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Miroslav L Djordjevic, Marko Bencic, Vladimir Kojovic, Borko Stojanovic, Marta Bizic, Sinisa Kojic, Zoran Krstic, Gradimir Korac
PURPOSE: Despite a variety of free flaps that have been described for creation of the neophallus in gender affirmation surgery, none present an ideal solution. We evaluated our patients and outcomes after gender affirmation phalloplasty using musculocutaneous latissimus dorsi free flap. METHODS: Between January 2007 and May 2017, 129 female transsexuals, aged 20-53 years (mean 24 years) underwent total phalloplasty using latissimus dorsi free flap. Urethral lengthening was performed by combining a vaginal flap, labia minora flaps and a clitoral skin flap...
January 23, 2019: World Journal of Urology
Miroslav L Djordjevic
The current management of female to male (FTM) gender confirmation surgery is based on the advances in neo phalloplasty, perioperative care and the knowledge of the female genital anatomy, as well as the changes that occur to this anatomy with preoperative hormonal changes in transgender population. Reconstruction of the neophallus is one of the most difficult elements in surgical treatment of female transsexuals. While there is a variety of available surgical techniques, their results are not equally acceptable to all patients...
August 2018: Translational Andrology and Urology
H Al-Hazmi, M Traby, F Al-Yami, A E Kattan, M M Al-Qattan
INTRODUCTION: Grade V post-circumcision penile injury is known as "total phallic loss". It is usually seen with the use of mono-polar electro-cautery for circumcision resulting in penile necrosis. We report on a newborn treated by release of the subcutaneous corporal remnant and explain why this option should be considered of choice in cautery-related Grade V injuries. REPORT OF A CASE: A 25-day old Saudi Arabian newborn with Grade V penile injury underwent reconstruction at our tertiary-care center...
2018: International Journal of Surgery Case Reports
Shane D Morrison, Jonathan P Massie, A Lee Dellon
INTRODUCTION:  Phalloplasty attempts to achieve a functional and aesthetic phallus. Sensation is a key component for sexual pleasure. Sensation is also important for protection in the setting of penile implant insertion. Little data are available on genital sensibility outcomes after phalloplasty, and there are no standardized approaches for assessment of either sensibility or erogenous perception. METHODS:  A literature search of PubMed, Google Scholar, and MEDLINE databases was conducted with terms related to genital sensibility after phalloplasty...
August 5, 2018: Journal of Reconstructive Microsurgery
Min Suk Jun, Slavica Pušica, Vladimir Kojovic, Marta Bizic, Borko Stojanovic, Zoran Krstic, Gradimir Korac, Miroslav L Djordjevic
OBJECTIVE: To present our technique of musculocutaneous latissimus dorsi (MLD) free-flap total phalloplasty. This technically demanding female-to-male gender reassignment surgery consists of creating a neophallus from extragenital tissue. METHODS: The presented technique included: removal of internal and/or external female genitalia, creation of neophallus using latissimus dorsi free flap, clitoral incorporation into the neophallus, urethral lengthening, and insertion of testicular implants into the newly created scrotum...
October 2018: Urology
Nick Esmonde, Rachel Bluebond-Langner, Jens U Berli
This article focuses on flap-related complications after creation of a neophallus for transgender individuals. It outlines the most frequently used flaps for this procedure and how flap-related complications can affect the overall outcome of the phalloplasty. With surgeons staging the procedure in different stages, it is important to understand the different strategies and the implication a flap-related complication can have on the end result and how it may be prevented.
July 2018: Clinics in Plastic Surgery
Ervin Kocjancic, Valerio Iacovelli
Phalloplasty represents the most complete genitoperineal transformation for trans men. Although voiding while standing is a priority for most trans men, most patients want to use the neophallus for sexual experience after they are accustomed to their new voiding abilities. Different techniques have been used to obtain rigidity in the neophallus, often resulting in complications and failure. Implantation of an erectile prosthesis remains the best option for achieving sexual intercourse in trans men. This article discusses the current state of art of penile prostheses in trans men, including a description of the prostheses, techniques for implantation, and complications...
July 2018: Clinics in Plastic Surgery
Lawrence J Gottlieb
The radial forearm free flap phalloplasty provides a thin, potentially sensate, minimally hair-bearing cutaneous flap. Since its initial description, several modifications of the technique have emerged. The earliest dimensions described needed to be increased because of the increase amount of subcutaneous fat in the Western population. Incorporating a centrally placed neo-urethra with a distal extension that gets folded over to create a semblance of a neoglans eliminates the distal/meatal stenosis. Performing a urethral extension at a preliminary surgery and extending the neourethra proximally has improved the position of the neophallus and minimized proximal urethral strictures and fistulas in transgender men...
July 2018: Clinics in Plastic Surgery
Tarryn Gabler, Robyn Charlton, Jerome Loveland, Ellen Mapunda
Congenital aphallia is a rare anomaly with little supporting literature and controversial management. The aim of this review is to assess the most recent literature with a focus on staged management of these cases. We performed a PubMed search of all English literature in the past 10 years using the term aphallia. Twenty-three articles were identified of which six were excluded. A further three papers meeting our criteria were found in the references to papers initially identified. We found that management can be staged in three phases: short, intermediate and long-term...
August 2018: Pediatric Surgery International
Geolani W Dy, Jeff Sun, Michael A Granieri, Lee C Zhao
PURPOSE OF REVIEW: A growing number of transgender patients are seeking gender-affirming genital reconstructive surgery (GRS). These complex procedures have high complication rates. We describe common surgical pitfalls in GRS and approaches for minimizing complications. RECENT FINDINGS: Penile inversion vaginoplasty has been associated with excellent cosmetic and functional outcomes. A robotic-assisted dissection may minimize risk of rectal injury. As a younger transgender population chooses pubertal suppression, alternative sources for lining the vaginal canal, such as enteric vaginoplasties, may be more widely utilized...
April 11, 2018: Current Urology Reports
Zhuming Yin, Liqiang Liu, Bingjian Xue, Jincai Fan, Wenlin Chen, Zheng Liu
INTRODUCTION: Prosthesis-assisted penile reconstruction has been performed extensively to restore a cosmetically acceptable phallus. However, a large number of patients will undergo revision surgery for various prosthesis-related complications. AIM: To develop a 1-stage prosthesis-free dynamic cavernosa reconstruction method using bilateral innervated gracilis muscles and to investigate the feasibility and reliability of the surgical design. METHODS: 10 fresh cadavers were dissected to assess the availability of bilateral gracilis muscles for functional cavernosa rebuilding...
June 2018: Sexual Medicine
Carlos A Medina, Lydia A Fein, Christopher J Salgado
INTRODUCTION AND HYPOTHESIS: For transgender men (TGM), gender-affirmation surgery (GAS) is often the final stage of their gender transition. GAS involves creating a neophallus, typically using tissue remote from the genital region, such as radial forearm free-flap phalloplasty. Essential to this process is vaginectomy. Complexity of vaginal fascial attachments, atrophy due to testosterone use, and need to preserve integrity of the vaginal epithelium for tissue rearrangement add to the intricacy of the procedure during GAS...
October 2018: International Urogynecology Journal
M Dennis, A Granger, A Ortiz, M Terrell, M Loukos, J Schober
In transgender surgery, the ideal neophallus is one that: (a) is constructed using a reproducible procedure, (b) possesses tactile and erogenous sensation, (c) is large and rigid enough (naturally, or using a prosthesis) to permit penetrative intercourse, (d) leaves acceptable donor site morbidity, (e) results in esthetically satisfactory appearance, and (f) allows for voiding while standing. The musculocutaneous latissimus dorsi (MLD) flap has favorable results in the area of neophalloplasty. Among its advantages are acceptable donor site appearance, stiffness sufficient for intercourse, and esthetically satisfactory genital appearance...
March 2018: Clinical Anatomy
Dylan Isaacson, Roxana Aghili, Non Wongwittavas, Maurice Garcia
BACKGROUND: In our practice we have encountered 4 female-to-male transgender patients seeking neophallus revision surgery for girth precluding penetrative vaginal or anal intercourse. Despite this, there is little evidence available to guide transitioning patients in neophallus sizing. In this work we examined the dimensions of bestselling realistic dildos, presuming that the most popular dimensions would reflect population preferences for penetrative toys and phalluses. AIM: To determine a maximal upper limit for girth compatible with penetrative intercourse based on measurements of bestselling realistic dildos and published erect penile dimensions...
November 2017: Journal of Sexual Medicine
Marco Falcone, Giulio Garaffa, Arianna Gillo, Dino Dente, Andrew N Christopher, David J Ralph
OBJECTIVES: To assess the oucomes of penile prosthesis (PP) implantation after total phallic reconstruction secondary to gender dysphoria. PATIENTS AND METHODS: We conducted a retrospective single-centre analysis of 247 consecutive patients. The recruitment period was January 2001 to October 2015. A total of 328 inflatable PPs were implanted. A two-staged inflatable PP implantation was carried out. As a first step, an extraperitoneal reservoir placement was performed simultaneously with the glans sculpture and the insertion of a single large testicular prosthesis into the labia majora...
January 2018: BJU International
Jordan D Frey, Grace Poudrier, Michael V Chiodo, Alexes Hazen
No abstract text is available yet for this article.
August 2017: Plastic and Reconstructive Surgery. Global Open
Lian Elfering, Mujde Özer, Marlon E Buncamper, Jan-Maerten Smit, Garry L S Pigot, Mark Bram Bouman, Margriet G Mullender
No abstract text is available yet for this article.
August 2017: Plastic and Reconstructive Surgery. Global Open
Selçuk Sarıkaya, David John Ralph
The neophallus creation is still a mystery and it remains challenging even today. In this article, we performed a comprehensive review of the literature regarding phalloplasty and penile reconstructive surgery between January 2008 and May 2016. In this review, we have included 15 research articles and the results of 276 patients were examined. Studies revealed several indications and when indications were reviewed, 191 patients were female-to-male transgender, 9 patients had disorder of sex development/micropenis, 16 had penile amputation/trauma, 9 had ambiguus genitalia, 40 had exstrophy and/or epispadias, 11 had other problems...
September 2017: Turkish Journal of Urology
William Watfa, Pietro G di Summa, Joaquim Meuli, Wassim Raffoul, Olivier Bauquis
BACKGROUND: Phalloplasty with the radial forearm free flap is associated with a large donor site defect. AIM: To compare two methods of donor site closure for functional and cosmetic long-term results: full-thickness skin grafting vs split-thickness skin grafting with MatriDerm. METHODS: Thirty-seven transgender patients had a neophallus created from a radial forearm free flap, and all were operated on by the same senior surgeon. Eight patients had their donor site defect closed by total skin grafting and 29 patients, operated on after 2009, received a split-thickness skin graft with MatriDerm closure...
October 2017: Journal of Sexual Medicine
Mona Ascha, Jonathan P Massie, Shane D Morrison, Curtis N Crane, Mang L Chen
PURPOSE: Phalloplasty is a critical step in female-to-male (transmale) gender confirming genital surgery. We examined outcomes between transmales who underwent phalloplasty with vaginectomy and full-length urethroplasty using the anterolateral thigh pedicled flap or the radial forearm free flap. MATERIALS AND METHODS: We performed a single center, retrospective study of patients who underwent phalloplasty with vaginectomy and full-length urethroplasty using an anterolateral thigh pedicled flap or a radial forearm free flap from April 2013 to July 2016...
January 2018: Journal of Urology
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