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| Name | V07-01: Labia Minora Ring Flap Pars Fixa Urethroplasty and Perineal Masculinization |
| Video Uploader | Video From AUAUniversity |
| Upload Date | This Video Uploaded At 05-10-2021 17:07:02 |
| Video Discription | V07-01: Labia Minora Ring Flap Pars Fixa Urethroplasty and Perineal Masculinization During Single Stage Phalloplasty Authors: Brad Figler, Alex Kavanagh, Mang Chen Introduction: Ring flap urethroplasty is a useful technique for creation of the pars fixa urethra during single stage gender affirming phalloplasty, particularly when significant urethral lengthening is required. In this video, we demonstrate our approach to labia minora ring flap pars fixa urethroplasty and perineal masculinization during single stage gender affirming phalloplasty. Methods: After placing a suprapubic tube, distal vaginal mucosa is excised, proximal vaginal mucosa is cauterized, and the vaginal canal is closed with interrupted suture. The ring flap consists of bilateral superiorly based labia minora flaps that are completely mobilized posteriorly to allow for maximal urethral lengthening. After developing the flaps, they are secured to eachother dorsally and ventrally to create the pars fixa urethra. The neo-scrotum is made from bilateral superiorly based labia majora flaps that are completely mobilized posteriorly then rotated 180 degrees and secured to eachother. A multi layer closure is performed over the penile and pars fixa urethra. The posterior perineum is reconstructed in a VY fashion to create a male appearing flat perineum. Results: From October 2017 through March 2020, this procedure was performed on 95 patients. Complications occurred in 39 (41%) patients, including fistula in 20 (21%), stricture in 12 (13%), and both fistula and stricture in 9 (9%). Most fistulas resolved without surgical intervention, and most strictures required surgery. A total of 23 (24%) patients underwent urethroplasty for strictures and/or fistulas. Anastomotic strictures were short with an average length of 1.4cm. In most cases, native-pars fixa strictures required buccal graft substitution urethroplasty whereas pars fixa-pars pendulans complications were treated with Heineke-Mikulicz urethroplasty. Conclusions: Labia minora ring flap pars fixa urethroplasty and perineal masculinization allows for creation of a reliable urethra and aesthetically pleasing external genitalia during single stage gender affirming phalloplasty. Rates of fistula and stricture formation are consistent with other published phalloplasty series, and can be readily managed with conventional urethral reconstructive techniques. Source of Funding: None |
| Category | Entertainment |
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