Division of Plastic & Reconstructive Surgery, Oregon Health & Science University, Portland, OR; Oregon Health & Science University, Transgender Health Program, Portland, OR; Department of Urology, Oregon Health & Science University, Portland, OR.
Division of Plastic & Reconstructive Surgery, Oregon Health & Science University, Portland, OR; Oregon Health & Science University, Transgender Health Program, Portland, OR; Department of Urology, Oregon Health & Science University, Portland, OR.
Urology. 2023 Mar;173:226-227. doi: 10.1016/j.urology.2022.12.020. Epub 2022 Dec 30.
To demonstrate an approach to skin management in cases of gender-affirming vaginoplasty in the setting of penoscrotal hypoplasia. Gender-affirming penile inversion vaginoplasty is a procedure that has traditionally relied upon the use of local genital tissues to both construct the vulva and line the neovaginal canal. Improved and earlier access to pubertal suppression has resulted in an increasing number of individuals presenting for vaginoplasty with penoscrotal hypoplasia and significantly less skin available to accomplish the goals of vaginoplasty. Robotic-assisted gender-affirming peritoneal flap vaginoplasty is one solution that has emerged to help address the challenge of limited skin and provide an alternative source of neovaginal lining. Although this technique provides valuable peritoneal tissue that is used to line a large portion of the neovaginal canal, external vulvar construction remains a challenge. Amid a growing number of cases of penoscrotal hypoplasia secondary to pubertal suppression, there is a need for resources that illustrate strategies to deal with these challenging scenarios. In this video the authors demonstrate their approach to vulvar construction in the setting of penoscrotal hypoplasia secondary to pubertal suppression.
This video demonstrates an approach to skin management during robotic peritoneal flap vaginoplasty in the setting of limited genital skin secondary to pubertal suppression at Tanner stage 2.
Penile inversion vaginoplasty typically relies upon the penile skin tube reaching and reconstructing the introitus, and forming the distal aspect of the neovaginal canal. However, in most cases of penoscrotal hypoplasia secondary to pubertal suppression, there will not be enough length of penile skin to reach or construct the introitus. In these cases, the inverted penile skin tube is also often also too narrow in caliber to accommodate passage of a dilator for neovaginal dilation. These clinical scenarios are challenging and often require construction of the introitus with skin graft, complete splitting of the ventral penile skin tube and optimization of remaining skin to form other critical vulvar structures (labia minora and clitoral hood).
As individuals with penoscrotal hypoplasia continue to present for gender-affirming vaginoplasty procedures, it is important to adjust traditional approaches to vulvar construction and optimize strategies to manage cases with limited genital skin. In this video the authors present their approach to skin management and vulvar construction in gender-affirming vaginoplasty with penoscrotal hypoplasia secondary to pubertal suppression.
展示一种在阴茎阴囊发育不全的情况下进行性别肯定阴道成形术的皮肤管理方法。性别肯定的阴茎倒置阴道成形术是一种传统上依赖于使用局部生殖器组织来构建外阴和阴道新腔的手术。青春期抑制的改善和更早的获得导致越来越多的人因阴茎阴囊发育不全而接受阴道成形术，并且可用于实现阴道成形术目标的皮肤明显减少。机器人辅助的性别肯定的腹膜瓣阴道成形术是一种解决方案，可以帮助解决皮肤有限的挑战，并提供阴道新腔衬里的替代来源。尽管这种技术提供了有价值的腹膜组织，用于衬里阴道新腔的大部分，但外阴的构建仍然是一个挑战。在越来越多的因青春期抑制而导致的阴茎阴囊发育不全的情况下，需要有资源来说明处理这些具有挑战性情况的策略。在这个视频中，作者展示了他们在因青春期抑制而导致的阴茎阴囊发育不全的情况下，进行机器人腹膜瓣阴道成形术时的外阴构建方法。
本视频演示了在因青春期抑制而导致的生殖器皮肤有限的情况下，进行机器人辅助腹膜瓣阴道成形术时的皮肤管理方法，此时的生殖器皮肤处于 Tanner 2 期。
阴茎倒置阴道成形术通常依赖于阴茎皮肤管到达并重建阴门，并形成阴道新腔的远端部分。然而，在大多数因青春期抑制而导致的阴茎阴囊发育不全的情况下，阴茎皮肤的长度不足以到达或构建阴门。在这些情况下，倒置的阴茎皮肤管的口径通常也太窄，无法容纳阴道扩张器以进行阴道扩张。这些临床情况具有挑战性，通常需要用皮瓣来构建阴门，完全分离阴茎皮肤管的腹侧部分，并优化剩余的皮肤来形成其他重要的外阴结构（小阴唇和阴蒂包皮）。
随着阴茎阴囊发育不全的个体继续接受性别肯定的阴道成形术，调整外阴构建的传统方法并优化有限生殖器皮肤的管理策略非常重要。在这个视频中，作者展示了他们在因青春期抑制而导致的阴茎阴囊发育不全的情况下进行性别肯定的阴道成形术时的皮肤管理和外阴构建方法。
