Browsing by Author "Stojanovic, Borko (54390096600)"

Purpose: This study aimed to evaluate a group of adult patients with non-urethral complications after hypospadias repair in childhood, their surgical treatment, and outcomes. Materials and methods: We analyzed 97 patients, mean age 22.5 years, who were treated in our center between January 2009 and December 2020, for non-urethral complications after previous hypospadias repair in childhood. Non-urethral complications were defined as glans deformity, residual curvature and trapped penis due to insufficient penile skin. A radical surgical approach was used to correct all deformities, in a one-stage or a two-stage procedure. A successful outcome was defined as a straight penis with good length, anatomically regular glans, and cosmetically acceptable appearance, without need for additional surgeries. Sexual function was evaluated using International Index of Erectile Function. Results: Mean follow-up was 75 months (ranged from 24 to 168 months). One-stage and two-stage repair were performed in 85.5% and 14.5% of cases, respectively. A higher success rate was noted after one-stage repair (94% compared to 86%). Complications included four cases of penile curvature with late onset, one case of glans dehiscence and partial skin necrosis. Erectile dysfunction was determined in 24% of patients. Discussion: Non-urethral complications may occur many years after primary hypospadias repair, with a strong impact on the quality of life. Treatment is individualized and usually involves a radical surgical approach to correct all associated deformities and to achieve successful cosmetic and psychosexual outcomes. Copyright © 2023 Stojanovic, Bizic, Bencic and Djordjevic.

The current management of female to male transgender surgery is based on the advances in neophalloplasty, perioperative care and the knowledge of the female genital anatomy, as well as the changes that occur to this anatomy with preoperative hormonal changes in transgender population. Since the clitoris plays the main role in female sexual satisfaction, its impact on the outcome in female to male transgender surgery is predictable. Although female genital anatomy was poorly described in majority of anatomical textbooks, recent studies have provided a better insight in important details such as neurovascular supply, ligaments, body configuration, and relationship with urethral/vaginal complex. This article aims to review current state of knowledge of the clitoral anatomy as well its impact on clitoral reconstruction in female to male sex reassignment surgery. © 2015 Wiley Periodicals, Inc.

Purpose: Severe hypospadias repair still presents a great challenge. We evaluated a novel approach of using a specially shaped buccal mucosa graft for simultaneous ventral tunica grafting and new urethral plate creation, in combination with longitudinal dorsal island skin flap, as a one-stage repair of severe hypospadias. Methods: Between July 2014 and September 2017, 26 patients (aged from 12 to 22 months) underwent scrotal hypospadias repair. Short and non-elastic urethral plate is divided. Buccal mucosa graft is harvested from the inner cheek, and designed in a special “watch” shape, with the spherical part in the middle and two rectangular parts on both sides. Tunica albuginea is opened ventrally for penile straightening and grafted to the spherical part of the “watch-shaped” buccal mucosa with 6–8 “U-shape” stitches. The rectangular parts are fixed to the tip of the glans distally and native urethral meatus proximally. Longitudinal dorsal skin flap is harvested, button-holed ventrally and joined with buccal graft. Penile skin reconstruction is performed using available penile skin. Results: The mean follow-up was 22 months (range from 9 to 46 months). Satisfactory results were achieved in 22 patients. Two urethral fistulas were successfully repaired by minor surgery after 3 months, while one meatal stenosis and one urethral diverticulum were successfully treated by temporary urethral dilation. There were no cases of residual curvature. Conclusion: Specially shaped buccal mucosa graft for simultaneous curvature correction and urethroplasty could be a good choice for single-stage repair of scrotal hypospadias with severe curvature. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

Urethral amyloidosis is a rare condition, but clinically relevant because it can mimic urothelial carcinoma. We report a case of localized urethral amyloidosis presenting with a long anterior urethral stricture. We used extensive grafts of buccal mucosa for standard augmentation urethroplasty, with a successful outcome at the 2-year follow-up. © 2015 Canadian Urological Association.

Severe hypospadias repair includes one-stage or two-stage reconstruction, depending on several hypospadiac parameters as well as surgeon’s preference. Penile and glans size, degree of curvature, urethral plate development, and availability of penile skin dictate the surgical approach. One-stage procedures have the advantage of correcting all deformities and complete reconstruction in one surgery, where possible. We previously published technique using buccal mucosa graft combined with longitudinal island skin flap for one-stage severe hypospadias repair. However, in most severe cases transection of urethral plate does not lead to complete penile straightening. In those cases, additional correction of curvature is required. Mobilization of neurovascular bundle would compromise glans vascularization, and dorsal plication would additionally shorten the penis. That is why ventral grafting presents more suitable option, as a lengthening procedure. There are several options for grafting material, and we presumed that buccal mucosa graft could be specially fashioned to be used for grafting, and simultaneously for urethral plate creation as well, in selected cases. Urethroplasty is finalized with previously described dorsal longitudinal island skin flap, button-holed on the ventral side. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024.

Severe hypospadias repair can be performed by applying different principles, either in one or in two stages. The main problem is that this form of hypospadias is usually associated with a marked chordee and short urethral plate. In these cases, the urethral plate should be divided, leading to penile lengthening and straightening. The choice of urethroplasty remains the great challenge. Different fasciocutaneous flaps (prepuce, penile skin, tunica vaginalis) and grafts (oral mucosa, bladder mucosa, skin), or combination of flaps and grafts could be used for urethral lengthening. Insufficient genital tissue in both severe and failed hypospadias causes a potential problem for urethral reconstruction. Using additional extragenital tissue offers easier correction in one-stage primary repair or staged urethroplasty in failed hypospadias. © 2014 by Nova Science Publishers, Inc. All rights reserved.

Although urethral strictures have been known since antiquity, the surgical management of urethral strictures has undergone a great (re)evolution over the last six decades, both in the perception of the disease and in the surgical repair techniques, always presenting itself as a challenge for the surgeon and patient. Reconstruction of urethral stricture disease involving a combination of grafts and flaps consists of a group of complex procedures with specific clinical indications. The knowledge of these procedures by reconstructive urologists is both necessary and relevant. A thorough understanding of the anatomy, including blood supply, is a crucial proviso for the correct evaluation and successful management of urethral stricture disease. We discuss the main techniques and indications in combined graft and flap urethroplasties. © The Author(s) 2022.

INTRODUCTION: Surgical treatment of epispadias has evolved significantly, from early tubularization techniques to modern penile disassembly approaches (1-3). Despite advancements, achieving urinary continence remains challenging and typically requiring multiple interventions (4). PURPOSE: The objective is to present complete penile disassembly (Belgrade) technique for primary epispadias repair. PATIENT AND METHOD: We present a case of isolated penopubic epispadias and severe dorsal curvature in 18-month-old boy. Meticulous dissection is conducted ventrally and dorsally to isolate the urethral plate and spongiosal tissues. The Buck's fascia is incised ventrally to isolate the neurovascular bundles, followed by complete separation of the corpora cavernosa from each other and from the glans. The urethral plate is dissected free, transposed ventrally, and tubularized over a catheter. Penile straightening and lengthening are achieved through internal rotation of the corpora cavernosa and dorsal corporotomy with skin grafting. Glans reconstruction is done. Reassemble of all entities is performed, followed by penile skin reconstruction. RESULTS: At the three-month follow-up, the patient demonstrated satisfactory voiding with a good urinary stream, without evidence of urethral fistula or stricture. The cosmetic outcome was favorable, with no signs of recurrent curvature. The patient remains under vacuum device therapy, till 12 month after sugery. CONCLUSION: The Belgrade approach for isolated penopubic epispadias includes radical approach with complete disassembly. This one-stage repair enables correction of all deformities - penile lengthening and strengthening, urethroplasty, glansplasty and penile skin reconstruction, with good outcomes. Copyright® by the International Brazilian Journal of Urology.

Distal hypospadias repair has become a relatively safe surgical procedure with tubularized incised plate urethroplasty. However, fistula formation still represents the most common complication, in various rates. Covering of the neourethra with vascularized tissue has proven effective in reducing urethrocutaneous fistula rate. We present our technique based on using dorsal dartos flap for neourethra covering. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024.

This retrospective study was designed to assess and compare the anatomical, functional, and esthetic appearance of the umbilical area in patients after repair of gastroschisis using the inner surface of the umbilical cord (UC) and in patients with omphalocele conservatively treated. Background Our procedure transformed gastroschisis into an 'artificial-surgical omphalocele' in which the prolapsed intestine was covered with an umbilical patch, the inner surface of which contained Wharton's jelly (WJ). Methods We have summarized an experience of 17 years in repairing gastroschisis using the inner surface of the UC. From 1986 to 2003, 21 infants with gastroschisis and one with a ruptured omphalocele were treated with this technique. We used Eagle's medium to prove the validity of the umbilical stump and the duration of its viability. The inner surface of the umbilical patch is a 'live' structure with WJ, which contains mucoid connective tissue and fibroblast-like cells-that is, stem cells producing cutis, adipose, and connective tissue. Results Using our method, early control assessment of 18 of 21 patients with gastroschisis, at intervals of 1-3 months, showed good functional and esthetic results. Clinical long-term results in terms of anatomical, clinical, and functional findings were excellent. Besides clinical testimony, we used high-frequency ultrasonography to make an appraisal of the effectiveness of WJ stem cells in the repair of gastroschisis, and compared our results with healthy volunteers and patients with omphalocele conservatively treated. Conclusion This paper describes the effect of the local application of WJ-that is, mesenchymal stromal cells derived from the inner surface of the umbilical stump-and its influence on the healing process of the birth defect and wound. © 2015 Annals of Pediatric Surgery.

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.

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

Background: Penile inversion vaginoplasty still remains the gold standard in genital gender affirming surgeries in transwomen. However, insufficiency of the penile skin due to either radical circumcision or puberty blockers presents great challenge in vaginal reconstruction. Peritoneal pull-through vaginoplasty is well known technique for the treatment of vaginal absence in cis-woman due to vaginal agenesis or trauma. Objective: We describe our laparoscopy assisted technique of using peritoneal flaps for neovaginal construction in male to female gender affirming surgery Methods: In period from March 2016 to June 2021, 52 transwomen, aged from 19 to 52 years (mean 27) underwent laparoscopy assisted peritoneal pull-through vaginoplasty. Indications were genital skin insufficiency (radical circumcision in 16, scrotal skin insufficiency in 3 and lichen sclerosis in 3 cases) and prepubertal blockers in 22 and 17 cases, respectively. In remaining 13 candidates, peritoneal pull-through vaginoplasty was preferable method of choice. Two peritoneal flaps are harvested from posterior bladder wall and anterior rectosigmoid peritoneum, using laparoscopy approach. Vaginal channel is created by combined perineal and laparoscopy approaches. Good vascularized peritoneal flaps are maximally mobilized and pulled-through to be joined with inverted penile skin. Peritoneal flaps are joined laterally to create neovagina. Gender affirming surgery is completed with reconstruction of external female genitalia, clitoris, labia minora and majora, and urethra. Vaginal packing is placed for 7 days postoperatively and followed by proper vaginal dilation for the first 12 months postoperatively. Results: Follow-up ranged from 6 to 69 months (mean 29 months). Complications occurred in 7 cases: 3 had prolonged hematoma of the labia majora, one had neovaginal introitus dehiscence and one had superficial necrosis of the left labia majora. None of the complications required additional surgeries. The depth of the neovagina at the control check-up in 6 months after surgery was 14.7 ± 0.5 cm, while width was about 3.4 ± 0.4 cm. Majority of patients (≈96%) were satisfied with the new genitalia, sensitivity, lubrication and possibility of engaging in sexual intercourse according to self-reports. One patient required reduction of the size of her clitoris because of hypersensitivity and the other one requested laser treatment of the incisional scars. Conclusion: Although known for quite a long time in vaginal reconstruction for cis-women with vaginal agenesis and different forms of vaginal absence, peritoneal pull-through vaginoplasty offers promising outcomes in transgender women, as an option that will give self-lubricating neovagina, with insignificant scarring and complications and high degree of patient's satisfaction. © 2022 Elsevier Inc.

Metoidioplasty represents a technique for creating a neophallus from hormonally hypertrophied clitoris, in female-to-male transsexuals. As a one-stage procedure, our approach includes lengthening and straightening of the clitoris to make a neophallus, urethral reconstruction to enable voiding while standing and scrotal reconstruction with insertion of testicular implants. This chapter provides an overview of the indications, possible complications, essential steps of the metoidioplasty procedure and postoperative care, as well as the sample of the operative dictation. © Springer International Publishing Switzerland 2017.

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.

Gender dysphoria is a condition where there is a discrepancy between the gender assigned at birth and the desired gender, leading the patient to pursue surgical intervention. Reconstruction of the neophallus for transmen is still challenging, even though there are many surgical techniques with satisfying results. The aim of neophallic reconstruction in gender affirmation surgery (GAS) for transmen is to provide stand-up voiding, erotic sensation, orgasm and penetration ability, and acceptable donor site morbidity with minimal scarring and complications. Metoidioplasty as a variant of phalloplasty for transmen is a one-stage procedure that results in male-like external genitals, with minimal scarring, ability of standing micturition, and full erogenous sensation with the ability to achieve orgasm during sexual intercourse. Metoidioplasty is a method of choice for those transmen who wish to have GAS in one procedure without multi-staged procedures to create the adult-male-sized neophallus. © The Author(s) 2020.

Metoidioplasty is a variant of the gender affirmation technique neophalloplasty, where a hormonally enlarged clitoris is reconstructed to become a small penis. The goals of metoidioplasty are male appearance of the genitalia, voiding in standing position, and completely preserved erogenous sensation of the neophallus. However, it does not enable penetrative sexual intercourse due to the small dimensions of the neophallus. Basic principles of metoidioplasty were established 50 years ago, and many refinements of the technique have been reported since. The latest improvements are based on the advances in urethroplasty, perioperative care, and new insights into female genital anatomy. The current metoidioplasty technique is a one-stage procedure that includes vaginectomy, straightening and lengthening of the clitoris, urethral reconstruction by combined flaps and grafts, and scrotoplasty with insertion of testicular implants. Good aesthetic, functional, and psychosexual outcomes are achieved with this type of neophalloplasty. © 2022 Georg Thieme Verlag. All rights reserved.

Introduction: Metoidioplasty is a variant of phalloplasty for transmen that includes the creation of the neophallus from a hormonally enlarged clitoris, urethral lengthening and scrotoplasty. The procedure results in male appearance of genitalia, voiding in standing position and preserved sexual arousal, but without possibility for penetrative intercourse. We evaluated outcomes of metoidioplasty at our center, based on latest surgical refinements. Methods: During the period of 14 years (from February 2006 to April 2020), 813 transmen with mean age of 24.4 years and mean body mass index of 24.6, underwent one stage metoidioplasty. Hysterectomy was simultaneously performed in 156, and mastectomy in 58 cases. Hysterectomy, mastectomy and metoidioplasty were done as a one-stage procedure in 46 transmen. Patients are divided in 5 groups, depending on the type of urethroplasty. Postoperative questionnaires were used to evaluate cosmetic and functional outcomes, as well as patients’ satisfaction. Results: Follow-up ranged from 16 to 180 months (mean 94 months). Mean surgery time was 170 minutes and mean hospital stay was 3 days. Length of the neophallus ranged from 4.8 cm to 10.2 cm (mean 5.6 cm). Urethroplasty was complication-free in 89.5% of cases, and ranged between 81% to 90.3% in different groups. Urethral fistula and stricture occured in 8.85% and 1.70% of cases, respectively. Other complications included testicular implant rejection in 2%, testicular displacement in 3.20% and vaginal remnant in 9.60% of cases. From 655 patients who answered the questionnaire, 79% were totally satisfied and 20% mainly satisfied with the result of surgery. All patients reported voiding in standing position and good sexual arousal of the neophallus, without possibility for penetrative intercourse due to small size of the neophallus. Conclusion: Metoidioplasty has good cosmetic and functional outcomes, with low complication rate and high level of patients’ satisfaction. In transmen who request total phalloplasty after metoidioplasty, all available phalloplasty techniques are feasable. © Copyright © 2021 Bordas, Stojanovic, Bizic, Szanto and Djordjevic.

Phalloplasty represents the latest step in female-to-male transitioning and still remains a great challenge for transgender surgeons. Since we have two options in this transitioning—metoidioplasty and total phalloplasty—the transgender surgeon has to fully inform the individual about all aspects such as surgical steps, outcomes, advantages and disadvantages, possible complications, and expectations. Total phalloplasty with the creation of a neophallus of a similar volume to that in genetic males, is a complex and multi-staged procedure. Many different tissues (i.e., flaps) can be used, and the ideal procedure is still not established. In contrast to the above complexities involved in total phalloplasty, metoidioplasty presents a simple and one-stage procedure for the creation of a neophallus from a hormonally enlarged clitoris. This technique is very promising for individuals who desire gender-affirmation surgery without having to undergo the difficult and multistage creation of a male-sized neophallus. Also, this technique prevents scarring to the extragenital region, making the final results more acceptable for transgender individuals. Our goal is to objectively present the techniques for metoidioplasty and to define their value based on postoperative results. © Translational Andrology and Urology. All rights reserved.