Gender reassignment surgery - a 13 year review of surgical outcomes. The aim of this "Transsexual surgery results" is to thoroughly report on surgical outcomes from patients who underwent male to female gender reassignment surgery GRS.
Records from patients who underwent GRS from to were reviewed. All patients were submitted to penile inversion vaginoplasty with glans-derived sensate clitoroplasty. Mean Transsexual surgery results was Surgical complications were stratified in 6 main groups: Regarding male to female GRS, a review of the current literature demonstrated scarce description of complications and their treatment options.
Transsexual surgery results These findings motivated a review of our surgical outcomes. Results showed a great number of adverse events, although Transsexual surgery results preserved. Comparision of our outcomes with recent publications additionally showed that treatment options provide satisfying results.
Moreover, outcomes reaffirm penile inversion vaginoplasty in combination with glans-derived sensate clitoroplasty as a safe technique. Nevertheless, discussing and improving surgical techniques in order to reduce complications and their influence on patient's quality of life is still strongly necessary and theme of our future reports. Transsexualism; Sex Reassignment Surgery; Outcomes.
Treatment of gender identity disorders has been controversial throughout its existence. After its first public description by Magnus Hirschfeld who coined the term 'transsexualismus' mentioning the 'seelischer Transsexualismus' [psychic Transsexualism], this entity has gone through enormous advances regarding its standard of care and surgical procedures 1.
Recent publications have been able to show technical improvements and great attention has been given to surgical outcomes and their influence on patient's quality of life Nevertheless, detailed description of individual technique, its complications as well as treatment options is still missing 8. Later on, Transsexual surgery results review of cases and their complications signalized the need for further and extensive analysis of surgical outcomes in our department Here we report on patients who underwent male to female penile inversion vaginoplasty with glans-derived sensate clitoroplasty in the urological department of the University of Essen - Germany.
A thorough description of adverse events related to surgery and their "Transsexual surgery results" options is provided. Attempts were made on reviewing existing literature and comparing them with our results, leading to frustrating data due to scarce information. Nevertheless, absence of data has encouraged us on writing, opening a precedent for future publications. A list of patients, mean age Analysis was Transsexual surgery results by a standardized method of data collection.
Available records were reviewed, case-notes were retrieved and analysed to identify epidemiological data. Early results during outpatient consultations and late events were also included. Information was collected from two distinct investigators from June to October Technique modifications introduced at the end of excluded patients operated thereafter from the actual study, avoiding bias on the end results. A total of patients were included. All Transsexual surgery results and relevant notes were reviewed, thoroughly analysed and results Transsexual surgery results both investigators were compared.
No significant disparity was found on retrieved data. The main goal was to identify the adverse events related to surgery and to describe their treatment options. Results were presented separately and comments were done to the main findings.
Indication for transgender Transsexual surgery results was based on psychological evaluation generating two medical reports from two different psychiatrists, defining surgery as the treatment of choice for all patients.
Hormonal therapy with estrogens and anti-androgens for at least 6 months as well as a social integration period of one year were obligatory conditions preceding surgery. Written informed consent was obtained from all patients as well as permission to publish picture data. Bowel preparation proceeded 2 days before surgery using osmotic solutions. Penile inversion vaginoplasty and glans-derived sensate clitoroplasty were the techniques of choice for all patients included and were done in a standardized technique.
A total of two planed settings resume surgical procedure, being the second directed to aesthetical and sometimes functional adjustments. After positioning of the patient and disinfection of surgical area, a 1 meter iodine embalmed tampon is introduced in the rectum used as guide during construction of the neovaginal space. Superficial dissection of scrotal skin is performed and the collected tissue conserved in saline medium in case of using it as free skin flap.
Bilateral orchiectomy is done followed by closure of the external inguinal ring. The base of the penis is laterally dissected apart from scrotal fat, which will be used to build the labia majora bilaterally. Penile skin is blunt dissected from the body after circular dissection about 0. After identification of the neurovascular bundle NVBlateral cauterization and incision along Buck's fascia from the penis base up to sulcus coronarius is performed Figure The NVB is ventrally dissected and separated from the corpora cavernosa following dismembering of the urethra from the corpora.
The corpora are dissected to their base, separated and resected after ligature at the level of the crura.
After positioning of lateral retractors exposing the bulbar urethra, the centrum tendineum is identified and dissected reaching Denovillier's fascia.
The urethra is carefully pulled upwards, retracting its bulbar portion, facilitating further dissection Figure The bladder is emptied to avoid possible lesions. Blunt dissection of neovaginal space with a Simon's retractor is performed.
Preparation is terminated when a depth over 14 cm is achieved. Identification of right anatomic layers, avoiding injuries the urethra, prostate, seminal vesicles, sphincter and bladder Transsexual surgery results essential.
After its distal closure, the phallic cylinder is stabilized with a vaginal stent inflatable silicone prosthesis-Coloplast TM and placed inside the cavity. The position of the clitoris and urethra are defined and a longitudinal incision is made in order to exteriorise both segments. Glans-derived sensate clitoroplasty is then performed. The long NVB is now positioned subcutaneously Transsexual surgery results the groin. The corpus spongiosum is on its ventral side in its extension resected, preventing further swelling during sexual stimulation.
The meatal orifice is incised on the 6 and 12 hour positions after resection of urethra to skin level and implanted with inverted sutures at skin limits. Finally, the phallic cylinder is placed in the vaginal space after superficial spraying of 2 mL fibrin glue Tissucol - Baxter Deutschland GmbH.
Two suction drains are positioned along the labia majora and adaptation of the subcutaneous and skin layers is done.
A suprapubic catheter is placed and compressive dressings applied. Wound inspection is made every two days until dismissal.