Genital Reconstruction Research Articles

Trauma, and Genital and Urethral Reconstruction.

No AccessJournal of UrologyUrological Survey1 Apr 2023Trauma, and Genital and Urethral Reconstruction Sean P. ElliottMD, MS Sean P. ElliottSean P. Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003165AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue 4April 2023Page: 799-801 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean P. Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...

Penile glans amputation and caverno-spongiosal disjunction following a dog bite: a case report

 Traumatic penile amputation is a rare surgical emergency. Successful surgical reimplantation is very challenging even in the hands of experience surgeons. We report the case of 13-year-old boy who presented with traumatic penile amputation with complete urethral section and caverno-spongiosal disjunction. This resulted from a dog bite injury which occurred 2 hours before consultation. Following primary and secondary surveys, the emergency management consisted of resuscitation, broad spectrum antibiotics and tubulisation of the sectioned urethra. Urethroplasty and subsequently a caverno-spongioplasty were then performed. The post-operative follow-up was uneventful and immunisation against rabies was done. Erection with the catheter in place was normal upon control. Patient was re-evaluated 8 years later and had a cosmetically acceptable penis and void with a good urinary stream. Microscopic penile reimplantation remains the gold standard though challenging and unavailable especially in resource limited settings. However, non-microscopic genital reconstruction is possible with satisfactory cosmetic and functional outcomes.

Trauma, and Genital and Urethral Reconstruction

No AccessJournal of UrologyUrological Survey15 Dec 2022Trauma, and Genital and Urethral Reconstruction Sean P. ElliottMD, MS Sean P. ElliottSean P. Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003107AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean P. Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...

Updates on feminizing genital affirmation surgery (vaginoplasty) techniques.

Vaginoplasty is a gender affirming surgery performed for transgender women who desire feminizing genital reconstruction. Over the last decade, access to surgical care has improved for patients, and vaginoplasty has been increasingly performed. Several vaginoplasty techniques exist, many of which are modifications of the traditional penile inversion vaginoplasty. In this paper, we review the penile inversion vaginoplasty, the intestinal segment vaginoplasty and the peritoneal flap vaginoplasty. An overview of the techniques employed to perform these procedures is provided, as well as an update on their published outcomes and complications.

Updates on metoidioplasty.

Metoidioplasty presents a variant of phalloplasty in transmen who require simple and safe genital gender affirmation surgery (GAS). The aim is to evaluate updates on the technique, as well as personal experience. The surgical steps of metoidioplasty are removal of the vagina, clitoral straightening and lengthening, urethral lengthening using available flaps and grafts, and creation of the scrotum with testicular prostheses implantation. The surgical goal is to achieve appearance of male genitalia, voiding in standing position, and full erogenous sensitivity. Modifications of the technique have developed due to recent advances in anatomy and new requests from transmen. Besides full metoidioplasty, other variants include metoidioplasty before, after or simultaneously with total phalloplasty. Each variant has its' own advantages, which must be discussed with the candidate preoperatively. A total of 938 transmen with the mean age of 29 years underwent one-stage metoidioplasty between January 2004 and January 2022. In majority of cases (65%) metoidioplasty was performed as a final option, and the length of the neophallus ranged between 4and 10 cm. Urethral complications occurred in 143 cases, dislocation and rejection of testicular implant in 55 and vaginal remnant in 92 cases. Voiding in standing position was reported in almost all cases (99%), and 12.5% of transmen requested phalloplasty after metoidioplasty. Metoidioplasty is a safe, one-stage procedure with good esthetic and functional outcomes. It includes a wide spectrum of variants that can be offered to transmen as a part of genital reconstruction, with goal of achieving patients' satisfaction.

Trauma, and Genital and Urethral Reconstruction.

No AccessJournal of UrologyUrological Survey1 Feb 2023Trauma, and Genital and Urethral Reconstruction Sean P. ElliottMD, MS Sean P. ElliottSean P. Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003066AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue 2February 2023Page: 436-438 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean P. Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...

Microsurgical Gender Affirmation Surgery.

Phalloplasty in the female to male transgender patient is a complex operation aimed at creating a functional and aesthetic phallus, external genitalia, and perineum. Functional goals include standing micturition and sexual function with erogenous and tactile sensation as well as the ability to participate in penetrative intercourse. Functional genital reconstruction relies on creating of a fully lengthened urethra from local tissues as well as the provision for additional length via tissue transplantation. This manuscript will review techniques for the creation of perineal urethral segment as well as primary flaps available for the creation of neophallus. Particular emphasis is given to our preferred method of reconstruction: single-stage urethral lengthening with radial forearm flap phalloplasty including a review of surgical techniques and complications.

Excision of pubic sarcome and complex genital reconstruction

Excision of pubic sarcome and complex genital reconstruction

An Overview of Gender-affirming Surgical Fellowships in the United States

PURPOSE: In recent years, there has been a significant increase in the awareness and demand of gender transition surgery. Surgical transition often occurs in specialized centers due to the involvement of a multidisciplinary team. Thus, residents may have limited clinical experience in gender transition and seek out fellowships. This study aims to assess the formation and characteristics of gender-affirming surgical fellowships in the United States. METHOD: A cross-sectional study was performed on all institutions with an accredited plastic surgery residency program in the United States. The official website for each program was reviewed for the presence of a gender transition fellowship. The authors then contacted program coordinators through email or telephone interview to collect data on the characteristics of the fellowship. RESULTS: The authors included 102 academic institutions in this study, less than half (n=48, 47%) were known as ‘Leader in LGBT Healthcare’ centers. Seven transgender fellowships were identified; however, data was only available for 6 fellowships. All fellowships (n=6) had a 12 month duration and the average stipend was $81,225. All offered training in masculinizing and feminizing chest reconstruction. Five provided training in both masculinizing and feminizing genital reconstruction (83%), whereas one fellowship provided training in neither. Strikingly, significantly more fellowships offered facial feminization training than facial masculinization (83% vs 33%, p<0.001). CONCLUSION: The creation of transgender surgery fellowships in plastic surgery reflects the growing demand for gender-affirming surgical training and provision. Although there is universal fellowship training in chest reconstruction, there are fewer learning opportunities for genital reconstruction and facial masculinization surgery.

Trauma, and Genital and Urethral Reconstruction.

No AccessJournal of UrologyUrological Survey1 Jan 2023Trauma, and Genital and Urethral Reconstruction Sean P. ElliottMD, MS Sean P. ElliottSean P. Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003029AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Trauma, and Genital and Urethral Reconstruction." The Journal of Urology, 209(1), pp. 288–289 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue 1January 2023Page: 288-289 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean P. Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...

Trauma, and Genital and Urethral Reconstruction.

No AccessJournal of UrologyUrological Survey1 Dec 2022Trauma, and Genital and Urethral Reconstruction Sean P. ElliottMD, MS Sean P. ElliottSean P. Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002982AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Trauma, and Genital and Urethral Reconstruction." The Journal of Urology, 208(6), pp. 1339–1340 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 208Issue 6December 2022Page: 1339-1340 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean P. Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...

Process Switching and Its Meaning towards Transgender Identity: An SFL Perspective

&lt;div class="WordSection1"&gt;&lt;p&gt;This SFL study attempts to scrutinise the process-type switching and its underlying meanings in the cyber-based interactive responses towards an issue of transgender. The issue is confined to the suspected genital reconstruction surgery of an Indonesian celebrity that becomes viral and triggers public debate on social media. 254 Indonesian clauses of interactive comments addressing the issue of transgender identity on a YouTube video of more than 2 million views were analysed. Prompting and replying responses were investigated for their categorization of process types by employing the tables of analysis adapted from the experiential meaning framework of Halliday and Matthiessen (2004). The analysis reveals some occurrences of process type switching in the interactive responses among responders in addressing the Indonesian sensitive and viral issue of transgender identity. In responding to the prompting comments, responders tended to employ relational and material clauses to establish values, evidences, and impacts in objective ways while they also used mental and verbal processes to affect one another in subjective ways. This Hallidayan study hints that the process switching among responders in addressing the issue of transgender is associated with the strategies for maintaining and spreading their ideology by confirming, strengthening, adding, and even arguing.&lt;/p&gt;&lt;/div&gt;

Genital Reconstruction following Fournier's Gangrene.

Fournier's gangrene is a urological emergency, comprising of type I necrotizing fasciitis resulting in anatomic defects affecting the perineum, perianal region, and external genitalia in both men and women, often requiring reconstruction. The aim of this article is to provide a comprehensive review of the different reconstructive techniques for Fournier's gangrene. A literature search was performed on PubMed with the search terms "Fournier"s gangrene" "genital reconstruction" and "Fournier's gangrene phalloplasty." The European Association of Urology's guidelines on Urological infections were also consulted for recommendations. Reconstructive procedures include primary closure, scrotal advancement flaps, fasciocutaneous flaps, myocutaneous flaps, skin grafts, and phalloplasty. There is insufficient evidence to support that flaps lead to better outcomes than skin grafts, or vice versa, particularly for scrotal defects. Both techniques have been shown to have satisfactory aesthetic results, with good skin color match and natural scrotal contour. With regards to phalloplasty, there is a lack of data specifically relating to Fournier's gangrene, as most articles were addressed toward gender affirmation surgery. Furthermore, there is a lack of guidelines in both the immediate and reconstructive management of Fournier's gangrene. Lastly, the outcomes reported following reconstructive surgery have been objective rather than subjective, meaning that patient satisfaction was rarely recorded. Further research is required in the field of reconstructive surgery specific to Fournier's gangrene, which should also take into consideration patient demographics and subjective reports regarding cosmesis and sexual function.

Trauma, and Genital and Urethral Reconstruction.

Trauma, and Genital and Urethral Reconstruction.

Trauma, and Genital and Urethral Reconstruction.

No AccessJournal of UrologyUrological Survey1 Oct 2022Trauma, and Genital and Urethral Reconstruction Sean P. ElliottMD, MS Sean P. ElliottSean P. Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002874AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Trauma, and Genital and Urethral Reconstruction." The Journal of Urology, 208(4), pp. 923–924 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 208Issue 4October 2022Page: 923-924 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean P. Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...

Bilateral Pudendal Thigh Flap In The Creation of A Neovagina and Restoration of Utero-Neovaginal Continuity – A Case Report

The pudendal thigh flap is a sensate flap based on the posterior labial artery, which has shown great versatility in the reconstruction of genital anomalies as well as genital oncologic reconstruction. This report showcases the creation of a neovagina with the restoration of uterovaginal continuity in a 12-year-old girl who had vaginal atresia. She presented with concealed menstruation and cyclical abdominal pain and had a creation of a neovagina with utero-vaginal continuity using a bilateral pudendal thigh fascio-cutaneous flap. Post-operatively, she attained normal menstrual flow and a sensate neovagina with a satisfactory vaginal canal depth. Partial wound dehiscence of the flap donor site was managed with dressing and healing by secondary intention. Even in new centres, the pudendal thigh flap remains a versatile flap for managing vaginal atresia.

Modern approaches to the management of gender dysphoria from endocrinologist`s viewpoint: clinical case

Providing medical care to people with gender dysphoria is a complex multidisciplinary task, the success of which is determined by the close cooperation of specialists qualified in helping such patients, such as a psychiatrist, endocrinologist, and surgeon. In addition to diagnostic testing, patients with gender dysphoria require psychotherapy or psychological counseling, hormone replacement therapy, and, if necessary, gender confirmation surgery. Before prescribing hormone therapy, it is necessary to make sure that the patient meets the criteria for the diagnosis of gender dysphoria, to be sure that the patient’s desire to change gender is justified, all the consequences of therapy, including possible physical changes and the timing of their occurrence, are explained. Genital reconstruction procedures are possible only after at least one year of hormone therapy and life in the role of the chosen gender. The algorithms of medical care for persons with gender dysphoria developed to date describe in detail the mechanism of gender reassignment, the contribution of various specialists to this process, as well as possible risks and methods for their prevention. Only careful observance of the stages of diagnosis and treatment without violating their sequence can lead to the successful achievement of the result. while any deviations from the algorithms, due to objective and subjective reasons, entail serious life-threatening consequences, which is clearly demonstrated in the clinical cases presented in this article.

Trauma, and Genital and Urethral Reconstruction.

No AccessJournal of UrologyUrological Survey1 Sep 2022Trauma, and Genital and Urethral Reconstruction Sean P. ElliottMD, MS Sean P. ElliottSean P. Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002817AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Trauma, and Genital and Urethral Reconstruction." The Journal of Urology, 208(3), pp. 727–728 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 208Issue 3September 2022Page: 727-728 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean P. Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...

Gluteal Fold V-Y Advancement Flap for Genital Reconstruction following Radical Vulvectomy with Bilateral Inguinofemoral Lymphadenectomy in Vulvar Cancer: A Case Report

Background: Vulvar cancer is a rare malignancy representing about 4% of all genital cancers in women. Historically, the gold standard for treatment of squamous cell carcinoma of the vulva was en bloc radical vulvectomy with bilateral inguinofemoral lymphadenectomy. For the reconstruction the options are primary closure, skin grafts, or local and distant flaps. In this case we used the gluteal fold fasciocutaneous V-Y advancement flap that is sensate and thin with a reliable blood supply, can be advanced easily, and can be performed in a single-stage procedure. Care Report: We present a clinical case of an 82- year old female patient who had an exophytic vulvar lesion, which grew progressively with the histopathologic diagnosis of invasive vulvar squamous cell carcinoma. It was decided to perform radical vulvectomy with right unilateral lymphadenectomy and reconstruction with Gluteal Fold V-Y Advancement Flap. During the post-surgical period it recurred with wound dehiscence and finally skin necrosis developed in the area of the left thigh. Surgical debridement, escharectomy, harvesting and application of skin graft, and closure of the femoral hernia with omentum patch were performed with no associated complications. Follow-up was carried out during the next 3 months after surgery. She presented adequate evolution of the flap and left thigh area. Conclusions: The Gluteal Fold V-Y Advancement Flap is an excellent option for the reconstruction of the vulvovaginoperineal area after a radical vulvectomy. It provides us with a good prognosis and quality of life for the patient. Article Details Issue

Gluteal Fold V-Y Advancement Flap for Genital Reconstruction following Radical Vulvectomy with Bilateral Inguinofemoral Lymphadenectomy in Vulvar Cancer: A Case Report

Gluteal Fold V-Y Advancement Flap for Genital Reconstruction following Radical Vulvectomy with Bilateral Inguinofemoral Lymphadenectomy in Vulvar Cancer: A Case Report