Anatomical implications of sex reassignment surgery in male-to-female transsexualism and follow-up study
Authors:
Ladislav Jarolím 1; Jiří Šedý 2; Marek Schmidt 1; Jan Jerie 1; Kateřina; Bartoníčková 1; Matúš Chocholatý 1
Authors place of work:
Urologická klinika 2. LF UK a FN Motol
Praha
1; Ústav experimentální medicíny AV ČR
v. v. i., Praha
2
Published in the journal:
Ces Urol 2010; 14(1): 55-63
Category:
Original article
Summary
Aim:
Greater acceptance of sexual minorities has enabled people with transsexualism access to adequate treatment and social integration. Gender reassignment surgery is a part of the complex care of transsexual patients. In response to a greater volume of patients, surgical techniques have evolved and the outcome in patients with male-to-female transsexualism has become very similar imitation of female genitalia, enabling sexual intercourse with orgasm. The aim of this retrospective study was to evaluate the results of surgical reassignment of genitalia in male-to-female transsexuals.
Material and methods:
The surgical techniques are described in detail. We performed a 3 month follow-up study of patients’ opinions following gender reassignment surgery in 136 patients having a primary procedure (8 of whom had later sigmoideocolpoplasty) and 5 patients undergoing sigmoideocolpoplasty following an initial unsuccessful procedure at other units.
Results:
All patients were satisfied with the first phase operation. Thirteen patients (9.2%) underwent successful sigmoideocolpoplasty. Main complications were as follows: rectal lesions developing during preparation of the vaginal canal (1.4%); bleeding from the stump of the shortened urethra in the first 48 hours postoperatively requiring secondary suturing (4.3%); temporary urinary retention requiring repeated insertion of urinary catheters for up to 6 days (5%); and healing of the suture between the perineum and the posterior aspect of the vaginal introitus healing by secondary intention (5%). The neoclitoris had erogenous sensitivity in 94,3% of patients and 67,6% reached orgasm in first 3 months.
Conclusion:
In conclusion, surgical conversion of the genitalia is a safe and important phase of the treatment of male-to-female transsexuals.
Key words:
anatomy, male-to-female transsexualism, sex reassignment surgery.
Zdroje
1. Sohn M, Bosinski HA. Gender identity disorders: diagnostic and surgical aspects. J Sex Med 2007; 4: 1193–1120.
2. Fifková H, Weis P, Procházka I, Cohen Kettenis PT, Pfäfflin F, Jarolím L, Veselý J, Weis V. Transsexualism. 2. vydání. Praha: Grada Publishing, 2008, 202 s.
3. Fang RH, Chen CF, Ma S. A new method for clitoridoplasty in male-to-female sex reassignment surgery. Plast Reconstr Surg 1992; 89: 679–682.
4. Rehman J, Melman A. Formation of neoclitoris from glans penis by reduction glansplasty with preservation of neurovascular bundle in male-to-female gender surgery: functional and cosmetic outcome. J Urol 1999; 161: 200–206.
5. Šedý J, Naňka O, Belišová M, Walro JM, Jarolím L. Sulcus nervi dorsalis penis/ clitoridis: anatomical structure and clinical significance. Eur Urol 2006; 50: 1079– 1085.
6. Šedý J, Naňka O, Špačková J, Jarolím, L. Clinical implications of a close vicinity of nervus dorsalis penis/clitoridis and os pubis. J Sex Med 2008; 5: 1572–1581.
7. Jarolím L. Surgical conversion of genitalia in transsexual patients. BJU Internat 2000; 85: 851–856.
8. Freitas Filho LG, Carnevale J, Mělo CE, Laks M, Miranda EG. Sigmoid reconfigured vaginal construction in children. J Urol 2001; 166: 1426–1428.
9. Jayaram BN. Complications and undesirable results of sex-reasignment surgery in male-to-female transsexuals. Arch Sex Behav 1978; 7: 337–345.
10. Lawrence AA. Patient-reported complications and functional outcomes of male-tofemale sex reassignment surgery. Arch Sex Behav 2006; 35: 717–727.
11. Hoebeke P, Selvaggi G, Ceulemans P, De Cuypere G, T‘Sjoen G, Weyers S, Decaestecker K, Monstrey S. Impact of sex reassignment surgery on lower urinary tract function. Eur Urol 2005; 47: 398–402.
12. Stein M, Tiefer L, Melman A. Followup observations of operated male-to-female transsexuals. J Urol 1990; 143: 1188–1192.
13. Liguori G, Trombetta C, Buttazzi L, Belgrano E. Acute peritonitis due to introital stenosis and perforation of a bowel neovagina in a transsexual. Obstet Gynecol 2001; 97: 828–829.
14. Sukumaran S, Moran PA, Makar A. An unusual cause of vaginal discharge following gender reassignment. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20: 253– 254.
15. Jarolím L. Surgical conversion of genitalia in transsexual patients. BJU Internat 2000; 85: 851–856.
16. Jarolím L. Surgical treatment of transsexualism. Andrologie 2000; 1: 30–37.
17. Jarolím L, Teršípová L, Rejchrt M, Schmidt M, Kaliská K, Pročková M, Bartoníčková K, Hanek P, Šedý J, Naňka O. Transsexualizmus a chirurgická konverze pohlaví. Urol Listy 2006; 4: 36–42.
18. Freitas Filho LG, Carnevale J, Mělo CE, Laks M, Miranda EG. Sigmoid reconfigured vaginal construction in children. J Urol 2001; 166: 1426–1428.
19. Jarolím L. Surgical conversion of genitalia in transsexuals. Rozhl Chir 1998; 77: 487–492.
20. Jayaram BN. Complications and undesirable results of sex-reasignment surgery in male-to-female transsexuals. Arch Sex Behav 1978; 7: 337–345.
21. Lawrence AA. Patient-reported complications and functional outcomes of male-tofemale sex reassignment surgery. Arch Sex Behav 2006; 35: 717–727.
22. Hoebeke P, Selvaggi G, Ceulemans P, De Cuypere G, T‘Sjoen G, Weyers S, Decaestecker K, Monstrey S. Impact of sex reassignment surgery on lower urinary tract function. Eur Urol 2005; 47: 398–402.
23. Stein M, Tiefer L, Melman A. Followup observations of operated male-to-female transsexuals. J Urol 1990; 143: 1188–1192.
24. Liguori G, Trombetta C, Buttazzi L, Belgrano E. Acute peritonitis due to introital stenosis and perforation of a bowel neovagina in a transsexual. Obstet Gynecol 2001; 97: 828–829.
25. Stanojevic DS, Djordjevic ML, Milosevic A, Sansalone S, Slavkovic Z, Ducic S, Vujovic S, Perovic SV, Belgrade Gender Dysphoria Team. Sacrospinous ligament fixation for neovaginal prolapse prevention in male-to-female surgery. Urology 2007; 70: 767–771.
26. Corman V, Legros JJ. Hormonal treatment in transsexual patients. Metabolic consequences. Ann Endocrinol (Paris) 2007; 68: 258–264.
27. Brown JA, Wilson TM. Benign prostatic hyperplasia requiring transurethral resection of prostate in a 60-year-old male-to-female transsexual. Br J Urol 1997; 80: 956–957.
28. Thurston AV. Carcinoma of the prostate in a transsexual. Br J Urol 1994; 73: 217.
29. Van Harst EP, Newling,DWW, Gooren LJG, Asscheman H, Pregner DM. Metastatic prostatic carcinoma in a male-to-female transsexual. Br J Urol 1998; 81: 776.
Štítky
Paediatric urologist Nephrology UrologyČlánok vyšiel v časopise
Czech Urology
2010 Číslo 1
Najčítanejšie v tomto čísle
- Aggressive prostate cancer in patients with low PSA
- Anatomical implications of sex reassignment surgery in male-to-female transsexualism and follow-up study
- Laparoscopic nephropexis – technique with three non-absorbable stitches
- Prostate cancer incidence, diagnostic and treatment in HIV-positive patients