Walton Alice B, Hellstrom Wayne J G, Garcia Maurice M
Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA.
Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA.
Sex Med Rev. 2021 Oct;9(4):605-618. doi: 10.1016/j.sxmr.2021.07.002. Epub 2021 Sep 5.
Masculinizing genital gender affirmation surgery (MgGAS) has witnessed significant change in recent years. With the increasing number of patients seeking out GAS, optimization of techniques is mandated.
To critically review the evolution of MgGAS, in a manner that encompasses the history and scope of the procedures, including phalloplasty with and without urethral lengthening, metoidioplasty with and without urethral lengthening, penile prosthesis placement, scrotoplasty, testicular prosthesis placement, vaginectomy, and hysterectomy.
A comprehensive literature review was conducted in accordance with PRISMA guidelines, using PubMed. For our search, we generated a comprehensive list of MgGAS, combined with synonyms for GAS to ensure that articles included transgender cohorts. We identified a total of 547 articles from the search terms. Of these articles, 144 abstracts were relevant. Among these abstracts, 108 manuscripts were reviewed in full of which 98 were acceptable for inclusion. We excluded non-English-language studies without translation and studies that did not describe primary gGAS (eg, revision surgeries).
The evolution of MgGAS encompasses mostly refinements of pre-existing procedures, rather than new techniques or "watershed" procedures. The literature is somewhat lacking in outcomes-reporting that identifies the specific anatomy and surgical technique(s) used during gGAS. Without clarity regarding anatomy and technique, it is not feasible to compare surgical outcomes.
There is no ideal MgGAS; thus, it is critical that the physician assist the patient in understanding the outcomes and potential morbidity of the procedures to make the most informed decision. We envision that the future of MgGAS will advance with refinement of surgical techniques that minimize complications, improvement of tissue therapeutic technologies, new surgical tools and prosthetics designed for gGAS, advances in aftercare, and an immense selection of surgical options. Walton A, Hellstrom WJG, Garcia M. Options for Masculinizing Genital Gender Affirming Surgery: A Critical Review of the Literature and Perspectives for Future Directions. Sex Med Rev 2021;9:605-618.
近年来，男性化生殖器性别确认手术（MgGAS）发生了显著变化。随着寻求性别确认手术（GAS）的患者数量不断增加，手术技术的优化势在必行。
以涵盖手术历史和范围的方式，对MgGAS的发展进行批判性回顾，包括带或不带尿道延长的阴茎成形术、带或不带尿道延长的阴囊成形术、阴茎假体植入、阴囊成形术、睾丸假体植入、阴道切除术和子宫切除术。
按照PRISMA指南，使用PubMed进行全面的文献综述。为了进行搜索，我们生成了一份MgGAS的综合列表，并结合GAS的同义词，以确保文章纳入了跨性别群体。我们从搜索词中总共识别出547篇文章。其中，144篇摘要相关。在这些摘要中，对108篇手稿进行了全文审查，其中98篇可接受纳入。我们排除了没有翻译的非英语研究以及未描述原发性性别确认手术（如修复手术）的研究。
MgGAS的发展主要包括对现有手术的改进，而非新技术或“分水岭”式手术。文献在结果报告方面有所欠缺，缺乏对性别确认手术期间使用的具体解剖结构和手术技术的识别。如果解剖结构和技术不明确，比较手术结果是不可行的。
不存在理想的MgGAS；因此，医生协助患者了解手术结果和潜在并发症至关重要，以便做出最明智的决定。我们设想，MgGAS的未来将随着手术技术的改进而发展，这些改进将最大限度地减少并发症、改善组织治疗技术、设计用于性别确认手术的新手术工具和假体、术后护理的进步以及大量的手术选择。沃尔顿A、赫尔斯特伦WJG、加西亚M。男性化生殖器性别确认手术的选择：文献的批判性综述及未来方向展望。性医学评论2021；9：605 - 618。
