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Geschlechtsangleichung von Frau zu Mann

Phallusplastik

Gender reassignment from female to male

Phalloplasty

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Zusammenfassung

Hintergrund

Die Zunahme der Prävalenz an Geschlechtsinkongruenz erfordert eine Standortbestimmung zur Phallusplastik bei Frau-zu-Mann(FzM)-Transidenten.

Fragestellung

Der folgende Artikel bietet einen Überblick über die aktuellen Verfahren der Phallusplastik und Urethraplastik, der Prothetik sowie deren Komplikationsmöglichkeiten.

Material und Methode

Aktuelle internationale Reviews sowie Publikationen der letzten 10 Jahre wurden ausgewertet und eigene Erfahrungen an einem interdisziplinären Schwerpunktzentrum der letzten 25 Jahre an ca. 350 FzM-Transidenten beschrieben.

Ergebnisse

Freie Radialisunterarmlappen stellen die häufigste Lappentechnik zur Phallusplastik dar, gefolgt von anterolateralen Oberschenkellappen (ALT-Flaps), gestielt oder mikrochirurgisch transplantiert. Bevorzugt werden hydraulische Mehrkomponentenprothesen, ergänzend können Zusatzeingriffe wie Skrotum- oder Glansplastiken sinnvoll und/oder erforderlich werden. Die Komplikationsmöglichkeiten nach Phallusplastik und späterer prothetischer Versorgung sind erheblich. Trotzdem liegen die Zufriedenheitsraten nach Phallusplastik häufig bei >80 %.

Schlussfolgerung

Aufgrund der Prävalenzzunahme besteht aktuell ein Bedarf an interdisziplinären Zentren zur operativen Therapie der Geschlechtsinkongruenz. Eine gewisse Standardisierung der operativen Techniken und des Timing wäre wünschenswert, ist jedoch aus dem Stand der gegenwärtigen Fachliteratur nicht abzuleiten. Die jüngst unter der Schirmherrschaft der deutschen Gesellschaft für Urologie und der Gesellschaft für Plastische- und Wiederherstellungschirurgie gegründete S2K-Leitlinienkommission zur operativen Therapie der Geschlechtsinkongruenz lässt eine erste Sammlung von Empfehlungen für das Jahr 2021 erhoffen.

Abstract

Background

The increasing prevalence of gender dysphoria necessitates an evaluation of the literature of phalloplasty techniques for female to male transgender individuals.

Objective

The following article provides an overview of the current surgical concepts and complications of phalloplasty, associated urethrogenitoplasty and the implantation of prostheses in phalloplasty.

Material and methods

Current international reviews and original publications from 2010 to 2020 were reviewed and correlated with our referral center experience with more than 350 female to male transgender patients over the last 25 years.

Results

Free radial forearm flap phalloplasty is the most widely used technique, followed by an anterolateral thigh flap (ALT flap) and pedicled or microsurgical transplantation. Hydraulic multicomponent prostheses are given preference and supplementary surgical techniques, such as scrotoplasty and glans sculpturing can make sense or be necessary. The complication rates after phalloplasty and after insertion of penile prostheses are substantial. Nevertheless, the overall patient reported satisfaction rate in the majority of studies is often over 80%.

Conclusion

Due to the increasing prevalence of gender dysphoria there is currently a need for interdisciplinary referral centers for gender reassignment surgery. A certain standardization of surgical techniques and timing would be desirable but a review of the current literature shows a high heterogeneity so that this cannot be derived from the currently available literature. It is hoped that the recently founded S2K guideline committee on operative treatment of gender dysphoria under the auspices of the German Society for Urology and the Society for Plastic and Reconstructive Surgery can report an initial collection of experiences in 2021.

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Authors and Affiliations

  1. Urologische Klinik und Klinik für robotisch assistierte Urologie, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Deutschland

    M. Sohn & S. Morgenstern

  2. Klinik für Plastische, Ästhetische Chirurgie, Wiederherstellungs- und Handchirurgie, Agaplesion Markus Krankenhaus Frankfurt, Frankfurt, Deutschland

    U. Rieger

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  1. M. Sohn
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  3. S. Morgenstern
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Correspondence to M. Sohn.

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M. Sohn, U. Rieger und S. Morgenstern geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt.

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Sohn, M., Rieger, U. & Morgenstern, S. Geschlechtsangleichung von Frau zu Mann. Urologe 59, 1340–1347 (2020). https://doi.org/10.1007/s00120-020-01328-0

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