Construction of the Neophallus in Female-to-Male Transsexuals: The Amsterdam Experience

Hage, J. Joris; Bouman, F. G.; Graaf, F. H. De; Bloem, J.

doi:10.1016/s0022-5347(17)36416-9

Cited by 70 publications

(41 citation statements)

References 17 publications

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“…From November 1993 through to April 2003 we performed a total of 105 phalloplasties using the radial forearm flap technique [5]. All of these patients were followed-up by the different members of our gender team and were treated according to the guidelines of the Harry Benjamin International Gender Dysphoria Association [6].…”

Section: Methodsmentioning

confidence: 99%

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Two-stage versus one-stage sex reassignment surgery in female-to-male transsexual individuals

et al. 2006

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The objective was to compare the outcome of a combined total hysterectomy-vaginectomy-phalloplasty procedure vs. a vaginectomy-phalloplasty procedure in female-to-male (FTM) gender dysphoric individuals, and to report on a large series of vaginectomies in young women. This was a retrospective study and the setting was the Gender Team at Ghent University Hospital. One hundred and five consecutive cases of vaginectomyphalloplasty with (one-stage) or without (two-stage) total hysterectomy between 1993 and 2003 were included in the study. Patient files of 69 one-stage and of 36 two-stage procedures were reviewed and analysed. Operation time, the need for transfusions, complications, repeated surgery and hospitalisation time were the main outcome measures. Patients were equally distributed over the study period of 10 years. Comparing the two groups, there was a greater need for transfusion in the group of patients undergoing the one-stage procedure. There was no difference in operation time, rate of major complications or hospitalisation time. One-stage sex reassignment surgery (SRS) in FTM transsexual individuals is associated with more blood loss. However, there is no difference in operative and postoperative complications. Vaginectomy seems to be a safe and relatively simple procedure in FTM transsexual patients.

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Section: Methodsmentioning

confidence: 99%

“…Simultaneously, a team of plastic surgeons prepares the radial forearm flap, which is used for phallic construction [5]. All vaginectomies were performed by the same surgeon (PH).…”

Section: Methodsmentioning

confidence: 99%

Two-stage versus one-stage sex reassignment surgery in female-to-male transsexual individuals

et al. 2006

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“…20 This should not be expected to result in erogenous phallic sensibility even though some of our patients claim this to be the case. 21 For this reason, the contralateral clitoral dorsal nerve and the clitoris should be left unharmed in female-to-male transsexuals to preserve erogenous sensibility. 3 Whenever two nerves are available in any flap, one of the ilioinguinal nerves may be recruited to be coapted to the second nerve of the transplant in this particular group of patients.…”

Section: Sensibilitymentioning

confidence: 99%

Fibula free flap phalloplasty: Modifications and recommendations

1996

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Radial forearm flap phalloplasty should be regarded as the gold standard. The large forearm donor site scar, however, has led to the search for other donor areas. We present our modifications and recommendations for addressing the ideal goals of phalloplasty better when applying the fibula free flap. We recommend preconstruction and secondary anastomosis of the neo-urethra. Preoperative infiltration of the cutaneous nerve is recommended for planning of the sensate flap. The osseous part of the flap should be long enough to be fixed to the tunica albuginea. We recommend a longitudinal, rather than a transverse, design for the flap. For aesthetic reasons, the flap should include two triangular tongues. Even so, secondary surgery will be needed. The patient may be left with functional loss in the donor region. A case report illustrates all of these points. We conclude that the sensate fibula free flap has a place in phalloplasty in case the patient refuses a forearm scar.

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“…At the beginning of our experience, we used to perform the SRS in one single intervention, which consisted, in most patients, of a subcutaneous mastectomy, a hysterectomy and oophorectomy through a modified Pfannenstiel incision, a vaginectomy via a combined vaginal and abdominal route with reconstruction of the perineal urethra using the vaginal mucosa under the clitoris [11], a phalloplasty with a radial fore arm flap [12], and the creation of a neo-scrotum using the skin of the labiae maiorae. Realizing that an intervention lasting, on average, more than 10 h might compromise the result of the SRS, we changed our policy in 1993 by performing the mastectomy as a separate first step.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic hysterectomy as the method of choice for hysterectomy in female-to-male gender dysphoric individuals

et al. 2008

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The objective of this paper was to report on a large series of laparoscopic hysterectomy in female-to-male (FTM) transsexual patients. A retrospective study was carried out by the gender team of Ghent University Hospital, Ghent, Belgium. The patient files of 83 consecutive cases of laparoscopic hysterectomy between April 2003 and August 2007 were reviewed and analyzed. The average operating time for the laparoscopic hysterectomy was 64 (30-150) min. The estimated blood loss for the laparoscopic hysterectomy averaged 86 (25-600) ml. We encountered two bladder perforations, which were immediately repaired, and one hematoma of the vaginal dome, which necessitated a second intervention. The serious complication rate of our series is 3.6%. Sex reassignment surgery (SRS) has proven to be the most effective treatment for patients with gender dysphoria. In FTM transsexual individuals, hysterectomy is an essential part of SRS. Since 2003, we have performed laparoscopic hysterectomy in conjunction with a subcutaneous mastectomy as a first step in SRS in FTM transsexual patients, thus, facilitating the transition for the patient and improving the operative planning for the different surgical teams. Laparoscopic hysterectomy has undoubtedly proven to be superior to abdominal hysterectomy regarding postoperative pain and recuperation, while it is as safe as the vaginal or abdominal route. We think that laparoscopic hysterectomy is the most appropriate method for hysterectomy in FTM transsexual patients.

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Construction of the Neophallus in Female-to-Male Transsexuals: The Amsterdam Experience

Cited by 70 publications

References 17 publications

Two-stage versus one-stage sex reassignment surgery in female-to-male transsexual individuals

Two-stage versus one-stage sex reassignment surgery in female-to-male transsexual individuals

Fibula free flap phalloplasty: Modifications and recommendations

Laparoscopic hysterectomy as the method of choice for hysterectomy in female-to-male gender dysphoric individuals

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