Department of Urology, University of Tuebingen, Tuebingen, Germany.
Eur Urol. 2013 Jul;64(1):141-9. doi: 10.1016/j.eururo.2012.12.030. Epub 2013 Jan 5.
The primary challenge of male-to-female reassignment surgery is to create natural-appearing female genitalia with neovaginal dimensions adequate for intercourse, neoclitoris sensitivity, and minimal risk of complications. Surgical positioning is an important component of the procedure that successfully minimizes the risk of morbidity.
We modified various vaginoplasty techniques to better position the urethral neomeatus in the proper anatomic location to minimize the chance for complications and enhance aesthetic satisfaction.
DESIGN, SETTING, AND PARTICIPANTS: We retrospectively reviewed data stored in a prospective database for 24 consecutive patients who underwent male-to-female gender reassignment at a German university clinic between January 2007 and March 2011.
First, orchiectomy and penile disassembly are performed with the patient in the supine position. Both corpora cavernosa are resected with the patient in the lithotomy position, and neovaginal construction is accomplished with the incorporation of the penile urethra into the penile shaft skin. The glans is preserved and resized to form the neoclitoris. The assembled neovagina is inverted, inserted into the expanded rectoprostatic space, and secured to the sacrospinous ligament. Scrotal skin is tailored to create the labia.
Complications and patient satisfaction with neovaginal depth, appearance, neoclitoral sensation, and capacity for sexual intercourse were evaluated.
The mean neovaginal depth was 11cm (range: 10-14cm); median follow-up was 39.7 mo (range: 19-69 mo). All patients reported satisfactory vaginal functionality. One patient noted stenosis after 4 yr that was histologically confirmed as lichen sclerosus. Neoclitoral sensation was good or excellent in 97% of patients; 33% reported regular intercourse. No major complications were observed. Because this is a retrospective review to describe a complex reconstructive surgery and illustrate these techniques in the accompanying intraoperative surgery-in-motion video, no control group was undertaken.
Gender reassignment can be performed with minimal complications using penile skin with incorporated penile urethra and intraoperative repositioning of the patient to achieve adequate neovaginal dimensions for intercourse and neoclitoral sensation.
男性向女性转变手术的主要挑战是创建具有足够阴道尺寸的自然外观的女性生殖器官，以进行性交、拥有足够的阴蒂敏感度，并将并发症风险最小化。手术定位是该手术成功降低发病率的重要组成部分。
我们对各种阴道成形术技术进行了修改，以更好地将尿道新尿道口定位在适当的解剖位置，从而最大程度地降低并发症发生的机会并提高美学满意度。
设计、环境和参与者：我们回顾性地分析了 2007 年 1 月至 2011 年 3 月在德国一家大学诊所接受男性向女性性别转变的 24 例连续患者的数据，这些数据存储在一个前瞻性数据库中。
首先，患者仰卧位进行睾丸切除术和阴茎拆卸。患者处于截石位时切除两个海绵体，然后将阴茎尿道与阴茎海绵体皮肤结合起来构建新阴道。保留并调整龟头以形成新的阴蒂。组装好的新阴道被翻转，插入扩大的直肠前列腺间隙，并固定到骶棘韧带。对阴囊皮肤进行剪裁，以形成阴唇。
评估了新阴道的深度、外观、阴蒂感觉、性交能力以及并发症和患者满意度。
平均新阴道深度为 11cm（范围：10-14cm）；中位随访时间为 39.7 个月（范围：19-69 个月）。所有患者均报告阴道功能满意。1 例患者在 4 年后出现狭窄，组织学证实为硬化性苔藓。97%的患者阴蒂感觉良好或极佳；33%的患者有规律的性生活。未观察到重大并发症。由于这是一项回顾性综述，旨在描述复杂的重建手术，并在随附的术中手术移动视频中展示这些技术，因此未进行对照组。
使用带有内置阴茎尿道的阴茎皮肤和术中重新定位患者的方法，可将并发症最小化，从而实现足够的阴道尺寸进行性交和阴蒂感觉，同时进行性别重置。
