7 results
Search Results
2. Surgical outcomes and proposal for a treatment algorithm for urethral strictures in transgender men.
- Author
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de Rooij, Freek P. W., Peters, Femke R. M., Ronkes, Brechje L., van der Sluis, Wouter B., Al‐Tamimi, Muhammed, van Moorselaar, R. Jeroen A., Bouman, Mark‐Bram, and Pigot, Garry L. S.
- Subjects
URETHRA stricture ,TRANS men ,TREATMENT effectiveness ,SKIN grafting ,URETHROPLASTY ,FREE flaps ,ALGORITHMS - Abstract
Objectives: To assess our results of surgical treatment for urethral strictures in transgender men, and to provide a surgical treatment algorithm. Patients and methods: A single centre, retrospective cohort study was conducted of transgender men who underwent surgical correction of their urethral stricture(s) between January 2013 and March 2020. The medical charts of 72 transgender men with 147 urethral strictures were reviewed. The primary outcomes were the success and recurrence rates after surgical treatment for urethral strictures. Results: The median (interquartile range [IQR]) follow‐up was 61 (25–202) months. At last follow‐up, 50/72 (69%) were able to void while standing (after one [60%], two [20%], three [6%], four [8%], five [4%], or seven [2%] procedures), 10/72 (14%) await further treatment, two of the 72 (3%) sat to void despite good urodynamic function, and 10/72 (14%) had a definitive urethrostomy. Of 104 surgical treatments included in separate success rate analysis, 65 (63%) were successful (43/75 [57%] after phalloplasty, 22/29 [76%] after metoidioplasty). The highest success rates in short urethral strictures were seen after a Heineke‐Mikulicz procedure (six of seven cases), and in longer or more complicated urethral strictures after two‐stage with graft (four of six), two‐stage without graft (10/12), pedicled flap (11/15, 73%), and single‐stage graft (seven of seven) urethroplasties. Grafts used were buccal mucosa or full‐thickness skin grafts. Success rates improved over time, with success rates of 38% and 36% in 2013 and 2014, to 71% and 73% in 2018 and 2019, respectively. We concluded with a surgical treatment algorithm based on previous literature, stricture characteristics, and our surgical outcomes. Conclusion: The highest success rates were seen after a Heineke‐Mikulicz procedure in short urethral strictures; and after graft, pedicled flap, or two‐stage urethroplasties in longer or more complicated urethral strictures. Finally, most of the transgender men were able to void while standing, although in some multiple surgical procedures were necessary to accomplish this. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
3. The role of androgens in clitorophallus development and possible applications to transgender patients.
- Author
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Grimstad, Frances, Boskey, Elizabeth R., Taghinia, Amir, Estrada, Carlos R., and Ganor, Oren
- Subjects
TRANSGENDER people ,ANDROGENS ,TESTOSTERONE ,GENDER affirming care ,GENDER - Abstract
Background: The clitorophallus, or glans, is a critical structure in sexual development and plays an important role in how gender is conceptualized across the life span. This can be seen in both the evaluation and treatment of intersex individuals and the use of gender‐affirming masculinizing therapies to help those born with a clitoris (small clitorophallus with separate urethra) enlarge or alter the function of that structure. Objectives: To review the role of testosterone in clitorophallus development from embryo to adulthood, including how exogenous testosterone is used to stimulate clitorophallus enlargement in masculinizing gender‐affirming therapy. Materials and Methods: Relevant English‐language literature was identified and evaluated for data regarding clitorophallus development in endosex and intersex individuals and the utilization of hormonal and surgical masculinizing therapies on the clitorophallus. Studies included evaluated the spectrum of terms regarding the clitorophallus (genital tubercle, clitoris, micropenis, penis). Results: Endogenous testosterone, and its more active metabolite dihydrotestosterone, plays an important role in the development of the genital tubercle into the clitorophallus, primarily during the prenatal and early postnatal periods and then again during puberty. Androgens contribute to not only growth but also the inclusion of a urethra on the ventral aspect. Exogenous testosterone can be used to enlarge the small clitorophallus (clitoris or micropenis) as part of both intersex and gender‐affirming care (in transmasculine patients, up to 2 cm of additional growth). Where testosterone is insufficient to provide the degree of masculinization desired, surgical options including phalloplasty and metoidioplasty are available. Discussion and Conclusion: Endogenous testosterone plays an important role in clitorophallus development, and there are circumstances where exogenous testosterone may be useful for masculinization. Surgical options may also help some patients reach their personal goals. As masculinizing gender‐affirming care advances, the options available for clitorophallus modifications will likely continue to expand and improve. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
4. Quality of life after penile reconstruction using the radial forearm flap in adult bladder exstrophy patients - technique and outcomes.
- Author
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Ricketts, Sophie, Hunter-Smith, David James, and Coombs, Christopher John
- Subjects
PENIS diseases ,BLADDER abnormalities ,SURGICAL flaps ,MALE reproductive organ diseases ,BLADDER exstrophy - Abstract
Patients who have undergone reconstruction of bladder extrophy can have an extremely short penis, which can be functionally and psychologically debilitating. Penile reconstruction with the radial forearm free flap has the potential to provide these patients with improved genital appearance and sexual function. Quality of life after penile reconstruction is an important outcome measure in evaluation of the procedure. We describe five patients who underwent total penile reconstruction with radial forearm free flaps and interview them with a quality of life questionnaire. Responses were overwhelmingly positive with regard to improved self-image as well as sexual function. This series supports the overwhelmingly positive change in quality of life to be gained with radial forearm free flap penile reconstruction for patients with an extremely short native penis in the adult exstrophy patient. [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
- View/download PDF
5. Pedicled pubic phalloplasty in females with gender dysphoria.
- Author
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Bettocchi, Carlo, Ralph, David J., and Pryor, John P.
- Subjects
PLASTIC surgery ,FEMALE-to-male surgery ,ARTIFICIAL implants ,SEXUAL intercourse ,GENDER dysphoria ,PHALLOPLASTY - Abstract
To describe a novel phalloplasty technique and to study the results and complications in female patients with gender dysphoria.Between 1989 and 2000, 85 female-to-male transsexual patients had a phalloplasty fashioned from suprapubic abdominal wall flap that was tubed to form the phallus, and which incorporated the neourethra made from a pedicled tube of labial skin. The complete neourethral reconstruction was in one stage in 32 patients and in two in 48; five patients did not wish to have the neourethra fashioned.The cosmetic appearance of the phallus was considered good in 68% of the patients. The major complications (in 60 patients) were related to the neourethra (75%) with stricture formation (64%) and/or fistulae (55%) predominating. This complication rate was significantly less (P < 0.001) when the neourethra was created in two stages. Once the neourethra was completed, patients were then offered both penile and testicular prostheses. Sexual intercourse was possible with no prosthesis in 16 patients.The pubic phalloplasty offers an acceptable neophallus without disfiguring the donor skin site. The main complications stem from creating the neourethra and these may be reduced by a two-stage procedure. [ABSTRACT FROM AUTHOR]
- Published
- 2005
- Full Text
- View/download PDF
6. News and Notes.
- Author
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Miller, Peter and Savva, Susan
- Subjects
DRUG abuse ,HEROIN ,CIRCUMCISION ,PENIS surgery ,PHALLOPLASTY ,HIV infections ,ALCOHOLS (Chemical class) ,ADVERTISING ,ALCOHOL ,MARKETING - Abstract
The article discusses several issues of concern pertinent to medical field and practice. According to the "British Medical Journal," the prescription of diamorphine to drug users in Germany will not be extended when the project expires on June 2006. The program is being implemented in seven centers all over Germany. A report from the "Medical News Today" confirms the significance of male circumcision towards HIV prevention. Studies reveal a 50 to 60 percent reduction in HIV infection among circumcised males. Moreover, a ban on alcohol advertising on radio and TV was proposed by the incoming Dutch cabinet according to the Foundation for Alcohol prevention in the Netherlands (STAP).
- Published
- 2007
- Full Text
- View/download PDF
7. PEDICLED PUBIC PHALLOPLASTY IN FEMALES WITH GENDER DYSPHORIA.
- Author
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Dabernig, Jörg
- Subjects
LETTERS to the editor ,PHALLOPLASTY - Abstract
Presents a letter to the editor in response to the article "Pedicled Pubic Phalloplasty in Females With Gender Dysphoria," previously published in the journal "BJU International."
- Published
- 2005
- Full Text
- View/download PDF
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