Ott
- Department of Obstetrics and Gynecology, Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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27
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Bizic M, Stojanovic B, Bencic M, Bordás N, Djordjevic M. Overview on metoidioplasty: variants of the technique. Int J Impot Res 2020; 33:762-770. [PMID: 32826970 DOI: 10.1038/s41443-020-00346-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/28/2020] [Accepted: 08/13/2020] [Indexed: 11/09/2022]
Abstract
Number of gender dysphoric people increased over the last few decades with positive social acceptance of transpopulation. Genital gender affirming surgeries are of utmost importance in order to adjust body to the mind of these individuals. Creation of the phallus is usually the last step in transmen transition, which remains demanding and challenging for surgeons, with different options for phalloplasty available. The ideal phallus is esthetically appealing, with preserved tactile and erogenous sensation, enables standing micturition and sexual function with minimal donor-site morbidity. Metoidioplasty, as a variant of phalloplasty, uses the hormonally hypertrophied clitoris to create the neophallus. Metoidioplasty can be considered as a method of choice for thin-built individuals looking for male genitalia with preserved erogeneity, in one-stage genital gender affirming surgery. It can be combined together with removal of reproductive organs and vaginectomy. Preoperative consultation with patients and postoperative follow-up as well as multidisciplinary approach are essential for successful treatment.This literature review aims to assess and discuss different metoidioplasty approaches with a special reference to authors' current metoidioplasty technique.
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Affiliation(s)
- Marta Bizic
- Department of Urology, University Children's Hospital, Faculty of Medicine, University of Belgrade, Belgrade, Serbia. .,Belgrade Center for Urogenital Reconstructive Surgery, Belgrade, Serbia.
| | - Borko Stojanovic
- Department of Urology, University Children's Hospital, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Belgrade Center for Urogenital Reconstructive Surgery, Belgrade, Serbia
| | - Marko Bencic
- Department of Urology, University Children's Hospital, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Belgrade Center for Urogenital Reconstructive Surgery, Belgrade, Serbia
| | - Noémi Bordás
- Belgrade Center for Urogenital Reconstructive Surgery, Belgrade, Serbia.,Department of Urology, Kiskunhalasi Semmelweis Kórház, Kiskunhalas, Hungary
| | - Miroslav Djordjevic
- Department of Urology, University Children's Hospital, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Belgrade Center for Urogenital Reconstructive Surgery, Belgrade, Serbia
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Prospective Quality-of-Life Outcomes after Facial Feminization Surgery: An International Multicenter Study. Plast Reconstr Surg 2020; 145:1499-1509. [PMID: 32459779 DOI: 10.1097/prs.0000000000006837] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND No data exist on the prospective outcomes of facial feminization surgery. This study set out to determine the effects of facial feminization surgery on quality-of-life outcomes for gender-diverse patients. METHODS A prospective, international, multicenter, cohort study with adult gender-diverse patients with gender dysphoria was undertaken. Facial feminization outcome score was calculated preoperatively and postoperatively (1-week to 1-month and >6 months). Photogrammetric cephalometries were measured at the same time points. Self-perceived preoperative masculinity and femininity were recorded. Externally rated gender appearance (scale of 1 to 5, with 1 being most feminine) and general aesthetics (scale of 1 to 10, with 10 being very good) for 10 facial feminization surgery patients were compared with those of five cisgender controls. Univariate linear regression analyses were used to predict outcomes from facial feminization surgery. RESULTS Sixty-six consecutive patients were enrolled. Patients noted that their brows, jaws, and chins were the most masculine aspects of their faces (54.5 percent, 33.3 percent, and 30.3 percent, respectively). Median facial feminization outcome score increased from 47.2 preoperatively to 80.6 at 6 months or more postoperatively (p < 0.0001). Mean satisfaction was excellent (3.0 at both 1-month and ≥6-month follow-up; p = 0.46). Cephalometric values were significantly more feminine after surgery. Gender appearance was feminine to very feminine (1.83 ± 0.96) and general aesthetics were good (6.09 ± 2.01) but different from those of cisgender women controls (1.25 ± 0.49 and 7.63 ± 1.82, respectively; p < 0.001 for each). CONCLUSION Facial feminization achieved improved quality of life, feminized cephalometries, feminine gender appearance, good overall aesthetics, and high satisfaction that were present at 1 month and stable at more than 6 months. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Nazarian M, Bluebond-Langner R, Smereka P, Zhao L, Ream J, Hindman N. Spectrum of imaging findings in gender-affirming genital surgery: Intraoperative photographs, normal post-operative anatomy, and common complications. Clin Imaging 2020; 69:63-71. [PMID: 32659682 DOI: 10.1016/j.clinimag.2020.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/30/2020] [Accepted: 06/26/2020] [Indexed: 01/03/2023]
Abstract
Gender-affirming surgery is becoming more accessible, and radiologists must be familiar with both terminology and anatomy following gender-affirming surgical procedures. This essay will review the most common gender-affirming genital surgeries, their post-operative anatomy, and common complications by providing intraoperative photographs, illustrations, and cross-sectional images. Routine radiologic imaging recommendations for transgender patients will also be reviewed.
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Affiliation(s)
- Matthew Nazarian
- NYU Langone Medical Center, 660 First Avenue, New York, NY 10016, USA.
| | | | - Paul Smereka
- NYU Langone Medical Center, 560 First Avenue, New York, NY 10016, USA.
| | - Lee Zhao
- NYU Langone Medical Center, 222 E 41st St, New York, NY 10017, USA.
| | - Justin Ream
- NYU Langone Medical Center, 660 First Avenue, New York, NY 10016, USA
| | - Nicole Hindman
- NYU Langone Medical Center, 660 First Avenue, New York, NY 10016, USA.
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30
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Stowell JT, Horowitz JM, Thomas S. Gender-affirming surgical techniques, complications, and imaging considerations for the abdominal radiologist. Abdom Radiol (NY) 2020; 45:2036-2048. [PMID: 31915851 DOI: 10.1007/s00261-019-02398-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Gender-affirming surgery is a group of surgical procedures that alters the physical appearance of a transgender person to resemble that socially associated with their identified gender. Masculinization and feminization surgeries include chest and breast surgery as well as genital reconstruction. The genital reconstruction surgeries have unique anatomic imaging features and are associated with complications that may require radiologic evaluation. This review provides a review of the imaging anatomy, expected findings, and complications associated with gender-affirming surgeries.
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Affiliation(s)
- Justin T Stowell
- Department and Institution Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Jeanne M Horowitz
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stephen Thomas
- Department of Radiology, Sharp Rees-Stealy Medical Group, San Diego, CA, USA.
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31
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Nassiri N, Maas M, Basin M, Cacciamani GE, Doumanian LR. Urethral complications after gender reassignment surgery: a systematic review. Int J Impot Res 2020; 33:793-800. [PMID: 32488213 DOI: 10.1038/s41443-020-0304-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/20/2020] [Accepted: 05/05/2020] [Indexed: 11/09/2022]
Abstract
The aim of the present systematic review is to evaluate the impact of gender reassignment surgery on the development of urethral complication. A systematic search in accordance the Preferred Reporting Items for Systematic Review and Meta-Analyses statement for original articles published up until June 2019 was performed using the Pubmed, Scopus, Embase, and Web of Science databases. Pooled analyses were done when appropriate. The bibliographic search with the included terms (("Transsexualism"[Mesh])) AND ("Sex Reassignment Surgery"[Mesh]) produced a literature of 879 articles altogether. After removing papers of not interest or articles in which the outcomes could not be deduced, 32 studies were examined for a total of 3463 patients screened. Thirty-two studies met our inclusion criteria and were evaluated, and references were manually reviewed in order to include additional relevant studies in this review. Female-to-male (FtM) surgery and male-to-female (MtF) surgery was discussed in 23 and 10 studies, respectively. One study discussed both. Varying patterns of complications were observed in FtM and MtF surgeries, with increased complications in the former because of the larger size of the neourethra. Meatal stenosis is a particular concern in MtF surgery, with complication rates ranging from 4 to 40%, and usually require meatotomy for repair. Stricture and fistulization are frequently reported complications following FtM surgery. In studies reporting on fistulae involving the urethra, 19-54% of fistulae resolved spontaneously without further surgical intervention. High rates of complications are reported in the current literature, which should be understood by patients and practitioners alike. Shared decision making with patients regarding incidence and management of urethral complications including stricture disease and fistulae, particularly after FtM surgery, is critical for setting expectations and managing postoperative outcomes.
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Affiliation(s)
- N Nassiri
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - M Maas
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - M Basin
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - G E Cacciamani
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - L R Doumanian
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA.
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32
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Dubin S, Lane M, Morrison S, Radix A, Belkind U, Vercler C, Inwards-Breland D. Medically assisted gender affirmation: when children and parents disagree. JOURNAL OF MEDICAL ETHICS 2020; 46:295-299. [PMID: 31892617 DOI: 10.1136/medethics-2019-105567] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/22/2019] [Accepted: 12/12/2019] [Indexed: 05/28/2023]
Abstract
Institutional guidelines for transgender children and adolescent minors fail to adequately address a critical juncture of care of this population: how to proceed if a minor and their parents have disagreements concerning their gender-affirming medical care. Through arguments based on ethical, paediatric, adolescent and transgender health research, we illustrate ethical dilemmas that may arise in treating transgender and gender diverse youth. We discuss three potential avenues for providing gender-affirming care over parental disagreement: legal carve-outs to parental consent, the mature minor doctrine and state intervention for neglect. Our discussion approaches this parent-child disagreement in a manner that prioritises the developing autonomy of transgender youth in the decision-making process surrounding medically assisted gender affirmation. We base our arguments in the literature surrounding the risks and benefits of gender-affirming therapy in transgender children and the existing legal basis for recognising minors' decision-making authority in certain medical situations.
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Affiliation(s)
| | - Megan Lane
- Department of Surgery, Section of Plastic Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Shane Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, New York City, New York, USA
| | - Uri Belkind
- Callen-Lorde Community Health Center, New York City, New York, USA
| | - Christian Vercler
- Department of Surgery, Section of Plastic Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - David Inwards-Breland
- Department of Medicine, Division of Adolescent Medicine, Seattle Children's Gender Clinic, University of Washington Medical Center, Seattle, Washington, USA
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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.
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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
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34
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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]
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35
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Navigating Insurance Policies in the United States for Gender-affirming Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2564. [PMID: 32537307 PMCID: PMC7288898 DOI: 10.1097/gox.0000000000002564] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/16/2019] [Indexed: 11/26/2022]
Abstract
Patients with gender dysphoria seeking to undergo gender affirmation surgery are often challenged by lack of insurance coverage. The authors aim to review gender affirmation surgery policies and to highlight discrepancies between qualifying criteria across top insurance companies in the United States.
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36
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Genitourinary vascularized composite allotransplantation: a review of penile transplantation. Curr Opin Organ Transplant 2019; 24:721-725. [DOI: 10.1097/mot.0000000000000704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Al-Tamimi M, Pigot GL, van der Sluis WB, van de Grift TC, van Moorselaar RJA, Mullender MG, Weigert R, Buncamper ME, Özer M, de Haseth KB, Djordjevic ML, Salgado CJ, Belanger M, Suominen S, Kolehmainen M, Santucci RA, Crane CN, Claes KE, Monstrey S, Bouman MB. The Surgical Techniques and Outcomes of Secondary Phalloplasty After Metoidioplasty in Transgender Men: An International, Multi-Center Case Series. J Sex Med 2019; 16:1849-1859. [DOI: 10.1016/j.jsxm.2019.07.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/19/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
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39
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Andrew TW, Kanapathy M, Murugesan L, Muneer A, Kalaskar D, Atala A. Towards clinical application of tissue engineering for erectile penile regeneration. Nat Rev Urol 2019; 16:734-744. [PMID: 31649327 DOI: 10.1038/s41585-019-0246-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2019] [Indexed: 11/09/2022]
Abstract
Penile wounds after traumatic and surgical amputation require reconstruction in the form of autologous tissue transfers. However, currently used techniques are associated with high infection rates, implant erosion and donor site morbidity. The use of tissue-engineered neocorpora provides an alternative treatment option. Contemporary tissue-engineering strategies enable the seeding of a biomaterial scaffold and subsequent implantation to construct a neocorpus. Tissue engineering of penile tissue should focus on two main strategies: first, correcting the volume deficit for structural integrity in order to enable urinary voiding in the standing position and second, achieving erectile function for sexual activity. The functional outcomes of the neocorpus can be addressed by optimizing the use of stem cells and scaffolds, or alternatively, the use of gene therapy. Current research in penile tissue engineering is largely restricted to rodent and rabbit models, but the use of larger animal models should be considered as a better representation of the anatomical and physiological function in humans. The development of a cell-seeded scaffold to achieve and maintain erection continues to be a considerable challenge in humans. However, advances in penile tissue engineering show great promise and, in combination with gene therapy and surgical techniques, have the potential to substantially improve patient outcomes.
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Affiliation(s)
- Tom W Andrew
- Centre for Nanotechnology & Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London, UK.
| | - Muholan Kanapathy
- Centre for Nanotechnology & Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London, UK
| | - Log Murugesan
- Centre for Nanotechnology & Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London, UK
| | - Asif Muneer
- Department of Urology, University College London Hospital, London, UK
| | - Deepak Kalaskar
- Centre for Nanotechnology & Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London, UK
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Winston Salem, NC, USA
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Stowell JT, Grimstad FW, Kirkpatrick DL, Brown ER, Santucci RA, Crane C, Patel AK, Phillips J, Ferreira MA, Ferreira FR, Ban AH, Baroni RH, Wu CC, Swan KA, Scott SA, Andresen KJ. Imaging Findings in Transgender Patients after Gender-affirming Surgery. Radiographics 2019; 39:1368-1392. [DOI: 10.1148/rg.2019190010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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41
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Abstract
Gender affirmation surgery for transmale patients is still challenging, as creation of the neophallus is one of the most demanding steps in surgical treatment. Metoidioplasty, as a one-stage procedure, can be considered in patients who desire gender affirmation surgery without undergoing a complex, multistage procedure with creation of an adult-sized neophallus. Metoidioplasty presents one of the variants of phalloplasty for patients in whom the clitoris is large enough under testosterone treatment. Advanced urethral reconstruction provides low complication rates with satisfying results of standing micturition.
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Affiliation(s)
- Marta R Bizic
- Belgrade Center for Genitourinary Reconstructive Surgery, Kumodraska 241v, Belgrade 11000, Serbia; Department of Urology, Faculty of Medicine, University of Belgrade, Tirsova 10, Belgrade 11000, Serbia.
| | - Borko Stojanovic
- Belgrade Center for Genitourinary Reconstructive Surgery, Kumodraska 241v, Belgrade 11000, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Joksic
- Belgrade Center for Genitourinary Reconstructive Surgery, Kumodraska 241v, Belgrade 11000, Serbia; Clinic for Gynecology and Obstetrics "Narodni Front", Kraljice Natalije 62, Belgrade 11000, Serbia
| | - Miroslav L Djordjevic
- Belgrade Center for Genitourinary Reconstructive Surgery, Kumodraska 241v, Belgrade 11000, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Injury in the transgender population: What the trauma surgeon needs to know. J Trauma Acute Care Surg 2019; 85:799-809. [PMID: 30256770 DOI: 10.1097/ta.0000000000001859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Gender dysphoria, or the distress caused by the incongruence between a person's assigned and experienced gender, can lead to significant psychosocial sequelae and increased risk of suicide (>40% of this population) and assault (>60% of this population). With an estimated 25 million transgender individuals worldwide and increased access to care for the transgender population, trauma surgeons are more likely to care for patients who completed or are in the process of medical gender transition. As transgender health is rarely taught in medical education, knowledge of the unique health care needs and possible alterations in anatomy is critical to appropriately and optimally treat transgender trauma victims. Considerations of cross-gender hormones and alterations of the craniofacial, laryngeal, chest, and genital systems are offered in this review. Further research on the optimal treatment mechanisms for transgender patients is needed.
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Pereira-Lourenço MJ, Eliseu M, Temido P, Figueiredo A. Urethral lithiasis after phalloplasty. BMJ Case Rep 2019; 12:12/7/e229825. [PMID: 31302623 DOI: 10.1136/bcr-2019-229825] [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: 11/04/2022] Open
Abstract
Female-to-male transsexual patient, 22 years old, with neophallus from radial forearm free flap (phalloplasty in March 2014), history of urethral fistula and urethral stricture 1 year later treated with surgical correction (fistulectomy) and suprapubic urinary diversion. Subsequently, he developed a new urethral stenosis located in the urethral anastomosis. Immediately proximal to the stenosis, there was a urethral dilatation (pseudodiverticulum) with a fibrous septum and several retracted stones. The stones were fragmented, the fibrous septum destroyed and the urethral stricture corrected, all with holmium laser. After 40 months of follow-up the patient shows satisfactory urinary flow with no signs of residual lithiasis or stricture.
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Affiliation(s)
| | - Miguel Eliseu
- Urology and Kidney Transplantation, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Paulo Temido
- Urology and Kidney Transplantation, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Arnaldo Figueiredo
- Urology and Kidney Transplantation, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Faculdade de Medicina, Universidade de Coimbra, Coimbra, Coimbra, Portugal
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Matsuo K, Ichihara K, Gotoh M, Masumori N. Comparison of the Uroflowmetry Parameter Results Between Transgender Males Undergoing Gender-Affirming Hormone Therapy and Age-Matched Cisgender Females: Preliminary Data. Transgend Health 2019; 4:152-156. [PMID: 31321304 PMCID: PMC6637770 DOI: 10.1089/trgh.2019.0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Gender-affirming hormone therapy (GHT) using testosterone is administered to transgender males. Although various effects caused by hormonal therapy have been reported, those on lower urinary tract function have remained unclear. The present study compared the uroflowmetry (UFM) parameter results between transgender males and age-matched cisgender females. Methods: A total of 26 transgender males who received GHT for longer than 1 year and the same number of age-matched cisgender females were enrolled. The UFM parameter results and postvoid residual urine volume (PVR) were compared between groups. Results: The median age at enrollment was 31.5 years, and the median duration of hormonal therapy was 2.7 years. There was no significant difference in the maximum flow rate or average flow rate between groups, whereas the mean voided volume (VV) (370±168 vs. 252±73 mL, p<0.001) and PVR (57.3±39.5 vs. 19.4±30.5 mL, p<0.001) were significantly greater in the transgender male group than those in the cisgender female group. Conclusion: The VV on UFM and postvoided residual urine volume in the transgender males who received GHT for >1 year were significantly increased compared with age-matched cisgender females.
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Affiliation(s)
- Kazuna Matsuo
- Department of Urology, School of Medicine, Sapporo Medical University, Sapporo, Japan.,Department of Urology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Koji Ichihara
- Department of Urology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Momokazu Gotoh
- Department of Urology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Naoya Masumori
- Department of Urology, School of Medicine, Sapporo Medical University, Sapporo, Japan
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van der Sluis WB, Pigot GLS, Al-Tamimi M, Ronkes BL, de Haseth KB, Özer M, Smit JM, Buncamper ME, Bouman MB. A Retrospective Cohort Study on Surgical Outcomes of Penile Prosthesis Implantation Surgery in Transgender Men After Phalloplasty. Urology 2019; 132:195-201. [PMID: 31229517 DOI: 10.1016/j.urology.2019.06.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess surgical outcomes of penile prosthesis implantation in transgender men who underwent phalloplasty. PATIENTS AND METHODS Transgender men who underwent penile prosthesis implantation after phalloplasty between January 1989 and September 2018 were retrospectively identified. A chart study was performed recording patient demographics, perioperative complications, and reoperations. RESULTS A total of 32 patients were identified: 22 underwent free radial forearm flap, 5 anterolateral thigh, 4 anterolateral thigh/free radial forearm flap, and 1 fibular flap phalloplasty. The median age at prosthesis implantation was 36 (range 21-59) years, the mean BMI 25.9 ± 4.0 kg/m2. At first implantation, 16 inflatable (AMS Dynaflex (n = 13), AMS Ambicor (n = 3)) and 16 malleable (Coloplast genesis (n = 14), AMS Spectra (n = 2)) prostheses were placed. Of these, 5 (16%) were removed/replaced because of infection, 2 (6%) because of leakage, 2 because of extrusion, 2 because of dislocation, 2 because of dysfunction, and 1 (3%) because of pain. The postoperative course was completely uneventful in 10 (31.3%) patients. Of all implanted prostheses, including revision procedures (n = 45), 21 (44%) were surgically replaced or removed. CONCLUSION Prosthesis explantation, replacement, or revision surgery occurs frequently after penile prosthesis implantation. Patients need to be well-informed preoperatively on these complication rates.
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Affiliation(s)
- Wouter B van der Sluis
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Garry L S Pigot
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Muhammed Al-Tamimi
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Brechje L Ronkes
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Kristin B de Haseth
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Müjde Özer
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jan Maerten Smit
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Marlon E Buncamper
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Howard KN, Zhao LC, Weinberg AC, Granieri M, Bernstein MA, Grucela AL. Robotic transanal minimally invasive rectal mucosa harvest. Surg Endosc 2019; 33:3478-3483. [DOI: 10.1007/s00464-019-06893-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 06/04/2019] [Indexed: 01/23/2023]
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Rooker SA, Vyas KS, DiFilippo EC, Nolan IT, Morrison SD, Santucci RA. The Rise of the Neophallus: A Systematic Review of Penile Prosthetic Outcomes and Complications in Gender-Affirming Surgery. J Sex Med 2019; 16:661-672. [DOI: 10.1016/j.jsxm.2019.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
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48
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Miller TJ, Wilson SC, Massie JP, Morrison SD, Satterwhite T. Breast augmentation in male-to-female transgender patients: Technical considerations and outcomes. JPRAS Open 2019; 21:63-74. [PMID: 32158888 PMCID: PMC7061686 DOI: 10.1016/j.jpra.2019.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/28/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Gender-affirmation surgery is essential in the management of gender dysphoria. For male-to-female transgender women (transwomen), feminization of the chest is a component in this process. There is minimal literature describing effective and safe techniques for breast augmentation in transwomen. Here we describe our operative techniques and considerations. Methods A retrospective review of a single surgeon experience was performed for transwomen who underwent primary breast augmentation between October 1, 2014, and February 1, 2017. Surgical outcomes and complications were analyzed. Results Thirty-four patients with an average age of 34.4 years were included in this series (range 19-59 years). Surgical approach was through an inframammary incision with a submuscular pocket and either silicone smooth round (24%) or textured anatomic implants (76%). Six patients experienced postoperative complications (17.6%). Two patients underwent reoperation for implant extrusion (5.9%). Higher BMI and longer preoperative hormonal therapy duration were significantly associated with complications (p = 0.008; p = 0.039, respectively). Feedback from the respondents was overall positive. Most of patients (92.7%) reported being happier and feeling more satisfied with their chest than before their operation. All respondents (100%) reported improvement in their gender dysphoria and would undergo the operation again. Patient dissatisfaction was significantly associated with longer time on preoperative hormones (p = 0.008) and had a trend toward association with higher implant volume (p = 0.083). Conclusions Breast augmentation in transwomen is safe and typically leads to high patient satisfaction with improvement of gender dysphoria. Larger, longer term studies are needed to appropriately delineate complication risks and contributing factors.
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Affiliation(s)
- Travis J Miller
- Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Stelios C Wilson
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, NY, United States
| | - Jonathan P Massie
- Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, United States
| | - Thomas Satterwhite
- Brownstein and Crane Surgical Services, San Francisco, CA, United States
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Ascha M, Swanson MA, Massie JP, Evans MW, Chambers C, Ginsberg BA, Gatherwright J, Satterwhite T, Morrison SD, Gougoutas AJ. Nonsurgical Management of Facial Masculinization and Feminization. Aesthet Surg J 2019; 39:NP123-NP137. [PMID: 30383180 DOI: 10.1093/asj/sjy253] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Transgender patients may seek nonsurgical methods for facial masculinization and feminization as an adjunct or alternative to undergoing surgical procedures. OBJECTIVES The authors reviewed the existing literature regarding this topic and provided an overview of nonsurgical techniques for facial masculinization and feminization. METHODS A comprehensive literature search of the PubMed and MedLine databases was conducted for studies published through December 2017 for techniques and outcomes of nonsurgical facial masculinization and feminization. Keywords were used in performing the search. Data on techniques, outcomes, complications, and patient satisfaction were collected. RESULTS Four articles fit our inclusion criteria. Given the lack of published literature describing facial injectables in transgender patients, data from the literature describing techniques in cisgender patients were utilized to supplement our review. CONCLUSIONS Facial feminization can be achieved through injectables such as neurotoxin and fillers for lateral brow elevation, lip augmentation, malar augmentation, and improvement of rhytids. Facial masculinization can be achieved with injectables used for genioplasty, jawline augmentation, and supraorbital ridge augmentation. One must develop best practices for these techniques in the transgender patient population and increase awareness regarding nonsurgical options. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Mona Ascha
- Division of Plastic Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Marco A Swanson
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jonathan P Massie
- Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Morgan W Evans
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Christopher Chambers
- Division of Oculoplastic Surgery, Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA
| | - Brian A Ginsberg
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Alexander J Gougoutas
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
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50
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Morrison SD, Satterwhite T. Lower Jaw Recontouring in Facial Gender-Affirming Surgery. Facial Plast Surg Clin North Am 2019; 27:233-242. [PMID: 30940389 DOI: 10.1016/j.fsc.2019.01.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Facial gender-affirming surgery can have significant impact on patient quality of life for some gender-dysphoric patients. Lower jaw contouring can be used to harmonize the face during facial gender-affirming surgery through masculinization or feminization. During feminization, the mandibular angle and body and chin are reduced in width and size. During masculinization, augmentation of the mandibular angle and body and chin are completed with alloplastic implants, fat, or bone. Complications are minimal. Further research is needed on outcomes of these procedures.
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Affiliation(s)
- Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, 325 9th Avenue Mailstop #359796, Seattle, WA 98104, USA.
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