Hochstätter Rüdiger, Bertholin Y Galvez Marie-Christine, Hartleb Riccarda, Laback Christian, Aigmüller Thomas, Tamussino Karl, Gold Daniela
Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.
Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Graz, Austria.
Int J Transgend Health. 2021 May 17;24(1):108-112. doi: 10.1080/26895269.2021.1924916. eCollection 2023.
Colpectomy is a frequent part of gender-affirming surgery in transgender men. Urologic complications with these procedures can complicate and delay further management. Aim: We reviewed the rate of postoperative voiding dysfunction after colpectomy with urethral lengthening in transgender men.
We reviewed postoperative voiding in 47 transgender men (age, 19-50 years) who underwent colpectomy with urethral lengthening. Thirty-eight patients (81%) had undergone hysterectomy (36 total, 2 subtotal/supracervical) previously and 11 (23%) underwent concomitant hysterectomy or removal of the residual cervix (4 abdominal, 6 laparoscopic, 1 transvaginal). Colpectomy was done transvaginally by opening and developing laterally the vesicovaginal and rectovaginal spaces and then transecting the lateral vaginal attachments with bipolar vessel sealing. Urethral lengthening with an anterior vaginal flap was performed in the same procedure as colpectomy. A transurethral catheter was left in situ for 14 days postoperatively. Voiding dysfunction was defined as failure of spontaneous micturition after removal of the catheter at 14 days.
40/47 (85%) patients were able to void after catheter removal, 7 (15%) were not. Voiding dysfunction occurred in 3/11 (27%) patients undergoing concomitant hysterectomy or removal of a residual cervix and in 4/36 patients (11%) status post total hysterectomy. Voiding dysfunction persisted for a median of 3 months (2 days - 46 months).
In this series voiding dysfunction developed in 15% of transgender men undergoing colpectomy with urethral lengthening and appeared to be more common in patients undergoing concomitant hysterectomy or removal of a residual cervix than in those status post hysterectomy. Patients should be counseled accordingly.
阴道切除术是变性男性性别确认手术中常见的一部分。这些手术的泌尿系统并发症会使后续治疗变得复杂并延误。目的：我们回顾了变性男性行阴道切除术加尿道延长术后排尿功能障碍的发生率。
我们回顾了47例（年龄19 - 50岁）行阴道切除术加尿道延长术的变性男性的术后排尿情况。38例患者（81%）此前接受过子宫切除术（全子宫切除术36例，次全子宫切除术/宫颈上子宫切除术2例），11例（23%）同时接受了子宫切除术或残余宫颈切除术（4例经腹，6例经腹腔镜，1例经阴道）。经阴道行阴道切除术，打开并向外侧分离膀胱阴道间隙和直肠阴道间隙，然后用双极血管封闭器切断阴道侧方附着组织。与阴道切除术同期进行前阴道瓣尿道延长术。术后经尿道留置导尿管14天。排尿功能障碍定义为术后14天拔除导尿管后不能自主排尿。
47例患者中有40例（85%）在拔除导尿管后能够排尿，7例（15%）不能排尿。在同时接受子宫切除术或残余宫颈切除术的11例患者中有3例（27%）发生排尿功能障碍，在全子宫切除术后的36例患者中有4例（11%）发生排尿功能障碍。排尿功能障碍持续的中位时间为3个月（2天 - 46个月）。
在本系列研究中，15%行阴道切除术加尿道延长术的变性男性出现排尿功能障碍，且在同时接受子宫切除术或残余宫颈切除术的患者中似乎比全子宫切除术后的患者更常见。应据此对患者进行咨询。
