Browsing by Author "Bizic, Marta R. (23970012900)"

Introduction: Metoidioplasty presents one of the variants of phalloplasty in female transsexuals. Urethral lengthening is the most difficult part in this surgery and poses many challenges. Aim: We evaluated 207 patients who underwent metoidioplasty, aiming to compare two different surgical techniques of urethral lengthening, postoperative results, and complications. Methods: The study encompassed a total of 207 patients, aged from 18 to 62 years, who underwent single stage metoidioplasty between September 2002 and July 2011. The procedure included lengthening and straightening of the clitoris, urethral reconstruction, and scrotoplasty with implantation of testicular prostheses. Buccal mucosa graft was used in all cases for dorsal urethral plate formation and joined with one of the two different flaps: I-longitudinal dorsal clitoral skin flap (49 patients) and II-labia minora flap (158 patients). Main Outcome Measurement: Results were analyzed using Z-test to evaluate the statistical difference between the two approaches. Also, postoperative questionnaire was used, which included questions on functioning and esthetical appearance of participating subjects as well as overall satisfaction. Results: The median follow-up was 39 months (ranged 12-116 months). The total length of reconstructed urethra was measured during surgery in both groups. It ranged from 9.1 to 12.3cm (median 9.5) in group I and from 9.4 to 14.2cm (median 10.8) in group II. Voiding while standing was significantly better in group II (93%) than in group I (87.82%) (P<0.05). Urethral fistula occurred in 16 patients in both groups (7.72%). There was statistically significant difference between the groups, with lower incidence in group II (5.69%) vs. group I (14.30%) (P<0.05). Overall satisfaction was noted in 193 patients. Conclusion: Comparison of the two methods for urethral lengthening confirmed combined buccal mucosa graft and labia minora flap as a method of choice for urethroplasty in metoidioplasty, minimizing postoperative complications. © 2013 International Society for Sexual Medicine.

Aim: This paper presents the latest surgical approaches for epispadias treatment in the pediatric population, as well as those for adolescent and adult populations after initial failed repair in childhood. Methods: The retrospective study was conducted between March 2005 and May 2020 and included 18 patients with the mean age of 21 months (range 11-48 months) (Group A), who underwent primary epispadias repair and 15 patients with the mean age of 18 years (range 13-29 years) (Group B), who underwent redo surgery after failed epispadias repair in childhood. In Group A, the surgery was performed as a one-stage procedure using complete penile disassembly technique, while, in Group B, the surgery was done as a two-stage procedure and included complete straightening and lengthening of the penis, followed by urethral reconstruction. Penile straightening and lengthening were achieved by tunica albuginea incision and grafting. In Group A, the urethral plate was mobilized, transposed ventrally, and tubularized and augmented with vascularized preputial skin flap where needed. In Group B, the urethra was reconstructed either using the buccal mucosa graft and genital skin flaps or with tubularization of genital skin flaps. Successful treatment was defined as a functional and esthetically acceptable penis without complications. Results: The mean follow-up was 88 months (range 15-197 months). Satisfactory results were achieved in 26/33 patients. Urethral fistula occurred in 4/18 patients from Group A and in 3/15 patients in Group B and was surgically repaired after four months. Skin dehiscence occurred in eight patients, five from Group A and three from Group B. Recurrent penile curvature was observed in 2/18 patients from Group A and required surgical correction and in 2/15 patients from Group B and was mild and did not need surgical repair. Eleven patients from Group B who filled out the International Index for Erectile Function reported satisfying erectile function, sexual desire, intercourse, and overall satisfaction. Conclusion: Primary or redo epispadias repair is challenging even for experienced reconstructive urologists. Only radical surgical approach can lead to complete correction of all deformities and provide successful outcome. © The Author(s) 2022.

Neophalloplasty is one of the most difficult surgical procedures in genital reconstructive surgery. Many different tissues have been applied such as local vascularized flaps or microvascular free transfer grafts. The main goal of the neophalloplasty is to construct the functional and cosmetically acceptable penis. Although voiding while standing is a priority for most female-to-male transgenders, most patients want to use the neophallus for sexual experience. Erectile function in male transgenders is based on erogenous sensitivity and possibility to achieve erection. In transgenders who underwent metoidioplasty, erogenous sensation is fully preserved while the erectile size of the reconstructed clitoris is not enough for penetration. In patients with total phalloplasty, erectile dysfunction is occurred due to the lack of erectile tissue and penile prosthesis implantation presents a suitable option. Two types of penile prostheses, semi-rigid and inflatable, are usually used after total phalloplasty. Different techniques have been described to enable insertion of both types of prosthesis, but they often resulted in complications and failure. The main limiting factor is presented by the fact that there is no adequate substitute for the penile erectile tissue after phalloplasty. In contrary to serious complications reported in the past, new techniques and modifications for penile prosthesis implantation into the neophallus seem to be safe in experienced hands. © 2020 by Nova Science Publishers, Inc. All rights reserved.

[No abstract available]

Introduction Gender dysphoria is defined as one's belief that his/her body does not reflect his/her true “inner” identification of physical sex and requires medical and/or surgical treatment that will alter his/her body to better reflect what he/she believes is his/her true gender. Objective The aim was to describe current surgical techniques available in genital reconstruction for female-to-male (FTM) and male-to-female (MTF) transgender patients. Study design We reviewed recently published papers concerning the most common procedures in genital reconstruction in FTM transgenders and in MTF transgenders. Results There is a wealth of available surgical procedures for FTM transgenders that will adjust their body and genitals toward the male gender. Chest masculinization combined with either metoidioplasty or phalloplasty are the most common procedures resulting in high patient satisfaction. Standardization of the procedures for vaginoplasty in MTF transgenders led to the penile inversion skin technique becoming a “gold standard” for vaginal lining in MTF patients, providing satisfying functional and esthetical outcome of the surgery. In extreme cases of shortage of skin, or when a vaginoplasty has failed, a vaginal lining can be created from hairless skin grafts, or a section of intestine may be used (bowel vaginoplasty). Conclusion A multidisciplinary approach including psychiatrists, psychologists, plastic surgeons, urologists, and gynecologists is the only effective treatment in transgenders. The surgeons' familiarity with the surgical procedure and the patients' desired body images should meet at the same level to guarantee a successful outcome. © 2017 Journal of Pediatric Urology Company

Gender affirmation surgeries in male-to-female trans individuals (transwomen) present usually the last step in their transition. The genital gender affirmation surgery, commonly referred as vaginoplasty, includes the removal of masculine genitalia and creation of female genitals. There is a huge number of described vaginoplasty techniques but the gold standard is still the penile inversion technique. It is proved that gender affirmation surgeries have a positive impact to quality of life and overall satisfaction of transgender and gender-nonconforming individuals. Herein, we will review the options for vaginoplasty in transgender women and present in details the most commonly used surgical approaches and their outcomes and complications. © Springer Nature Switzerland AG 2023.

Objective: To describe the surgical outcomes of ileal vaginoplasty in transgender women and patients with disorders of sex development (DSD). Patients and Methods: Transgender women and patients with DSD, who underwent ileal vaginoplasty at the VU University Medical Center Amsterdam, University Hospital Trieste, University Hospital Essen, and Belgrade University Hospital, were retrospectively identified. A chart review was performed, recording surgical technique, intraoperative characteristics, complications, and re-operations. Results: We identified a total of 32 patients (27 transgender and five non-transgender), with a median (range) age of 35 (6–63) years. Ileal vaginoplasty was performed as the primary procedure in three and as a revision procedure in the remaining 29. The mean (sd) operative time was 288 (103) min. The procedure was performed laparoscopically (seven patients) or open (25). An ileal ‘U-pouch’ was created in five patients and a single lumen in 27. Intraoperative complications occurred in two patients (one iatrogenic bladder damage and one intraoperative blood loss necessitating transfusion). The median (range) hospitalisation was 12 (6–30) days. Successful neovaginal reconstruction was achieved in all. The mean (sd) achieved neovaginal depth was 13.2 (3.1) cm. The median (range) clinical follow-up was 35 (3–159) months. In one patient a recto-neovaginal fistula occurred, which lead to temporary ileostomy. Introital stenosis occurred in four patients (12.5%). Conclusion: Ileal vaginoplasty can be performed with few intra- and postoperative complications. It appears to have similar complication rates when compared to sigmoid vaginoplasty. It now seems to be used predominantly for revision procedures. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd

Gender affirmation surgery for transmale patients is still challenging, as creation of the neophallus is one of the most demanding steps in surgical treatment. Metoidioplasty, as a one-stage procedure, can be considered in patients who desire gender affirmation surgery without undergoing a complex, multistage procedure with creation of an adult-sized neophallus. Metoidioplasty presents one of the variants of phalloplasty for patients in whom the clitoris is large enough under testosterone treatment. Advanced urethral reconstruction provides low complication rates with satisfying results of standing micturition. © 2019 Elsevier Inc.

Complications after hypospadias repair can be either anatomical (surgical) or psychological (non-surgical). Surgical complications can be classified in two groups: complications related to the urethra and nonurethral complications. Although urethral complications are more common and have been extensively analyzed, non-urethral surgical complications carry a risk of repeated surgery and may lead to severe functional and psychological disorders. The most common non-urethral complications are glans deformity, residual curvature and trapped penis due to penile skin deficiency. Each of these complications needs to be carefully examined because they can lead to unacceptable penile appearance, with consecutive psychological and psychosexual disturbances. Urethral complications, on the other hand, are usually related only to voiding disorders. Moreover, non-urethral complications can lead to complete anatomical and psychological inability for sexual intercourse. Therefore, long-term follow-up related to all aspects is considered important for a successful outcome with satisfactorily psychosexual development. In addition to surgeons? or parents? judgment, independent evaluation of patient satisfaction is essential for establishing legitimate results of the treatment. © 2014 by Nova Science Publishers, Inc. All rights reserved.

Background: The main goal in women with Mayer-Rokitansky-Küster-Hauser syndrome (vaginal agenesis) is creation of a neovagina that will satisfy the patient's desire. We evaluated sexual and psychosocial adjustment in patients who underwent rectosigmoid vaginoplasty because of vaginal agenesis. Methods: A total of 36 women, aged 21 to 38 years (mean=26) who underwent rectosigmoid vaginoplasty from 1997 to 2006 were evaluated. Sexual and psychosocial appraisal included the Female Sexual Function Index (FSFI), Beck's Depression Inventory (BDI), and standardised questionnaires about postoperative satisfaction, social and sexual adjustment. Results: Mean FSFI score was 28.9 (range=11.5-35.7) with a cut-off score of 26.55 for sexual dysfunction. Out of the 36 women, 10 (27, 8%) had sexual dysfunction. Mean BDI score was 7.55 (cut-off score=0-9 for non-depression). Twenty-eight women (77.8%) were without symptoms of depression, six women (BDI range=10-29) had moderate and two women had severe depression (BDI=42). There were a significant number of patients (P<0.01) with a high satisfaction score in FSFI and low BDI results. Thirty-two (88.9%) of the patients believed that surgery was done at the right time and the main postoperative support came from their family. Thirty-four (94.4%) of the patients reported satisfactory femininity, with a heterosexual orientation. Thirty patients (83. 3%) were very satisfied with the surgery, while 34 considered surgery as the best treatment. Conclusions: The sexual function and psychosocial status of these patients should be followed long-term to estimate their quality of life. © CSIRO 2011.

Introduction. There are several techniques for creation of a neovagina. However, rectosigmoid segment presents the most natural substitute for vaginal tissue. Aim. To evaluate the anatomical and functional results of sigmoid vaginoplasty and long-term sexual and psychological outcomes in 86 patients with vaginal absence. Methods. Between April 2000 and February 2009, 86 patients, aged 18 to 57 years (mean 22) underwent rectosigmoid vaginoplasty. Indications were vaginal agenesis (54), female transgenderism (27), and genital trauma (5). Rectosigmoid segments ranging from 8cm to 11cm were isolated, to avoid excessive mucus production. Preferably, it should be dissected distally first in order to check its mobility and determine the correct site for its proximal dissection. Stapling device was used for the colorectal anastomosis as the safest procedure. Creation of perineal cavity for vaginal replacement was performed using a simultaneous approach through the abdomen and perineum. Perineal skin flaps were designed for anastomosis with rectosigmoid vagina for the prevention of postoperative introital stenosis. Main Outcome Measures. Sexual and psychosocial outcomes assessment was based on the Female Sexual Function Index, Beck Depression Inventory, and standardized questionnaires. Results. Follow-up ranged from 8 to 114 months (mean 47 months). Good aesthetic result was achieved in 77 cases. Neovaginal prolapse (7) and deformity of the introitus (9) were repaired by minor surgery. There was no excessive mucus production, vaginal pain, or diversion colitis. Satisfactory sexual and psychosocial outcome was achieved in 69 patients (80.23%). Conclusions. Rectosigmoid colon presents a good choice for vaginoplasty. According to our results, sexual function and psychosocial status of patients who underwent rectosigmoid vaginoplasty were not affected in general, and patients attained complete recovery. © 2011 International Society for Sexual Medicine.

Introduction: Sex reassignment surgery (SRS) has proved an effective intervention for patients with gender identity disorder. However, misdiagnosed patients sometimes regret their decision and request reversal surgery. This review is based on our experience with seven patients who regretted their decision to undergo male-to-female SRS. Aims: To analyze retrospectively seven patients who underwent reversal surgery after regretting their decision to undergo male-to-female SRS elsewhere. Methods: From November 2010 through November 2014, seven men 33 to 53 years old with previous male-to-female SRS underwent reversal phalloplasty. Preoperatively, they were examined by three independent psychiatrists. Surgery included three steps: removal of female genitalia with scrotoplasty and urethral lengthening, total phalloplasty with microvascular transfer of a musculocutaneous latissimus dorsi flap, and neophallus urethroplasty with penile prosthesis implantation. Main Outcome Measures: Self-reported esthetic and psychosexual status after reversion surgery and International Index of Erectile Function scores for sexual health after phalloplasty and penile prosthesis implantation. Results: Follow-up was 13 to 61 months (mean = 31 months). Good postoperative results were achieved in all patients. In four patients, all surgical steps were completed; two patients are currently waiting for penile implants; and one patient decided against the penile prosthesis. Complications were related to urethral lengthening: two fistulas and one stricture were observed. All complications were repaired by minor revision. According to patients' self-reports, all patients were pleased with the esthetic appearance of their genitalia and with their significantly improved psychological status. Conclusion: Reversal surgery in regretful male-to-female transsexuals after SRS represents a complex, multistage procedure with satisfactory outcomes. Further insight into the characteristics of persons who regret their decision postoperatively would facilitate better future selection of applicants eligible for SRS. © 2016 International Society for Sexual Medicine.

Introduction: Sex reassignment surgery (SRS) has proved an effective intervention for patients with gender identity disorder. However, misdiagnosed patients sometimes regret their decision and request reversal surgery. This review is based on our experience with seven patients who regretted their decision to undergo male-to-female SRS. Aims: To analyze retrospectively seven patients who underwent reversal surgery after regretting their decision to undergo male-to-female SRS elsewhere. Methods: From November 2010 through November 2014, seven men 33 to 53 years old with previous male-to-female SRS underwent reversal phalloplasty. Preoperatively, they were examined by three independent psychiatrists. Surgery included three steps: removal of female genitalia with scrotoplasty and urethral lengthening, total phalloplasty with microvascular transfer of a musculocutaneous latissimus dorsi flap, and neophallus urethroplasty with penile prosthesis implantation. Main Outcome Measures: Self-reported esthetic and psychosexual status after reversion surgery and International Index of Erectile Function scores for sexual health after phalloplasty and penile prosthesis implantation. Results: Follow-up was 13 to 61 months (mean = 31 months). Good postoperative results were achieved in all patients. In four patients, all surgical steps were completed; two patients are currently waiting for penile implants; and one patient decided against the penile prosthesis. Complications were related to urethral lengthening: two fistulas and one stricture were observed. All complications were repaired by minor revision. According to patients' self-reports, all patients were pleased with the esthetic appearance of their genitalia and with their significantly improved psychological status. Conclusion: Reversal surgery in regretful male-to-female transsexuals after SRS represents a complex, multistage procedure with satisfactory outcomes. Further insight into the characteristics of persons who regret their decision postoperatively would facilitate better future selection of applicants eligible for SRS. © 2016 International Society for Sexual Medicine.

Objective To review our experience with severe penile trauma, mechanism of injury, and their treatment modalities in 16 children younger than 18 years. Management of penile trauma poses diverse challenges to the reconstructive urologist, as injuries vary from abrasions to total emasculation. Methods Analysis of 16 patients with severe penile injuries referred to us between 2002 and 2011 was undertaken. The median age at surgery was 13 years (range, 5-17). Etiology of penile trauma and choice of treatment were evaluated. The management included a wide variety of surgical techniques that were tailored to the individual patient. Results were analyzed to define etiology, that is, mechanism of penile injury and to estimate modalities of surgical management and postoperative outcomes. Also, postoperative questionnaire was used, which included questions on functioning and esthetical appearance of participating patients and overall satisfaction. Results The causes of penile injury in these series were traffic accidents (2), iatrogenic trauma (5), self-amputation (1), electrocution (1), burns (3), dog bite (2), zipper injury (1), and mother's hair strangulation (1). The mean follow-up was 46 months (range, 14-122), and examinations were uneventful, except for 2 fistulae formation after neophallic urethral reconstruction. Conclusion The main goal of reconstructive surgery is to have a penis with normal appearance and functions. Severe penile injuries should be treated on a case-by-case basis using the most propitious techniques. © 2014 Published by Elsevier Inc.

Vaginoplasty is the main surgical problem in male-to female sex reassignment surgery. There are many operative techniques reported, but none is ideal. Thus, there is a continued search for new and better solutions. For changing anatomical sex from male to female, the testicles are removed and the skin of foreskin and penis is usually inverted, as a flap preserving blood and nerve supply to form a sensate vagina. A fully innervated clitoris can be formed from a part of the glans of the penis. If the patient has been previously circumcised, the penile skin available for the neovagina may be insufficient in which case, a scrotal graft can be used after removing its hair follicles. The remaining scrotal tissue forms the labia majora. In extreme cases of skin shortage, or case of a failed vaginoplasty, a vaginal lining can be created from hairless skin grafts; alternatively, a section of the colon may be used (colovaginoplasty). These linings may not provide the same sensate quality as the penile inversion method, but the vaginal opening is identical, and the degree of sensation is approximately the same as that of most women, so there should be no decrease in pleasure. In last couple of decades, Belgrade has established itself as one of the few centers for sex reassignment surgery. In this chapter, accompanied by several instructive photographs, we describe the techniques of vaginoplasty in male-to-female transsexuals. From a reconstructive standpoint, this is indeed a sensible and elegant surgical procedure. It employs techniques which involve urology, and plastic surgery. Many of the patients are able to lead normal sexual lives postoperatively, although the level of satisfaction in this population varies. Psychosocial and psychosexual outcomes allow us to understand the significance of surgical repair, as well as its impact on the lives of both patients and their partners following surgery. Postoperative complications and pitfalls give rise to many physical and psychological problems and should be recognized and corrected in time however patients must realize that these procedures, although may be considered cosmetic, are reconstructive in nature given the multiple tissue planes in which the surgeon works, and therefore should be considered a reconstructive process. © 2014 by Nova Science Publishers, Inc. All rights reserved.

Purpose: We evaluated the results of 1-stage and multistage penile reconstruction in adults with complications after multiple failed epispadias repairs. Materials and Methods: A total of 23 adults underwent penile disassembly for repeat epispadias repair from February 2006 to June 2011. Median age at surgery was 27 years (range 17 to 41). Surgical treatment included penile disassembly with complete straightening and lengthening of the penis, followed by urethral reconstruction. The corpora cavernosa were completely separated from the glans cap with the neurovascular bundles and from the urethra. The urethra, which was short in all cases, was divided at the glans level. Penile straightening and lengthening were achieved by tunica albuginea incision and grafting. The urethra was reconstructed 3 to 6 months later using combined buccal mucosa graft and genital skin flaps. Success was defined as a functional penis without urethral fistula or stricture, or residual chordee as well as a cosmetically acceptable penile appearance. Results: Mean followup was 33 months (range 14 to 78). Of the patients 19 had a completely straightened and lengthened penis. Improved length of the erect penis was 2.7 to 6.6 cm. In 4 patients mild curvature developed without the need for additional correction. Urethral fistula in 3 cases was repaired 6 months after urethroplasty in 2, while it closed spontaneously in 1. All 21 sexually active patients reported good erectile function. Conclusions: Adults with complications after childhood epispadias repair are still a difficult population to treat. A radical surgical approach must be used to achieve a successful outcome. © 2013 American Urological Association Education and Research, Inc.