Bohr Julia
Klinik für Urologie, Kinderurologie und urologische Onkologie, Evang. Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Deutschland.
Urologe A. 2022 Feb;61(2):205-213. doi: 10.1007/s00120-022-01783-x.
The necessity and the benefits of genital approximating surgery in gender dysphoria are established, therefore the indications after careful diagnostics are indisputable. For vaginoplasty, the method of choice is penile inversion, in which the penile skin is inserted as a pedicled flap into the prepared vaginal space. Alternatively, free skin grafts or intestinal segments can be used. Lifelong bougienage of the vagina is obligatory for all methods. The spectrum of complications after vaginoplasty is broad. Of particular note, although rare, is injury to the anterior rectal wall, from which rectovaginal fistulas can result. During the course strictures of the urinary meatus or also the neovagina occur. Corrections must often be surgically undertaken but conservative measures, e.g. intensified bougienage and topical estrogen treatment, can also be successful. Neovaginal infections are treated analogously to infections of a native vagina. A special situation is inflammation of the intestinal neovagina, which must be treated with mesalazine.
性别焦虑症患者进行生殖器再造手术的必要性和益处已得到确立，因此经过仔细诊断后的手术指征是无可争议的。对于阴道成形术，首选方法是阴茎翻转术，即将阴茎皮肤作为带蒂皮瓣插入准备好的阴道空间。另外，也可使用游离皮片或肠段。所有方法都必须对阴道进行终身扩张。阴道成形术后的并发症范围很广。特别值得注意的是，虽然罕见，但可能会损伤直肠前壁，进而导致直肠阴道瘘。在此过程中，尿道口或新阴道也会出现狭窄。通常必须进行手术矫正，但保守措施，如加强扩张和局部雌激素治疗，也可能成功。新阴道感染的治疗方法与天然阴道感染类似。一种特殊情况是肠道新阴道炎症，必须用美沙拉嗪治疗。
