Vaginal-mucosal graft metoidioplasty: a novel surgical technique for urethral reconstruction in transmasculine surgery.

IF 3.3 3区 医学 Q1 UROLOGY & NEPHROLOGY
Kanae Nakamura, Toru Sakurai, Aiko Sakamoto, Kumi Watanabe, Rei Ogawa
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引用次数: 0

Abstract

Background: Metoidioplasty is a genital-masculinization surgery for transmen with gender dysphoria that creates a small penis from a hormonally enlarged clitoris, and while standing urination is currently facilitated by urethroplasty using buccal (Belgrade method) or labia-minora (Ring method) mucosal grafts combined with a vaginal flap, these techniques involve buccal wounds and are associated with high urethral-fistula rates.

Aim: This study aims to describe our vaginal-mucosal graft metoidioplasty technique and report early outcomes from a case series of seven patients, based on the hypothesis that our approach may offer advantages over existing methods by avoiding buccal wounding seen in the Belgrade method and potentially reducing urinary complications compared to the Ring method.

Methods: We performed vaginal-mucosal graft metoidioplasty on seven patients who expressed a desire to undergo metoidioplasty during preoperative counseling. At our institution, metoidioplasty is performed simultaneously with hysterectomy, oophorectomy, and vaginal closure, which allows us to harvest long vaginal flaps and vaginal-mucosal grafts of various sizes. We incorporate these grafts into urethroplasty to improve surgical outcomes.

Outcomes: Primary outcome was the incidence of urinary complications, namely, urethral fistula and stricture.

Results: Median blood loss was 1610 mL. Median operative time was 4:57 h:min. Median postoperative follow-up period was 5 (range 2-11) months. One patient developed urethral fistula requiring closure surgery. Another had mild urethral stricture that is still under observation. The remaining patients had no noticeable complications.

Clinical implications: Vaginal-mucosal graft metoidioplasty does not involve buccal wounding and it had similar urethral-fistula rates in our small series as the Belgrade method (14% vs. 7%-15%).

Strengths & limitations: The technique permits urethral reconstruction with readily available vaginal mucosa. Blood loss was high because the vaginal flap is elevated with scissors and the vaginal-mucosal graft must be harvested in a circumferential manner. However, we believe blood loss will improve with experience. Our case series also only involved seven patients and follow-up of 2-11 months, and patient satisfaction regarding cosmetic, urinary, and sexual outcomes was not routinely recorded. Longer follow-up, more cases, and the use of patient-recorded outcome measures are needed to determine long-term surgical, urinary, cosmetic, and sexual outcomes.

Conclusion: Vaginal-mucosal graft metoidioplasty provides an accessible method for urethral reconstruction and may have acceptable urinary-complication rates, although further studies are required to confirm its safety and efficacy.

阴道-粘膜移植子宫内膜成形术:跨男性手术中尿道重建的新技术。
背景:阴唇成形术是一种针对性别焦虑的变性人的生殖器男性化手术,通过激素放大的阴蒂产生小阴茎,目前使用颊部(贝尔格莱德法)或小阴唇(环法)粘膜移植结合阴道皮瓣进行尿道成形术有助于站立排尿,这些技术涉及颊部伤口,并伴有高尿道瘘发生率。目的:本研究的目的是描述我们的阴道粘膜移植子宫内膜成形术,并报告7例患者的早期结果,基于我们的方法可能比现有方法具有优势,避免了贝尔格莱德方法中出现的口腔损伤,并且与Ring方法相比可能减少泌尿系统并发症。方法:我们对7例在术前咨询时表示希望进行子宫内膜成形术的患者进行阴道粘膜移植。在我们的机构,子宫内膜成形术与子宫切除术、卵巢切除术和阴道关闭术同时进行,这使我们能够收获各种大小的长阴道皮瓣和阴道粘膜移植物。我们将这些移植物纳入尿道成形术以改善手术效果。结果:主要观察结果为泌尿系统并发症,即尿道瘘和尿道狭窄的发生率。结果:中位失血量1610 mL,中位手术时间4:57 h:min。术后中位随访时间为5个月(2-11个月)。1例患者出现尿道瘘,需要进行闭锁手术。另一名患者有轻度尿道狭窄,仍在观察中。其余患者无明显并发症。临床意义:阴道粘膜移植物子宫内膜成形术不涉及颊部损伤,在我们的小系列研究中,其尿道瘘发生率与贝尔格莱德方法相似(14%对7%-15%)。优势与局限性:该技术允许尿道重建与现成的阴道粘膜。失血量很大,因为阴道瓣是用剪刀抬高的,阴道粘膜移植物必须以周向的方式切除。然而,我们相信失血会随着经验的增加而改善。我们的病例系列也只涉及7名患者,随访2-11个月,患者对美容、泌尿和性结局的满意度没有常规记录。需要更长时间的随访,更多的病例,并使用患者记录的结果测量来确定长期的手术,泌尿,美容和性预后。结论:阴道粘膜移植物子宫内膜成形术是一种简便易行的尿道重建方法,尽管其安全性和有效性有待进一步研究证实,但其泌尿并发症发生率可接受。
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来源期刊
Journal of Sexual Medicine
Journal of Sexual Medicine 医学-泌尿学与肾脏学
CiteScore
6.20
自引率
5.70%
发文量
826
审稿时长
2-4 weeks
期刊介绍: The Journal of Sexual Medicine publishes multidisciplinary basic science and clinical research to define and understand the scientific basis of male, female, and couples sexual function and dysfunction. As an official journal of the International Society for Sexual Medicine and the International Society for the Study of Women''s Sexual Health, it provides healthcare professionals in sexual medicine with essential educational content and promotes the exchange of scientific information generated from experimental and clinical research. The Journal of Sexual Medicine includes basic science and clinical research studies in the psychologic and biologic aspects of male, female, and couples sexual function and dysfunction, and highlights new observations and research, results with innovative treatments and all other topics relevant to clinical sexual medicine. The objective of The Journal of Sexual Medicine is to serve as an interdisciplinary forum to integrate the exchange among disciplines concerned with the whole field of human sexuality. The journal accomplishes this objective by publishing original articles, as well as other scientific and educational documents that support the mission of the International Society for Sexual Medicine.
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