Transsexualism - Vaginoplasty using penile skin and a urethral flapThe surgical aim is to create a perineogenital complex as feminine in appearance and function as possible Male to female surgery includes removal of male genitalia with simultaneous creation of female genitalia is done in one stage.
Vaginoplasty using penile skin and a urethral flap. The present technique raccomended by the Team of Prof. Sava Perovic, is based on penile disassembly (after bilateral orchidectomy) and the use of all penile components for vaginoplasty (except the corpora cavernosa). The neovagina consists of two parts; a long vascularized urethral flap and a pedicled island tube skin flap created from the penile skin. The urethral flap is embedded into the skin tube. The tube, consisting of skin and the urethral flap, is inverted, thus forming the neovagina. The new vagina is inserted into the previously prepared perineal cavity between the urethra, bladder and rectum. The neovagina is then fixed to the sacrospinous ligament. The labia minora and majora are formed from remaining penile and scrotal skin.
Urethral Flap Vaginoplasty
If there is insufficient skin there are two possibilities. One is to use the penile skin to create only the distal part of the vagina, avoiding tension. In this case the proximal part and the base of the vagina are formed from the urethral flap and by secondary epithelialization, which begins on the edges of the well-vascularized urethral flap. If the tube pedicle is too short to place it into the perineal cavity, the new vagina is created using a vascularized urethral flap and free penile skin grafts. Thus, the technique may also be used in patients with a small and/or circumcised penis. In the present vaginoplasty the vascularized urethral flap is essential; it is of adequate length and is never the limiting factor in vaginoplasty. Using penile disassembly the corpus spongiosum is completely preserved and ensures an excellent blood supply. Also, the urethral flap allows a wider neovagina, especially the introitus. If the penile skin is insufficient, the creation of the vagina depends on the urethral flap, which also provides moisture and sensitivity to the neovagina. The results of the interviews showed that orgasm was mainly dependent on the urethral flap. The pseudocervix, made from the ventral part of the divided glans cap, contributes to the sensitivity of the neovaginal base.
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After penile disassembly, the corpora cavernosa are removed up to their attachments to the pubic bones. Remnants of the corpora cavernosa are destroyed (inset). The bulbospongiosus muscle is removed from the bulbous part of urethra.
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Fig.1 - Appearance at the end of surgery. The labia minora cover the neoclitoris.
Fig.2 - Outcome after 6 months.
Fig.3 - Outcome after two years.
- Sava Perovic technique
- Penile skin and urethral flap