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Geschlechtsangleichende Operationen bei Transidentität

Komplikationsvermeidung und -management an ausgewählten Beispielen

Gender reassignment surgery in transidentity

Complication avoidance and management in selected examples

  • Leitthema
  • Published:
Journal für Ästhetische Chirurgie Aims and scope

Zusammenfassung

Hintergrund

Aufgrund der ansteigenden Operationszahlen und der sich verändernden rechtlichen Bedingungen haben die operative Behandlung sowie das Komplikationsmanagement der geschlechtsangleichenden Eingriffe bei transsexuellen Menschen zunehmende Bedeutung für die beteiligten ärztlichen Disziplinen. Die Entwicklung von Therapiealgorithmen und die interdisziplinäre Therapie, die in einem individualisierten Vorgehen mündet, können dazu beitragen, Komplikationsraten geschlechtsangleichender Operationen zu reduzieren. Bei der Phalluskonstruktion bei FzM(Frau-zu-Mann)-transidenten Patienten zielt die Optimierung des operativen Outcomes insbesondere auf die Reduktion von Harnröhrenfisteln oder -stenosen sowie auf eine Reduzierung der Hebemorbidität ab. Geschlechtsangleichende Operationen von Mann zu Frau beinhalten eine hohe Rate von Korrekturoperationen, weshalb zahlreiche Operateure zu einem zweizeitigen Vorgehen tendieren. Die Rate an Major-Komplikationen kann reduziert werden, wenn die entsprechenden Eingriffe in versierten Zentren interdisziplinär durchgeführt werden.

Schlussfolgerung

Aufgrund der Komplexität der einzelnen Behandlungsschritte und hinsichtlich des Komplikationsmanagements der in der Regel elektiven Eingriffe, sollte die Behandlung transidenter Patienten im Rahmen eines individualisierten Behandlungskonzeptes in einem interdisziplinären Team erfolgen.

Abstract

Background

Due to the rising numbers of gender confirmation surgeries and changing legal conditions, the surgical treatment itself and, if necessary, adequate complication management of gender reassignment surgery for transsexual patients are of utmost importance for the medical disciplines involved in treatment. The development of treatment algorithms and the interdisciplinary treatment resulting in an individualized approach can help to reduce complication rates of gender confirmation surgery. In the construction of the phallus in female-to-male transgender patients (FtM) improvement of the surgical outcome specifically targets minimization of urethral fistulas and stenoses as well as reducing donor site morbidity. Sex reassignment surgery of male-to-female transgender patients (MtF) includes a high rate of revision procedures, which is why many surgeons favor a two-stage approach. The rate of major complications can be reduced if the respective interventions are performed in experienced centers by interdisciplinary teams.

Conclusion

Due to the complexity of the individual steps of treatment and the complication management of the typically elective surgery, the operative treatment of transgender patients should be carried out as part of an individualized treatment concept by an interdisciplinary and experienced team.

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Authors and Affiliations

  1. Klinik für Plastische Chirurgie, Wiederherstellungs- und Handchirurgie, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Deutschland

    T. Schlosshauer, S. Kühn,  G. Djedovic & U. M. Rieger

  2. Klinik für Urologie, Agaplesion Markus-Krankenhaus, Frankfurt am Main, Deutschland

    M. Sohn

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  1. T. Schlosshauer
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  2. S. Kühn
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  3. G. Djedovic
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  4. M. Sohn
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  5. U. M. Rieger
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Correspondence to T. Schlosshauer.

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Interessenkonflikt

T. Schlosshauer, S. Kühn, G. Djedovic, M. Sohn und U.M. Rieger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor.

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Schlosshauer, T., Kühn, S., Djedovic, G. et al. Geschlechtsangleichende Operationen bei Transidentität. J Ästhet Chir 11, 185–193 (2018). https://doi.org/10.1007/s12631-018-0162-3

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  • DOI: https://doi.org/10.1007/s12631-018-0162-3

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