103 TRANSSEXUAL GENITAL SURGERY: COMPLICATIONS AND FUNCTIONAL RESULTS AFTER 13 YEARS OF EXPERIENCE

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery (II)1 Apr 2013103 TRANSSEXUAL GENITAL SURGERY: COMPLICATIONS AND FUNCTIONAL RESULTS AFTER 13 YEARS OF EXPERIENCE Maria Helena Sircili, Francisco Tibor Dénes, Alessandro Tavares, Elaine Maria Frade Costa, Sorahia Domenice, Flávia Siqueira Cunha, Miguel Srougi, and Berenice Mendonça Maria Helena SirciliMaria Helena Sircili São Paulo, Brazil More articles by this author , Francisco Tibor DénesFrancisco Tibor Dénes São Paulo, Brazil More articles by this author , Alessandro TavaresAlessandro Tavares São Paulo, Brazil More articles by this author , Elaine Maria Frade CostaElaine Maria Frade Costa São Paulo, Brazil More articles by this author , Sorahia DomeniceSorahia Domenice São Paulo, Brazil More articles by this author , Flávia Siqueira CunhaFlávia Siqueira Cunha São Paulo, Brazil More articles by this author , Miguel SrougiMiguel Srougi São Paulo, Brazil More articles by this author , and Berenice MendonçaBerenice Mendonça São Paulo, Brazil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1481AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Due to continuous increase in the number of transsexual patients requiring genital reconstruction, the surgeons involved in sex reassignment should be prepared to perform the best technique and to deal with the complications of the procedures. Our aim is to present our results after 13 years of experience. METHODS From 1999 to 2012, 70 patients were submitted to sex reassignment [50 male (MT) and 20 female transsexuals (FT)], with average age of 35ys (23-68ys). All patients had confirmed psychiatric diagnosis and underwent psychological therapy for at least 2 years. All had hormonal replacement under endocrinological supervision. The techniques used were penile inversion to create the neovagina for MT and panhysterectomy with colpectomy followed by metoidioplasty in two staged procedure for FT. The mean follow-up was 6.5ys (1-12ys). RESULTS After male-to-female procedure, physical examination showed normal female appearance in all patients. The mean penile length before surgery was10.6 (9-15) and the neovaginal length was 8.8cm (5-12cm). Four patients had loss of the neovagina, due to hematoma in one and total vaginal prolapse with recto-vaginal fistula in 3. Six patients had urethral meatus stenosis. Five patients had partial vaginal prolapse, corrected by laparoscopy in one and by suprapubic suspension in 3. One patient had the glans removed because of prolapse to the labia majora. One patient had a compartmental syndrome in the left leg, treated with fasciotomy. The overall complication rate was 40% and reoperation was necessary in 20 patients, being more frequent in the first 20 patients (45% x 30%). After all procedures, 40 patients had normal sexual intercourse, 3 reported no desire for relationship, 4 had recent surgery and 3 are schedule for reoperation. The average number of procedures in the FT group was 3 (1-4). Twelve patients completed masculinization, and the length of the phallus was 5cm (4.8 to 5.5cm). Despite limited penile size, sexual satisfaction is achieved in all patients. Urethral stenosis occurred in 2 patients, and was treated by dilatation. CONCLUSIONS The surgery in MT is a single stage procedure with high rate of complications, but most patients have sexual intercourse with sensibility and orgasm. Surgery in FT is a staged procedure with a low rate of complications. Despite sexual satisfaction, penetration is limited by phallic length. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e41 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maria Helena Sircili São Paulo, Brazil More articles by this author Francisco Tibor Dénes São Paulo, Brazil More articles by this author Alessandro Tavares São Paulo, Brazil More articles by this author Elaine Maria Frade Costa São Paulo, Brazil More articles by this author Sorahia Domenice São Paulo, Brazil More articles by this author Flávia Siqueira Cunha São Paulo, Brazil More articles by this author Miguel Srougi São Paulo, Brazil More articles by this author Berenice Mendonça São Paulo, Brazil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...