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

Carlos Medina, Lydia A. Fein, Christopher Salgado

Research output: Contribution to journalArticle

5 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalInternational Urogynecology Journal
DOIs
StateAccepted/In press - Nov 29 2017

Keywords

  • Gender affirmation surgery
  • Gender reassignment surgery
  • Transgender
  • Vaginectomy

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Urology

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