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The transsexual is a person who suffers a profound identity disturbance caused by physical characteristics which do not correspond with mental traits and tendencies. The persistent sense of contradiction between sexual appearance and inner perception causes a strong need of harmonization. This condition can be reached by undergoing Sex Reassignment Surgery. Penoscrotal flap vaginoplasty represents the most widely used technique in Male-to-female transsexualism. Other techniques are represented by Simple penile skin inversion and Enterovaginoplasty. Common surgical steps in performing a penoscrotal flap vaginoplasty are: penile degloving, excision of corpora cavernosa, bilateral orchidectomy, creation of a retroprostatic space where to allocate the neovagina. Costitution of the neocavity will be made by assembling scrotal and penile flaps by three interrupted sutures at level of cul-de-sac, right and left edges. Fixation of the neovagina is made by performing a simple, personal technique which expects that prolene stitches are passed through the Denonvillier's fascia and the penoscrotal flap at level of cul-de-sac. In a 15 years personal experience, we performed 169 SRS operations on M-to-F patients: 103 (61%) were performed as penoscrotal flap vaginoplasty, 57 (34%) as simple penile skin inversion and 9 (5%) as colovaginoplasty. In our experience, a significant number of patients were satisfied with chosen surgery and felt comfortable with their new post-operative gender. Taking into account all the complications involved none of the patients felt regret and all would recommend the same operation to others. Overall results of studies carried out on patient satisfaction before and after SRS, show a net post-surgery improvement of patient sexual life.

Urodynamic analysis carried out with biocompatible catheterized fiber-optic probes, for dual measurement of pressure in bladder and in rectum, is presented. Medical tests have been performed in-vivo on seven patients; main highlights are reported.

The etio-pathological differences of the strictures and the various reconstructive concepts depend on the different structure of the penile and bulbar urethra. The study of the urethral strictures by new information of surgical anatomy-etiology-physiopathology and diagnosis have determined some important innovations concerning genito-urethral reconstructive surgery: a) the dorsal or ventral urethral augmentation, when the urethral plate can be preserved; b) the two-stage urethral reconstruction, when the urethral plate is not available; c) the cosmetic reconstruction of the glans penis and of the urethral meatus. In the modern era succesful urethral reconstructions has to guarantee not only the urinary function but also of sexual activity and the cosmetic aspect of the genitalia. The new trend of genito-urethral surgery focuses on less aggressive techniques less aggressive and reducing the risk of patient dissatisfaction. Thus, success outcome in urethral repair should be stated not only by objective voiding parameters but also by subjective parameters influencing patient satisfaction and these latter must be considered in the treatment choice.