Heß J, Sohn M, Küntscher M, Bohr J
Klinik und Poliklinik für Urologie, Uroonkologie und Kinderurologie, Universitätsklinik Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
Klinik für Urologie, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Straße 4, 60431, Frankfurt am Main, Deutschland.
Urologe A. 2020 Nov;59(11):1348-1355. doi: 10.1007/s00120-020-01337-z.
For many transwomen, the surgical assignment of the male genital into a female is a fundamental part of the transition. Erogenous sensation of the neoclitoris is achieved by meticulous preparation of the penile glans with the neurovascular bundle. Several techniques are available for the formation of a neovagina, the penile inversion technique developed by Burou in the 1950s being the gold standard. With this technique, the inverted penile shaft skin is used as a pedicled flap to line the neovaginal canal. Alternatively, free skin grafts can be used, which serve primarily as a technique for redo procedures. Another technique is the use of intestinal segments to line the vaginal canal. This method is mostly used for redo procedures, but can also be performed primarily if penile skin is too small. Due to the numerous steps involved in the preparation, a wide variety of complications must be expected. Injury to the rectum during dissection of the neovaginal space, with an incidence of 4.5%, represents the greatest challenge. The most common complications are urethra-associated; hereby both a deviation of the urinary stream and strictures of the urethra are possible. The subjective satisfaction of transwomen with the surgical outcome is high and is reported in various studies to be 72-92%. On the basis of validated questionnaires it could also be shown that gender reassignment surgery leads to an increase in the trans*specific quality of life and promotes both subjectively perceived well-being and sexual satisfaction.
对于许多跨性别女性来说，将男性生殖器手术改造为女性生殖器是转变过程的一个基本部分。通过精心保留神经血管束来制备阴茎头，从而实现新阴蒂的性感。形成新阴道有多种技术可供选择，20世纪50年代布劳开发的阴茎翻转技术是金标准。采用这种技术时，翻转的阴茎轴皮肤用作带蒂皮瓣来衬里新阴道管。另外，也可使用游离皮片移植，这主要用于修复手术。另一种技术是使用肠段来衬里阴道管。这种方法大多用于修复手术，但如果阴茎皮肤过小也可初次使用。由于制备过程涉及众多步骤，必然会出现各种各样的并发症。在新阴道空间解剖过程中直肠损伤的发生率为4.5%，这是最大的挑战。最常见的并发症与尿道相关；可能出现尿流偏斜和尿道狭窄。跨性别女性对手术结果的主观满意度很高，各项研究报告显示为72%至92%。基于经过验证的问卷还可以表明，性别重置手术会提高跨性别者的生活质量，并促进主观幸福感和性满意度。
