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https://www.readbyqxmd.com/read/29644476/reconstructive-management-pearls-for-the-transgender-patient
#1
REVIEW
Geolani W Dy, Jeff Sun, Michael A Granieri, Lee C Zhao
PURPOSE OF REVIEW: A growing number of transgender patients are seeking gender-affirming genital reconstructive surgery (GRS). These complex procedures have high complication rates. We describe common surgical pitfalls in GRS and approaches for minimizing complications. RECENT FINDINGS: Penile inversion vaginoplasty has been associated with excellent cosmetic and functional outcomes. A robotic-assisted dissection may minimize risk of rectal injury. As a younger transgender population chooses pubertal suppression, alternative sources for lining the vaginal canal, such as enteric vaginoplasties, may be more widely utilized...
April 11, 2018: Current Urology Reports
https://www.readbyqxmd.com/read/29622476/total-penile-reconstruction-a-systematic-review
#2
REVIEW
A Yao, M J Ingargiola, C D Lopez, P Sanati-Mehrizy, N M Burish, E M Jablonka, P J Taub
BACKGROUND: Phalloplasty poses a unique challenge to the plastic and reconstructive surgeon. The development of advanced microsurgical techniques has greatly augmented the range of surgical approaches available. METHODS: A systematic review of the MEDLINE and Cochrane databases was performed to identify clinical studies of total penile reconstruction published within the last 10 years using the search algorithm: "(phallus or penis or penile) and (reconstruction or phalloplasty or transplant)"...
February 14, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/29527241/barriers-to-gender-affirming-care-for-transgender-and-gender-nonconforming-individuals
#3
Jae A Puckett, Peter Cleary, Kinton Rossman, Michael E Newcomb, Brian Mustanski
Gender-affirming care, including hormone therapy, "top" (e.g., chest reconstruction surgery) and "bottom" (e.g., vaginoplasty, phalloplasty, metoidioplasty, etc.) surgeries, and puberty blockers, is an efficacious treatment of gender dysphoria for transgender and gender nonconforming (TGNC) individuals. However, many TGNC people encounter significant barriers in accessing gender-affirming care, which we detail via results from on online study. Participants included 256 TGNC individuals (78...
March 2018: Sexuality Research & Social Policy
https://www.readbyqxmd.com/read/29501425/a-new-technique-for-coronaplasty-in-penile-reconstruction
#4
Casper E Sommeling, Edward J De Wolf, Ali Salim, Stan Monstrey, Dries Opsomer, Karel Claes, Salvatore D'Arpa
BACKGROUND: The coronaplasty is an important step of the phalloplasty procedure as it creates a prominent coronal ridge and a constricted coronal sulcus, resulting in the transformation of a regular skin flap into a flap resembling a circumcised penis. AIM: The aim of this article is to describe our new coronaplasty technique that exploits opposing contracting forces of 2 different skin grafts to hold the shape of a thick, distally based skin flap, resulting in a natural looking neo-phallus...
February 28, 2018: Journal of Sexual Medicine
https://www.readbyqxmd.com/read/29454629/postoperative-pain-and-analgesia-administration-in-children-after-urological-outpatient-procedures
#5
A Schröder, F A Campbell, W A Farhat, J L Pippi Salle, D J Bägli, A J Lorenzo, M A Koyle
INTRODUCTION: There are limited data about pain patterns, analgesic requirements and factors predicting opioid requirements of children undergoing outpatient urologic surgery. This prospective study aimed to assess recovery profiles and pain medication requirements. METHODS: Patients between 6 months and 12 years of age were recruited prospectively between December 2013 and June 2014. Demographic and operative characteristics were collected. Following discharge home, the parents were asked to administer both acetaminophen and ibuprofen Q6H at a weight-adjusted dose, based on a schedule, until the end of postoperative day 2, and to administer the medication as required on postoperative day 3...
January 31, 2018: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/29369987/discussion-outcomes-after-phalloplasty-do-transgender-patients-and-multiple-urethral-procedures-carry-a-higher-rate-of-complication
#6
William M Kuzon
No abstract text is available yet for this article.
February 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29188324/total-vaginectomy-and-urethral-lengthening-at-time-of-neourethral-prelamination-in-transgender-men
#7
Carlos A Medina, Lydia A Fein, Christopher J Salgado
INTRODUCTION AND HYPOTHESIS: For transgender men (TGM), gender-affirmation surgery (GAS) is often the final stage of their gender transition. GAS involves creating a neophallus, typically using tissue remote from the genital region, such as radial forearm free-flap phalloplasty. Essential to this process is vaginectomy. Complexity of vaginal fascial attachments, atrophy due to testosterone use, and need to preserve integrity of the vaginal epithelium for tissue rearrangement add to the intricacy of the procedure during GAS...
November 29, 2017: International Urogynecology Journal
https://www.readbyqxmd.com/read/29178533/urethral-complications-after-transgender-phalloplasty-strategies-to-treat-them-and-minimize-their-occurrence
#8
REVIEW
Richard A Santucci
Radial forearm free flap phalloplasty (RFFP) is the current standard of care for most FTM gender confirmation surgeries. This procedure is associated with a rate of urethral stricture as high as 51%, which falls only to 23-35% even among the most experienced contemporary surgeons. While some modifications have been proposed to combat this high complication rate, it still remains a major source of lasting morbidity. The method involves literature review of RFFP literature. Lowest stricture rates are found when neourethra is made with a long, meticulously constructed tube of well-vascularized perivaginal/periurethral and labia minora tissue...
March 2018: Clinical Anatomy
https://www.readbyqxmd.com/read/29178488/the-anatomy-of-abdominal-flap-phalloplasty-for-transgender-surgery
#9
Seunghwan Kim, Margeaux Dennis, Jessica Holland, Mark Terrell, Marios Loukas, Justine Schober
Abdominal flap phalloplasty is surgical construction of a neophallus using a pedicled abdominal flap for patients transitioning female to male, for males whose penis is congenitally absent, or lost from trauma. It is an option for trans men whose goals do not require urethroplasty or vaginectomy but would like a phallus suitable for male gender appearance. A prosthesis can be placed for penetrative sexual capability. Surgical text descriptions were enhanced by creation of new anatomic illustrations. Anatomy of donor site and surgical technique leading to creation of the neophallus are demonstrated in detail with new relevant illustrations...
March 2018: Clinical Anatomy
https://www.readbyqxmd.com/read/29178477/the-anatomy-of-forearm-free-flap-phalloplasty-for-transgender-surgery
#10
S Kim, M Dennis, J Holland, M Terrell, M Loukas, J Schober
Transgender surgeries are becoming more frequent and visual interpretation of anatomy is essential for both surgeons and patients. Since the forearm free flap phalloplasty was introduced in 1984, it has been known to provide reliable cosmetic and functional results for transitioning men compared with phalloplasty by different flaps. Surgical text descriptions were enhanced by the creation of new anatomic illustrations. The forearm free flap consists of the anterior forearm skin, subcutaneous tissue, fascia containing the radial artery as the perforator and its venae comitantes, cephalic and basilic veins, and lateral and medial antebrachial cutaneous nerves are demonstrated in relation to the surgically derived flap...
March 2018: Clinical Anatomy
https://www.readbyqxmd.com/read/29178184/anatomy-of-the-pedicled-anterolateral-thigh-flap-for-phalloplasty-in-transitioning-males
#11
Mark Terrell, Wallisa Roberts, Charles Wesley Price, Michael Slater, Marios Loukas, Justine Schober
Incidence of transexualism and request for neophalloplasty is increasing yielding a current prevalence of trans-male in the USA of 1:2500. Surgeons have explored various techniques to improve desirable outcomes of neophallic construction, decrease the length of surgery, and minimize stigmatizing scars. The anterolateral thigh (ALT) flap is an alternative to the traditional radial forearm flap for patients who do not want a forearm scar. Surgical text descriptions were enhanced by the creation of new anatomic illustrations...
March 2018: Clinical Anatomy
https://www.readbyqxmd.com/read/29141257/phalloplasty-in-female-to-male-transsexuals-by-gottlieb-and-levine-s-free-radial-forearm-flap-technique-a-long-term-single-center-experience-over-more-than-two-decades
#12
Anna E Wirthmann, Pawel Majenka, Melanie C Kaufmann, Sascha V Wellenbrock, Lara Kasper, Susanne Hüttinger, Gabriel Djedovic, Ahmet Bozkurt, Michael Sohn, Ulrich M Rieger
No abstract text is available yet for this article.
November 15, 2017: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29128275/a-longitudinal-study-of-motivations-before-and-psychosexual-outcomes-after-genital-gender-confirming-surgery-in-transmen
#13
COMPARATIVE STUDY
Tim C van de Grift, Garry L S Pigot, Siham Boudhan, Lian Elfering, Baudewijntje P C Kreukels, Luk A C L Gijs, Marlon E Buncamper, Müjde Özer, Wouter van der Sluis, Eric J H Meuleman, Mark-Bram Bouman, Margriet G Mullender
BACKGROUND: Genital dissatisfaction is an important reason for transmen to undergo genital gender-confirming surgery (GCS; phalloplasty or metoidioplasty). However, little is known about motives for choosing specific techniques, how transmen benefit postoperatively, and whether psychosexual outcomes improve. AIM: To evaluate motivations for and psychosexual outcomes after GCS. METHODS: A longitudinal study of 21 transmen at least 1 year after GCS was conducted...
December 2017: Journal of Sexual Medicine
https://www.readbyqxmd.com/read/29031839/utilization-of-postpenile-surgery-illustrated-healing-atlas-a-comparative-study
#14
Michael E Chua, Jessica M Ming, Megan A Sauders, Nicolas Fernandez, Jessica H Hannick, Ibraheem Abu Awazayed, Rakan I Odeh, Darius J Bagli, Martin A Koyle, Walid A Farhat
OBJECTIVE: To determine the effect of the postpenile surgery illustrated healing atlas on caregivers' anxiety levels pre- and postoperatively, the frequency of family's postoperative communication with the urology care team, and the number of unplanned emergency room (ER) return for wound checks. METHODS: A prospective cohort enrolled children who underwent penile surgeries (distal hypospadias repair and phalloplasty) with no concomitant procedures from December 2016 to June 2017...
February 2018: Urology
https://www.readbyqxmd.com/read/29019859/outcomes-after-phalloplasty-do-transgender-patients-and-multiple-urethral-procedures-carry-a-higher-rate-of-complication
#15
Austin C Remington, Shane D Morrison, Jonathan P Massie, Christopher S Crowe, Afaaf Shakir, Stelios C Wilson, Krishna S Vyas, Gordon K Lee, Jeffrey B Friedrich
BACKGROUND: Phalloplasty is associated with improved quality-of-life in those with penile defects, and in female-to-male transgender (transmale) patients seeking gender-confirming surgery. However, aggregate complication and outcome data are sparse. This study compares phalloplasty outcomes between transmale and cismale patients and between those with primary versus staged urethroplasty. METHODS: A comprehensive literature search of PubMed, MEDLINE, and Google Scholar databases was conducted for studies relating to phalloplasty...
February 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28953722/phalloplasty-with-urethral-lengthening-addition-of-a-vascularized-bulbospongiosus-flap-from-vaginectomy-reduces-postoperative-urethral-complications
#16
Jonathan P Massie, Shane D Morrison, Stelios C Wilson, Curtis N Crane, Mang L Chen
BACKGROUND: Phalloplasty with urethral lengthening is the procedure of choice for female-to-male transgender patients who desire an aesthetic phallus and standing micturition, but is associated with complications, including urethral stricture and fistula formation. Horizontal urethra construction can be accomplished with labia minora flaps covered with additional vascularized layers of vestibular tissue when vaginectomy is performed concomitantly with phalloplasty. However, vaginectomy is not a requisite step in phalloplasty, and some individuals may choose to retain their vagina...
October 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28943352/genital-reconstruction-for-the-transgendered-individual
#17
REVIEW
Marta R Bizic, Borko Stojanovic, Miroslav L Djordjevic
INTRODUCTION: Gender dysphoria is defined as one's belief that his/her body does not reflect his/her true "inner" identification of physical sex and requires medical and/or surgical treatment that will alter his/her body to better reflect what he/she believes is his/her true gender. OBJECTIVE: The aim was to describe current surgical techniques available in genital reconstruction for female-to-male (FTM) and male-to-female (MTF) transgender patients. STUDY DESIGN: We reviewed recently published papers concerning the most common procedures in genital reconstruction in FTM transgenders and in MTF transgenders...
October 2017: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28940910/outcomes-of-inflatable-penile-prosthesis-insertion-in-247-patients-completing-female-to-male-gender-reassignment-surgery
#18
Marco Falcone, Giulio Garaffa, Arianna Gillo, Dino Dente, Andrew N Christopher, David J Ralph
OBJECTIVES: To assess the oucomes of penile prosthesis (PP) implantation after total phallic reconstruction secondary to gender dysphoria. PATIENTS AND METHODS: We conducted a retrospective single-centre analysis of 247 consecutive patients. The recruitment period was January 2001 to October 2015. A total of 328 inflatable PPs were implanted. A two-staged inflatable PP implantation was carried out. As a first step, an extraperitoneal reservoir placement was performed simultaneously with the glans sculpture and the insertion of a single large testicular prosthesis into the labia majora...
January 2018: BJU International
https://www.readbyqxmd.com/read/28861290/mystery-and-realities-of-phalloplasty-a-systematic-review
#19
REVIEW
Selçuk Sarıkaya, David John Ralph
The neophallus creation is still a mystery and it remains challenging even today. In this article, we performed a comprehensive review of the literature regarding phalloplasty and penile reconstructive surgery between January 2008 and May 2016. In this review, we have included 15 research articles and the results of 276 patients were examined. Studies revealed several indications and when indications were reviewed, 191 patients were female-to-male transgender, 9 patients had disorder of sex development/micropenis, 16 had penile amputation/trauma, 9 had ambiguus genitalia, 40 had exstrophy and/or epispadias, 11 had other problems...
September 2017: Turkish Journal of Urology
https://www.readbyqxmd.com/read/28843466/matriderm-decreases-donor-site-morbidity-after-radial-forearm-free-flap-harvest-in-transgender-surgery
#20
William Watfa, Pietro G di Summa, Joaquim Meuli, Wassim Raffoul, Olivier Bauquis
BACKGROUND: Phalloplasty with the radial forearm free flap is associated with a large donor site defect. AIM: To compare two methods of donor site closure for functional and cosmetic long-term results: full-thickness skin grafting vs split-thickness skin grafting with MatriDerm. METHODS: Thirty-seven transgender patients had a neophallus created from a radial forearm free flap, and all were operated on by the same senior surgeon. Eight patients had their donor site defect closed by total skin grafting and 29 patients, operated on after 2009, received a split-thickness skin graft with MatriDerm closure...
October 2017: Journal of Sexual Medicine
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