Advertisement

World Journal of Urology

, Volume 33, Issue 12, pp 2115–2123 | Cite as

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

  • Ying-Fan Zhang
  • Cai-Yue Liu
  • Chuang-Yu Qu
  • Li-Xuan Lu
  • An-Tang Liu
  • Lie Zhu
  • Hui Wang
  • Zi-Hao Lin
  • Yao-Zhong Zhao
  • Xiao-Hai ZhuEmail author
  • Hua-JiangEmail author
Original Article

Abstract

Purpose

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.

Results

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.

Conclusion

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.

Keywords

Female-to-male transsexual Urethral reconstruction Prefabrication Vaginal mucosal graft Urethral complication 

Notes

Acknowledgments

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.

Ethical standard

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.

References

  1. 1.
    Gilbert DA, Horton CE, Terzis JK et al (1987) New concept in phallic reconstruction. Ann Plast Surg 18:128–136CrossRefPubMedGoogle Scholar
  2. 2.
    Selvaggi G, Elander A (2008) Penile reconstruction/formation. Curr Opin Urol 18:589–597CrossRefPubMedGoogle Scholar
  3. 3.
    Selvaggi G, Bellringer J (2011) Gender reassignment surgery: an overview. Nat Rev Urol 8:274–282CrossRefPubMedGoogle Scholar
  4. 4.
    Wroblewski P, Gustafsson J, Selvaggi G (2013) Sex reassignment surgery for transsexuals. Curr Opin Endocrinol Diabetes Obes 20:570–574CrossRefPubMedGoogle Scholar
  5. 5.
    Hage JJ, Bloem JJ (1993) Review of the literature on construction of a neourethra in female-to-male transsexuals. Ann Plast Surg 30:278–286CrossRefPubMedGoogle Scholar
  6. 6.
    Hage JJ, Bouman FG, Bloem JJ (1993) Preconstruction of the pars pendulans urethrae for phalloplasty in female-to-male transsexuals. Plast Reconstr Surg 91:1303–1307CrossRefPubMedGoogle Scholar
  7. 7.
    Mckillop C (2007) Interview with Dr Guido Barbagli. Substitution urethroplasty: which tissues and techniques are optimal for urethral replacement? Eur Urol 52(3):602–604CrossRefGoogle Scholar
  8. 8.
    Bhargava S, Chapple CR (2004) Buccal mucosal urethroplasty: is it the new gold standard? BJU Int 93(9):1191–1193CrossRefPubMedGoogle Scholar
  9. 9.
    Patterson JM, Chapple CR (2008) Surgical techniques in substitution urethroplasty using buccal mucosa for the treatment of anterior urethral strictures. Eur Urol 53(6):1162–1171CrossRefPubMedGoogle Scholar
  10. 10.
    Thompson IO, van der Bijl P, van Wyk CW et al (2001) A comparative light-microscopic, electron-microscopic and chemical study of human vaginal and buccal epithelium. Arch Oral Biol 46(12):1091–1098CrossRefPubMedGoogle Scholar
  11. 11.
    Blaivas JG (1989) Vaginal flap urethral reconstruction: an alternative to the bladder flap neourethra. J Urol 141(3):542–545PubMedGoogle Scholar
  12. 12.
    Blaivas JG, Heritz DM (1996) Vaginal flap reconstruction of the urethra and vesical neck in women: a report of 49 cases. J Urol 155(3):1014–1017CrossRefPubMedGoogle Scholar
  13. 13.
    Hendren WH (1998) Construction of a female urethra using the vaginal wall and a buttock flap: experience with 40 cases. J Pediatr Surg 33(2):180–187CrossRefPubMedGoogle Scholar
  14. 14.
    Hu ZQ, Hyakusoku H, Gao JH, Aoki R, Ogawa R, Yan X (2005) Penis reconstruction using three different operative methods. Br J Plast Surg 58(4):487–492CrossRefPubMedGoogle Scholar
  15. 15.
    Hage JJ, de Graaf FH (1993) Addressing the ideal requirements by free flap phalloplasty: some reflections on refinements of technique. Microsurgery 14:592–598CrossRefPubMedGoogle Scholar
  16. 16.
    Hoebeke P, Selvaggi G, Ceulemans P, De Cuypere G, T’Sjoen G, Weyers S, Decaestecker K, Monstrey S (2005) Impact of sex reassignment surgery on lower urinary tract function. Eur Urol 47:398–402CrossRefPubMedGoogle Scholar
  17. 17.
    Monstrey S, Hoebeke P, Selvaggi G et al (2009) Penile reconstruction: is the radial forearm forearm flap really the standard technique? Plast Reconstr Surg 124(2):510–518CrossRefPubMedGoogle Scholar
  18. 18.
    Fang RH, Kao YS, Ma S et al (1999) Phalloplasty in female-to-male transsexuals using free radial osteocutaneous flap: a series of 22 cases. Br J Plast Surg 52:217–222CrossRefPubMedGoogle Scholar
  19. 19.
    Byun JS, Cho BC, Baik BS (1994) Results of one-stage penile reconstruction using an innervated radial osteocutaneous flap. J Reconstr Microsurg 10:321–331CrossRefPubMedGoogle Scholar
  20. 20.
    Rohrmann D, Jakse G (2003) Urethroplasty in female-to-male transsexuals. Eur Urol 44(5):611–614CrossRefPubMedGoogle Scholar
  21. 21.
    Biemer E (1998) Penile construction by the radial arm flap. Clin Plast Surg 15(3):425–430Google Scholar
  22. 22.
    Filipas D, Fisch M, Fichtner J et al (1999) The histology and immunohistochemistry of free buccal mucosa and full-skin grafts after exposure to urine. BJU Int 84(1):108–111CrossRefPubMedGoogle Scholar
  23. 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
  24. 24.
    El-Sherbiny MT, Abol-Enein H, Dawaba MS et al (2002) Treatment of urethral defects: skin, buccal or bladder mucosa, tube or patch? An experimental study in dogs. J Urol 167(5):2225–2258CrossRefPubMedGoogle Scholar
  25. 25.
    Levine LA, Elterman L (1998) Urethroplasty following total phallic reconstruction. J Urol 160(2):378–382CrossRefPubMedGoogle Scholar
  26. 26.
    Glim JE, van Egmond M, Niessen FB et al (2013) Detrimental dermal wound healing: what can we learn from the oral mucosa? Wound Repair Regen 21(5):648–660CrossRefPubMedGoogle Scholar
  27. 27.
    Zhang Y, Lu L, Zhang W et al (2010) A simple and effective method for phalloplasty in female-to-male transsexuals. Plast Reconstr Surg 126(5):264e–265eCrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Ying-Fan Zhang
    • 1
  • Cai-Yue Liu
    • 1
  • Chuang-Yu Qu
    • 2
  • Li-Xuan Lu
    • 1
  • An-Tang Liu
    • 1
  • Lie Zhu
    • 1
  • Hui Wang
    • 1
  • Zi-Hao Lin
    • 1
  • Yao-Zhong Zhao
    • 1
  • Xiao-Hai Zhu
    • 1
    Email author
  • Hua-Jiang
    • 1
    Email author
  1. 1.Department of Plastic and Reconstructive Surgery, Changzheng HospitalSecond Military Medical UniversityShanghaiChina
  2. 2.Department of Urology, Changzheng HospitalSecond Military Medical UniversityShanghaiChina

Personalised recommendations