Is vaginal mucosal graft the excellent substitute material for urethral reconstruction in female-to-male transsexuals?

Zhang, Ying-Fan; Liu, Caiyue; Qu, Chao; Lu, Lixuan; Liu, Antang; Zhu, Lingling; Wang, Hui; Zhao, Yingyan; Zhu, Xiaodong; Hua-Jiang,

doi:10.1007/s00345-015-1562-z

Cited by 36 publications

(33 citation statements)

References 26 publications

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“…While prelamination has predominantly been performed with skin grafting, mucosal grafts allow for greater homology between native urethra and the constructed components. Histologically, mucosa has nonkeratinized epithelium and therefore has greater similarity to the urethra than skin, which has a keratinized epithelium [ 5 , 8 ]. There is also a greater chance of successful wound healing with mucosa, leading to less scar contracture at the recipient site [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Buccal mucosa is commonly used for reconstructive urethroplasty because it is hairless, accustomed to a wet environment, and easy to harvest and it has a thick epithelium [ 4 ]. Thus, vaginal mucosa, which possesses properties similar to buccal mucosa, is often used to construct the pars fixa in the FtM patient [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Given the historical success of reducing fistula and stricture rates in the fixed urethra with mucosa grafts, prelamination of the penile urethra with mucosa may be beneficial. In a series by Zhang et al, prelaminating the penile urethra with vaginal mucosa ahead of pedicled phalloplasty resulted in a stricture rate of only 4.5% and a fistula rate of 31.8%, of which nearly half healed spontaneously [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Prelamination of Neourethra with Uterine Mucosa in Radial Forearm Osteocutaneous Free Flap Phalloplasty in the Female-to-Male Transgender Patient

Salgado

Fein

Chim

et al. 2016

Case Reports in Urology

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Radial forearm free flap phalloplasty is the most commonly performed flap for neophallus construction in the female-to-male (FtM) transgender patient. Urological complications, however, can arise quite frequently and can prevent the patient from urinating in the standing position, an important postsurgical goal for many. Using mucosa to construct the fixed urethra and to prelaminate the penile urethra has been successful in reducing urologic complications, particularly strictures and fistulas. Until now, only buccal, vaginal, colonic, and bladder sites have been described as sources for these mucosal grafts. We present the successful use of uterine mucosa for prelamination of the neourethra in an FtM patient who underwent hysterectomy and vaginectomy at the prelamination stage of a radial forearm phalloplasty. Three months postoperatively, the patient was able to void while standing and showed no evidence of stricture or fistula on retrograde cystogram. These results suggest that uterine mucosa may be used for prelamination of the penile neourethra in patients undergoing phalloplasty.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prelamination of Neourethra with Uterine Mucosa in Radial Forearm Osteocutaneous Free Flap Phalloplasty in the Female-to-Male Transgender Patient

Salgado

Fein

Chim

et al. 2016

Case Reports in Urology

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“…However, due to anecdotal reports of urinary leakage and chronic accumulation in the vaginectomy cavity, which can require complex, secondary correction, some centers opt to perform vaginectomy at the time of hysterectomy and salpingo-oophorectomy [17,18] . Still, many high-volume centers prefer to perform vaginectomy at the time of pars fixa construction to allow the use of vascularized anterior vaginal myomucosal flaps to create a portion of the pars fixa urethra, hypothesizing that this may reduce the incidence of urinary strictures and fistulas [15,[19][20][21] . Note that although pars fixa construction has been described in patients who choose not to undergo vaginectomy, the significant risk profile for urethral complications with this approach leads most centers, current authors included, to advise against it.…”

Section: Hysterectomy Salpingo-oophorectomy Vaginectomymentioning

confidence: 99%

Phalloplasty: understanding the chaos

2020

Plast Aesthet Res

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Wide variation in overall strategies and surgical specifics for masculinizing genital surgery has created a "phalloplasty chaos" that is confusing to both surgeons and patients seeking gender confirming surgery. The purpose of this article is to review masculinizing genital confirming surgery, or "phalloplasty", focusing on specific goals and categorizing each component of the surgical process. Experienced surgeons from several highvolume centers review and categorize the commonly employed strategies and techniques for gender confirming phalloplasty, including the permutations of approaches to cutaneous flap for phallic construction, the sequence and staging of procedures, and strategies for urethral construction. There is no clear advantage or reduction in complications associated with particular sequences of urethral and phallic reconstruction. Because no single technique or staging strategy has proven superior for gender confirming genital surgery, it is paramount that surgeons are knowledgeable of all available options and the associated advantages, disadvantages, and risks.

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“…9 Furthermore, grafting techniques, whether using vaginal or buccal mucosa, also have a low urethral stricture rate, at 4.5% and 0%, respectively. 15,16 Much knowledge regarding urethral stricture is based on reports by Lumen et al 17,18 Their original papers indicated that the urethral anastomosis site is the most common location for stricture. Other indicated sites were the meatus, phallic urethra, fixed part urethra, and combined complex strictures, in descending order of incidence.…”

Section: Urethral Stricturementioning

confidence: 99%

Urethroplasty in Phalloplasty: Surgical Outcomes and Complications a Critical Review

Morgado

Tomada

2017

aup

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ResumoA faloplastia pode ser realizada como um procedimento de reconstrução peniana ou construção fálica, sobretudo em vítimas de traumatismo ou em cirurgia de reatribuição de sexo de feminino para masculino. Com o aparecimento da técnica de retalho livre de antebraço baseada na artéria radial e o reconhecimento da vontade de micção em ortostatismo pelos pacientes, a reconstrução da uretra tornou-se um procedimento padrão associado á faloplastia. Complicações como fístulas urinárias, estenoses uretrais ou cálculos uretrais são comuns e frequentemente recorrem após tratamento. Neste artigo de revisão as principais técnicas de reconstrução da uretra na faloplastia são revistas e comparadas. As complicações uretras são também revistas, bem como o seu tratamento.

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Is vaginal mucosal graft the excellent substitute material for urethral reconstruction in female-to-male transsexuals?

Cited by 36 publications

References 26 publications

Prelamination of Neourethra with Uterine Mucosa in Radial Forearm Osteocutaneous Free Flap Phalloplasty in the Female-to-Male Transgender Patient

Prelamination of Neourethra with Uterine Mucosa in Radial Forearm Osteocutaneous Free Flap Phalloplasty in the Female-to-Male Transgender Patient

Phalloplasty: understanding the chaos

Urethroplasty in Phalloplasty: Surgical Outcomes and Complications a Critical Review

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