Department of Urology, Oregon Health and Science University, Portland, OR.
Department of Urology, Oregon Health and Science University, Portland, OR.
Urology. 2020 Oct;144:263-265. doi: 10.1016/j.urology.2020.05.084. Epub 2020 Jul 6.
Gender-affirming vaginectomy treats gender dysphoria associated with the presence of a vagina in transgender males. Prior reported approaches include transperineal vaginectomy, mucosal fulguration, and robotic-assisted. We present key steps in transperineal gender-affirming vaginectomy in a 39-year-old transgender male.
Informed consent for video recording was obtained. The patient underwent a first-stage phalloplasty 6 months prior. He was placed in high lithotomy Tredelenberg position. After Foley placement, an incision was made along the mucocutaneous junction laterally and posteriorly. The anterior sulci were incised and a transverse incision made anteriorly at the bladder neck. The vaginal mucosa was excised, except for the distal anterior vaginal wall mucosa which would be mobilized as a flap for urethral lengthening later. The paravaginal space was closed with a series of purse-string sutures starting at the apex. The anterior vaginal wall flap is mobilized with the base of the flap at the urethral meatus. Cystoscopy confirms ureteral patency and no lower urinary tract involvement. A suprapubic tube was placed. The procedure then proceeded with a second-stage phalloplasty that included urethral lengthening and scrotoplasty.
The demonstrated procedure took 110 minutes and estimated blood loss was 75 mL. In our published series of 40 vaginectomies for 27 phalloplasties and 13 metoidioplasties, median operative time was 135 minutes and median estimated blood loss was 250cc. No complications related to the vaginectomy, including mucocele, fistulae to the vaginal space, or visceral injuries occurred. Peritoneal entry occurred in 44% of the cases and was closed primarily without further sequelae. Two patients required blood transfusion and 1 patient had C. difficile colitis. The anterior vaginal wall mucosa flap was incorporated in 83% of the time.
Transperineal vaginectomy results in low periprocedural complications, takes approximately 2 hours after a learning curve. Detailed results from our series of these procedures have been previously reported..
性别肯定性阴道切除术治疗与跨性别男性存在阴道相关的性别焦虑。先前报道的方法包括经会阴阴道切除术、黏膜电灼术和机器人辅助。我们介绍了一位 39 岁跨性别男性接受经会阴性别肯定性阴道切除术的关键步骤。
获得视频记录的知情同意。患者在 6 个月前接受了一期阴茎成形术。他被置于高位截石位 Tredelenberg 体位。 Foley 管插入后，沿粘膜皮肤交界处向外侧和后侧做一个切口。切开前沟，在膀胱颈前做一个横切口。切除阴道粘膜，但保留远端前阴道壁粘膜，稍后作为皮瓣用于尿道延长。阴道旁间隙用一系列荷包缝线从顶点开始缝合。将前阴道壁皮瓣从尿道外口基部向周围移动。膀胱镜检查确认输尿管通畅，无下尿路受累。放置耻骨上引流管。然后进行第二期阴茎成形术，包括尿道延长和阴囊成形术。
该手术耗时 110 分钟，失血量估计为 75 毫升。在我们发表的 40 例阴道切除术系列中，包括 27 例阴茎成形术和 13 例阴蒂成形术，手术时间中位数为 135 分钟，失血量中位数为 250cc。无与阴道切除术相关的并发症，包括粘膜囊肿、阴道空间瘘管或内脏损伤。44%的病例发生腹膜进入，直接缝合无进一步后遗症。2 例患者需要输血，1 例患者患有艰难梭菌结肠炎。前阴道壁粘膜瓣有 83%的时间被包含。
经会阴阴道切除术术后并发症发生率低，学习曲线后大约需要 2 小时。我们之前已经报道了这些手术的详细结果。
