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International Urogynecology Journal

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01-10-2018 | Original Article

Total vaginectomy and urethral lengthening at time of neourethral prelamination in transgender men

Authors: Carlos A. Medina, Lydia A. Fein, Christopher J. Salgado

Published in: International Urogynecology Journal | Issue 10/2018

Abstract

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. We designed the technique presented here to minimize complications and contribute to overall success of the phalloplasty procedure.

Methods

After obtaining approval from the Institutional Review Board, our transgender (TG) database at the University of Miami Hospital was reviewed to identify cases with vaginectomy and urethral elongation performed at the time of radial forearm free-flap phalloplasty prelamination. Surgical technique for posterior vaginectomy and anterior vaginal wall-flap harvest with subsequent urethral lengthening is detailed.

Results

Six patients underwent total vaginectomy and urethral elongation at the time of radial forearm free-flap phalloplasty prelamination. Mean estimated blood loss (EBL) was 290 ± 199.4 ml for the vaginectomy and urethral elongation, and no one required transfusion. There were no intraoperative complications (cystotomy, ureteral obstruction, enterotomy, proctotomy, or neurological injury). One patient had a urologic complication (urethral stricture) in the neobulbar urethra.

Conclusions

Total vaginectomy and urethral lengthening procedures at the time of GAS are relatively safe procedures, and using the described technique provides excellent tissue for urethral prelamination and a low complication rate in both the short and long term.

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Title: Total vaginectomy and urethral lengthening at time of neourethral prelamination in transgender men
Authors: Carlos A. Medina
Lydia A. Fein
Christopher J. Salgado
Publication date: 01-10-2018
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 10/2018
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-017-3517-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Total vaginectomy and urethral lengthening at time of neourethral prelamination in transgender men

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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