V10-01 NOVEL VAGINOPLASTY TECHNIQUE: INVERSION OF PENILE SKIN AND USE OF SCROTAL GRAFT WITHOUT SACROSPINAL FIXATION

Abstract

You have accessJournal of UrologyFemale Pelvic Medicine1 Apr 2018V10-01 NOVEL VAGINOPLASTY TECHNIQUE: INVERSION OF PENILE SKIN AND USE OF SCROTAL GRAFT WITHOUT SACROSPINAL FIXATION Ervin Kocjancic, Hari Vigneswaran, Laurel Sofer, Jorge Jaunarena, David Whitehead, Luca Morgantini, and Loren Schechter Ervin KocjancicErvin Kocjancic More articles by this author , Hari VigneswaranHari Vigneswaran More articles by this author , Laurel SoferLaurel Sofer More articles by this author , Jorge JaunarenaJorge Jaunarena More articles by this author , David WhiteheadDavid Whitehead More articles by this author , Luca MorgantiniLuca Morgantini More articles by this author , and Loren SchechterLoren Schechter More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2657AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The current gold standard in vaginoplasty for gender confirmation is the penile skin inversion technique. The three main challenges of this surgery are: maximal vaginal length, prevention of neovaginal prolapse and optimal cosmetic appearance. We present this video is to show our technique for vaginoplasty using scrotal graft and a modified dissection that prevents neovaginal prolapse, avoiding sacrospinal fixation. METHODS The patient was prepped in lithotomy position. A full–thickness skin graft was harvested from the scrotum, encapsulated, defatted, and sutured over a vaginal dilator. Scroto-perineal flap and penile flaps were designed and elevated, and the penis was degloved. Bilateral orchiectomy was performed. The vaginal cavity was then created using both blunt and sharp dissection with the aid of the Lowsley retractor allowing to fit a 15 x 4cm vaginal dilator. The neoclitoris was fashioned from the dorsal glans penis and dissected on the dorsal neurovascular pedicle incorporating Buck's fascia. The bulbospongiosus and ischiocavernosus muscles were resected, and the corpus spongiosum was separated from the corpora cavernosa, completely dissecting the latter. The spongiosa from the urethral bulb was then resected. Neurovascular bundle of glans was plicated and then sutured to the rectus fascia. The urethra was shortened and spatulated ventrally to create a neomeatus. The penile skin flap was then sutured to the scrotal perineal flap in a layered fashion. The scrotal skin graft was sutured to the penile flap with multiple W-plasties. The distal portion of the urethra is then used to create the vestibulum. An incision was made in this portion of the urethral plate to expose the neoclitoris. Two penrose drains were placed in the vagina. The labia majora were then closed in a layered fashion. The vagina was packed with two Sulfamylon–soaked vaginal packs and lubricating jelly. RESULTS The case took 360 minutes. EBL was 200 mL. Vaginal packing was removed on day 5, and patient was discharged on day 6. Final vaginal length was 13cm.Out of our 46 cases in the last two years, only one morbidly obese patient experienced a degree of neovaginal prolapse. CONCLUSIONS The combination of perineal flap and scrotal graft allows for a significant lengthening of the neovaginal cavity.The extended dissection of the recto-prostatic space, up to the level of the pouch of Douglas, allows for omission of sacrospinal fixation, thus reducing the risk of damage to the pudendal neurovascular bundle. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1072 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Ervin Kocjancic More articles by this author Hari Vigneswaran More articles by this author Laurel Sofer More articles by this author Jorge Jaunarena More articles by this author David Whitehead More articles by this author Luca Morgantini More articles by this author Loren Schechter More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...