Body dysmorphia is a debilitating disorder that centralizes on a preoccupation with one’s physical appearance. Often, these individuals seek surgical correction in an effort to subdue this preoccupation. A majority of complications from feminizing gender reassignment surgery, consists of urethral stricture or stenosis, leading to voiding dysfunction. The patient is 39-year old male who underwent bilateral nipple removal, bilateral orchiectomy, scrotectomy and total penectomy with perineal urethrostomy, one year prior to consult. The patient eventually presented with acute urinary retention secondary to perineal urethrostomy stenosis. Urethroplasty with revision of perineal urethrostomy site using a buccal graft was done; and on follow up, he was noted to have good urine flow on uroflowmetry with mild lower urinary tract symptoms. Complex urethral strictures may be noted in patients with prior reconstructive history and lengthy areas of fibrosis. Although perineal urethrostomy is a valid surgical course of treatment for patients with complex strictures, improper technique, suboptimal patient factors, and, poor healing may lead to stenosis. The study aims to describe the use of a buccal graft as a viable alternative and easily reproducible technique to augment a revision perineal urethrostomy and lessen the recurrence of stenosis.

Trsnssexualism, one of the gender identity disorders, has been increasing and evokes a serious social problem. The role of sex reassignment surgery in these patients are still controversial but in properly selected patients sex reassignment surgery is the best way to normalize their lives. However. guidelines for the proper selection of the patients for surgery is not yet established in Korea So. we present our experiences of two male transsexuals treated with rectosigmoid vaginoplasty and introduce the prerequisites to sex reassienment surgery.
Gender Identity ; Humans ; Korea ; Male* ; Sex Reassignment Surgery* ; Social Problems ; Transsexualism*

PURPOSE: Transgender is a disorder of gender identity, who have appropriate chromosomal, hormonal and anatomical characteristics corresponding to their sexual phenotype but feel strongly with respect to their sexual identity, that they belong to the opposite sex. There is a persistence discomfort and sense of inappropriateness about one's assigned sex in a person who has reached puberty. Transgender is a psychiatric problem, but surgical method provides more satisfactory adjustment for patients. In gender reassignment surgery for female to male transgender, mastectomy, nipple reduction, hysterectomy, oophorectomy and phalloplasty are included. And as the final operation, recommended for scrotoplasty and artificial testes insertion. So we investigated the necessity and method of scrotoplasty in the final operation of female to male transgender. METHODS: The authors have long term follow-up of 75 cases female to male transgender from January 1991 to February 2008. Among them, 13 cases were evaluated in this study. During phalloplasty, the labium major skin preserved. And this labium majoral skin flap was made for the neoscrotum. At least six months later, artificial testes were inserted in neoscrotum with local anesthesia. Middle sized(3cm diameter) artificial testes(silicon gel or carving soft silicone implant) were used because of the limitation of the neoscrotum. We evaluated the questionnaire and interview about the postoperative satisfaction in configuration of reconstructed scrotum, and the necessity of operation, the postoperative psychosocioeconomic improvement and limitation of body exposure activities such as swimming, public bathing. RESULTS: Based on this study, satisfaction of reconstructed scrotum after scrotoplasty was improved(92%). The necessity of scrotoplasty was in 92.3% and the postoperative psychosocioeconomic well-being improvement was 77% in answers. Less limitation of activities requiring body exposure was 54% in answers. Most of the patients were satisfied with the results of surgical operation despite of some postoperative complications. CONCLUSION: This study reports that the scrotoplasty in female to male transgender is not only a conversion of external genitalia but also an improvement of psychosocial state. As most of the patients sincerely hope to take this operation, we improve our surgical method for more good results.
Anesthesia, Local ; Baths ; Female ; Follow-Up Studies ; Gender Identity ; Genitalia ; Humans ; Hysterectomy ; Male ; Mastectomy ; Nipples ; Ovariectomy ; Phenotype ; Puberty ; Questionnaires ; Scrotum ; Sex Reassignment Surgery ; Silicones ; Skin ; Swimming ; Testis

Due to growing social acceptance, there has been an increasing number of gender-affirmation surgeries performed in North America. Most research in this patient population focuses on surgical outcomes and advancing techniques. However, little work has been done to study functional outcomes. To better evaluate urinary dysfunction in the postphalloplasty trans men patient population, our group developed a novel patient-reported outcome instrument - the postphalloplasty urinary function test (PP UFT) and protocol to measure postvoid urethral volume (PVUR), and we present our preliminary results. We conducted a cross-sectional pilot study in a cohort of 15 adult trans men who had undergone phalloplasty with urethral lengthening surgery between 2018 and 2021. Patients had stable urinary function via the neophallus at the time of survey. Patients filled out the PP UFT and were asked to record their PVUR as per our protocol. The average PP UFT score was 8.9 out of 40 and the average quality-of-life (QOL) score was 2.6. Postvoid dribbling constituted the major complaint and on average comprised 63.2% of the reported PP UFT score. The average PVUR was 2.2 ml (range: 0.5-5.6 ml). There was a positive correlation between higher PP UFT and worse-reported quality of life (P < 0.01; R² = 0.4). Current questionnaires accepted in cis-male urology have limitations for accurately capturing urinary dysfunction in this specific patient group. The combination of PP UFT and PVUR measurement offers potential for quantifying urinary function and quality of life in patients who undergo phalloplasty. Future studies will validate these instruments.
Adult ; Humans ; Male ; Quality of Life ; Cross-Sectional Studies ; Pilot Projects ; Sex Reassignment Surgery ; Urethra/surgery*

Transsexualism is a variety and complexity of conditions to the desire for sex change and may require medical treatments over psychological evaluations in some patients. Consequently, there is a potential confusion in the determination of anatomical sex in transsexuals arising from administration of hormone and/or sex reassignment surgery. In this article, we represent a case of a 52-year-old "woman"found dead on the road-side. "She"was naked on the scene and supposed to be murdered by strangulation of he neck. Surprisingly, autopsy findings as well as DNA typing revealed that "she"was transsexual once a man. We discuss medicolegal problems posed by medico-surgical treatment in transsexuals.
Autopsy* ; DNA Fingerprinting ; Female ; Homicide ; Humans ; Middle Aged ; Neck ; Sex Reassignment Surgery ; Transsexualism

It is believed that surgery on human immunodeficiency virus (HIV)-positive patients is dangerous and should be avoided due to the possibility of postoperative infection of the patients or HIV occupational transmission to the medical staff. We discuss here the preparations and measures needed to conduct surgery safely on HIV-positive patients, based on our experience. We performed sex reassignment surgery on two HIV-positive patients from January 2013 to January 2015. Both of them were receiving highly active antiretroviral therapy and were asymptomatic, with a normal CD4 count (>500 cells/microL). The HIV-RNA was undetectable within the bloodstream. All the staff wore protective clothing, glasses, and three pairs of protective gloves in the operating room because of the possibility of transmission. Prophylactic antibiotics were administered to the patients, and antiviral therapy was performed during their perioperative course. Neither of the patients had postoperative complications, and none of the medical staff experienced accidental exposure. Both patients had satisfactory surgery outcomes without complications. HIV-positive patients can undergo surgery safely without increased risk of postoperative complications or HIV transmission to the staff through the proper use of antibiotics, active antiretroviral therapy, and supplemental protective measures with post-exposure prophylaxis for the staff in case of HIV exposure.
Anti-Bacterial Agents ; Antiretroviral Therapy, Highly Active ; CD4 Lymphocyte Count ; Eyeglasses ; Glass ; Gloves, Protective ; HIV ; HIV Infections ; Humans* ; Medical Staff ; Operating Rooms ; Post-Exposure Prophylaxis ; Postoperative Complications ; Protective Clothing ; Sex Reassignment Surgery*