female to male genital reconstruction · epidemiology •prevalence transsexual men undergoing...
TRANSCRIPT
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Female to Male Genital Reconstruction
Curtis Crane MD
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Introduction
• Phalloplasty and metoidioplasty
• Free flap or pedicled flap from the forearm,
back (lat flap) or thigh
• Local tissue rearrangement
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Epidemiology
• Prevalence Transsexual men undergoing surgery
• 1 : 30,000
• Note: 1996 study
• Prevalence Transsexuals medical treatment
• VA study: 0.03% of VA population (1/3333)
• 700,000 transgender individuals in US
An epidemiological and demographic study of transsexuals in The Netherlands. 1996.
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In my practice
• More than 300 phalloplasties, largest volume
in the world
• Meta, ~150
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Results
• >300 phalloplasties performed
– 35% ALTs, 65% RF phalloplasties (2 MLD’s)
• Urethral Strictures
– MLD: 1 of 2 (50%) developed stricture
– ALT: 19%
– RF: 15%
• Urethrocutaneous fistulas
– ALT: 19%
– RF: 7%
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Management• Urethral strictures:
• Two predictable locations: distal, proximal penile urethra
• Distal: first stage Johanson
• Proximal: anastomotic urethroplasty
• Followup 1.2 years: 3 recurrences requiring repair
• Fistulas:
• Primary closure
• Adjacent tissue transfers
• Followup of 1.2 years, two recurrences requiring repair
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RUG
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Metiodioplasty
• Release dorsal ligament
• Ventral chordee
• Options for the cadillac
– urethra
– scrotum
– vaginectomy
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Complications
• Urethral lengthening
– Stricture
– Fistula
• Delayed wound healing
• Infection
• NO LOSS OF SENSATION !