Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center , New York , New York.
Department of Urology, New York University Langone Health , New York , New York.
J Urol. 2019 Jun;201(6):1171-1176. doi: 10.1097/JU.0000000000000107.
Penile inversion vaginoplasty is the most common procedure for genital reconstruction in transwomen. While penile inversion vaginoplasty usually provides an excellent aesthetic result, the technique may be complicated by vaginal stenosis and inadequate depth, especially in transwomen with limited penile and scrotal tissue. We describe a technique of using peritoneal flaps to augment the neovaginal apex and canal in penile inversion vaginoplasty for transwomen.
Between 2017 and 2018 we identified 41 transwomen who underwent primary penile inversion and peritoneal flap vaginoplasty. Two approximately 6 cm wide by 8 cm long peritoneal flaps were raised from the anterior aspect of the rectum and the sigmoid colon, and the posterior aspect of the bladder to create the apex of the neovagina.
Average ± SD age of the 41 patients was 34 ± 14 years. Average procedure duration was 262 ± 35 minutes and average length of stay was 5 days. Average followup was 114 ± 79 days. At the most recent followup vaginal depth and width were measured to be 14.2 ± 0.7 and 3.6 ± 0.2 cm, respectively. The peritoneal flap added an additional 5 cm of depth beyond the length of the skin graft, forming the vaginal canal in patients with limited scrotal skin.
Penile inversion vaginoplasty remains the gold standard for primary genital reconstruction in transwomen. Peritoneal flaps provide an alternative technique for increased neovaginal depth, creating a well vascularized apex with acceptable anticipated complications.
阴茎反转阴道成形术是跨性别女性生殖器重建最常见的手术。虽然阴茎反转阴道成形术通常能获得极好的美学效果，但该技术可能会使阴道狭窄和深度不足复杂化，尤其是在阴茎和阴囊组织有限的跨性别女性中。我们介绍了一种在阴茎反转阴道成形术中使用腹膜瓣来增加阴道新顶点和阴道管的技术。
在 2017 年至 2018 年间，我们确定了 41 例接受原发性阴茎反转和腹膜瓣阴道成形术的跨性别女性。从前直肠和乙状结肠以及膀胱的后侧面提起两个大约 6 厘米宽 8 厘米长的腹膜瓣，以形成阴道新顶点。
41 例患者的平均年龄为 34 ± 14 岁。平均手术时间为 262 ± 35 分钟，平均住院时间为 5 天。平均随访时间为 114 ± 79 天。在最近的随访中，阴道深度和宽度分别测量为 14.2 ± 0.7 和 3.6 ± 0.2 厘米。腹膜瓣在有限的阴囊皮肤患者中增加了 5 厘米的深度，形成了阴道管，超出了皮瓣的长度。
阴茎反转阴道成形术仍然是跨性别女性原发性生殖器重建的金标准。腹膜瓣提供了增加阴道新深度的替代技术，形成了一个有良好血供的顶点，预期并发症可接受。
