Dy Geolani W, Sun Jeff, Granieri Michael A, Zhao Lee C
Department of Urology, University of Washington School of Medicine, Seattle, WA, USA.
Department of Urology, New York University, 150 East 32nd Street, 2nd Floor, New York, NY, 10016, USA.
Curr Urol Rep. 2018 Apr 11;19(6):36. doi: 10.1007/s11934-018-0795-y.
A growing number of transgender patients are seeking gender-affirming genital reconstructive surgery (GRS). These complex procedures have high complication rates. We describe common surgical pitfalls in GRS and approaches for minimizing complications.
Penile inversion vaginoplasty has been associated with excellent cosmetic and functional outcomes. A robotic-assisted dissection may minimize risk of rectal injury. As a younger transgender population chooses pubertal suppression, alternative sources for lining the vaginal canal, such as enteric vaginoplasties, may be more widely utilized. Since adoption of microvascular techniques in phalloplasty, transmasculine individuals have potential for a sensate neophallus and penetrative intercourse. Urethral complications are common and challenging to manage; techniques using flap coverage may minimize ischemia-related strictures. Innovations in prosthesis placement require adaptations to neophallus anatomy. A growing number of transgender individuals are seeking genital reconstruction. Ongoing innovation in surgical technique is needed to improve patient outcomes.
越来越多的跨性别患者正在寻求性别确认性生殖器重建手术（GRS）。这些复杂手术的并发症发生率很高。我们描述了GRS中常见的手术失误以及将并发症降至最低的方法。
阴茎翻转阴道成形术具有出色的美容和功能效果。机器人辅助解剖可将直肠损伤风险降至最低。随着越来越年轻的跨性别群体选择青春期抑制，用于阴道内衬的替代来源，如肠道阴道成形术，可能会得到更广泛的应用。自从在阴茎成形术中采用微血管技术以来，男性化的跨性别者有可能拥有有感觉的新阴茎并进行插入式性交。尿道并发症很常见且处理起来具有挑战性；使用皮瓣覆盖的技术可将缺血相关狭窄降至最低。假体植入的创新需要适应新阴茎的解剖结构。越来越多的跨性别者正在寻求生殖器重建。需要持续的手术技术创新来改善患者预后。
