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.
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.