Is vaginal mucosal graft the excellent substitute material for urethral reconstruction in female-to-male transsexuals?
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Construction of a neourethra is always considered to be a difficult part in phalloplasty, especially for the female-to-male (FTM) transsexual patients. We report our experience with prefabricated pars pendulans urethrae using vaginal mucosal graft for phalloplasty in FTM transsexuals.
Materials and methods
We retrospectively reviewed notes on the 22 FTM patients treated with pedicled-flap phalloplasty with prefabricated pars pendulans urethrae using vaginal mucosal graft between January 2008 and December 2012. Surgical outcome, urological function, and complications were recorded. Histological difference between normal mucosa and skin, and pathological changes of vaginal mucosal graft were also observed.
All the reconstructive penis survived, and patients could void in a standing position finally at a median follow-up of 25.4 ± 6.0 months. Urethral fistula and urethral stricture rates were 31.8 % (7/22 patients) and 4.5 % (1/22 patients), respectively. The occurrence of the urethral stricture was remarkably low compared with previous reports. Our histological results also showed a pronounced similarity between vaginal and buccal mucosa. Morphologically, they resembled urethral epithelium more closely than the forearm skin. Following the free transfer, the vaginal mucosal graft also showed a good revascularization and the inflammatory reaction and the extent of fibrosis of the mucosa decreased to the normal level after a 6-month prefabrication.
With prefabrication of vaginal mucosal graft, we reconstruct a competent phallic neourethra in these FTM transsexuals. According to its histological similarities and source character, the vaginal mucosa is the excellent substitute material for promising urethral reconstruction in FTM transsexuals.
KeywordsFemale-to-male transsexual Urethral reconstruction Prefabrication Vaginal mucosal graft Urethral complication
Thanks to Benjamin G. Huey from Medical School of Emory University for his careful reading on grammar and expression of English, Dr. Yueju Su from Department of Mathematics & Statistics in Georgia State University for her statistical assistance. This work was supported by Grant Nos. 10ZR1439200, 2006079 of the Natural Science Foundation of Shanghai and 81100950 of Natural Science Foundation.
Conflict of interest
The authors declare that they have no conflict of interest.
All human have been approved by the Ethics Committee of Second Military Medical University and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study have been omitted.
- 21.Biemer E (1998) Penile construction by the radial arm flap. Clin Plast Surg 15(3):425–430Google Scholar
- 23.Zaino RJ, Robboy SJ, Bentley R et al (2004) Diseases of the vagina. In: Kurman R (ed) Blaustein’s pathology of the female genital tract, 4th edn. Springer, New York, pp 131–136Google Scholar