Skip to main content

Advertisement

SpringerLink
Log in

Is vaginal mucosal graft the excellent substitute material for urethral reconstruction in female-to-male transsexuals?

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

Construction of a neourethra is always considered to be a difficult part in phalloplasty, especially for the female-to-male (FTM) transsexual patients. We report our experience with prefabricated pars pendulans urethrae using vaginal mucosal graft for phalloplasty in FTM transsexuals.

Materials and methods

We retrospectively reviewed notes on the 22 FTM patients treated with pedicled-flap phalloplasty with prefabricated pars pendulans urethrae using vaginal mucosal graft between January 2008 and December 2012. Surgical outcome, urological function, and complications were recorded. Histological difference between normal mucosa and skin, and pathological changes of vaginal mucosal graft were also observed.

Results

All the reconstructive penis survived, and patients could void in a standing position finally at a median follow-up of 25.4 ± 6.0 months. Urethral fistula and urethral stricture rates were 31.8 % (7/22 patients) and 4.5 % (1/22 patients), respectively. The occurrence of the urethral stricture was remarkably low compared with previous reports. Our histological results also showed a pronounced similarity between vaginal and buccal mucosa. Morphologically, they resembled urethral epithelium more closely than the forearm skin. Following the free transfer, the vaginal mucosal graft also showed a good revascularization and the inflammatory reaction and the extent of fibrosis of the mucosa decreased to the normal level after a 6-month prefabrication.

Conclusion

With prefabrication of vaginal mucosal graft, we reconstruct a competent phallic neourethra in these FTM transsexuals. According to its histological similarities and source character, the vaginal mucosa is the excellent substitute material for promising urethral reconstruction in FTM transsexuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Gilbert DA, Horton CE, Terzis JK et al (1987) New concept in phallic reconstruction. Ann Plast Surg 18:128–136

    Article  CAS  PubMed  Google Scholar 

  2. Selvaggi G, Elander A (2008) Penile reconstruction/formation. Curr Opin Urol 18:589–597

    Article  PubMed  Google Scholar 

  3. Selvaggi G, Bellringer J (2011) Gender reassignment surgery: an overview. Nat Rev Urol 8:274–282

    Article  PubMed  Google Scholar 

  4. Wroblewski P, Gustafsson J, Selvaggi G (2013) Sex reassignment surgery for transsexuals. Curr Opin Endocrinol Diabetes Obes 20:570–574

    Article  PubMed  Google Scholar 

  5. Hage JJ, Bloem JJ (1993) Review of the literature on construction of a neourethra in female-to-male transsexuals. Ann Plast Surg 30:278–286

    Article  CAS  PubMed  Google Scholar 

  6. Hage JJ, Bouman FG, Bloem JJ (1993) Preconstruction of the pars pendulans urethrae for phalloplasty in female-to-male transsexuals. Plast Reconstr Surg 91:1303–1307

    Article  CAS  PubMed  Google Scholar 

  7. Mckillop C (2007) Interview with Dr Guido Barbagli. Substitution urethroplasty: which tissues and techniques are optimal for urethral replacement? Eur Urol 52(3):602–604

    Article  Google Scholar 

  8. Bhargava S, Chapple CR (2004) Buccal mucosal urethroplasty: is it the new gold standard? BJU Int 93(9):1191–1193

    Article  CAS  PubMed  Google Scholar 

  9. Patterson JM, Chapple CR (2008) Surgical techniques in substitution urethroplasty using buccal mucosa for the treatment of anterior urethral strictures. Eur Urol 53(6):1162–1171

    Article  PubMed  Google Scholar 

  10. Thompson IO, van der Bijl P, van Wyk CW et al (2001) A comparative light-microscopic, electron-microscopic and chemical study of human vaginal and buccal epithelium. Arch Oral Biol 46(12):1091–1098

    Article  CAS  PubMed  Google Scholar 

  11. Blaivas JG (1989) Vaginal flap urethral reconstruction: an alternative to the bladder flap neourethra. J Urol 141(3):542–545

    CAS  PubMed  Google Scholar 

  12. Blaivas JG, Heritz DM (1996) Vaginal flap reconstruction of the urethra and vesical neck in women: a report of 49 cases. J Urol 155(3):1014–1017

    Article  CAS  PubMed  Google Scholar 

  13. Hendren WH (1998) Construction of a female urethra using the vaginal wall and a buttock flap: experience with 40 cases. J Pediatr Surg 33(2):180–187

    Article  CAS  PubMed  Google Scholar 

  14. Hu ZQ, Hyakusoku H, Gao JH, Aoki R, Ogawa R, Yan X (2005) Penis reconstruction using three different operative methods. Br J Plast Surg 58(4):487–492

    Article  CAS  PubMed  Google Scholar 

  15. Hage JJ, de Graaf FH (1993) Addressing the ideal requirements by free flap phalloplasty: some reflections on refinements of technique. Microsurgery 14:592–598

    Article  CAS  PubMed  Google Scholar 

  16. Hoebeke P, Selvaggi G, Ceulemans P, De Cuypere G, T’Sjoen G, Weyers S, Decaestecker K, Monstrey S (2005) Impact of sex reassignment surgery on lower urinary tract function. Eur Urol 47:398–402

    Article  PubMed  Google Scholar 

  17. Monstrey S, Hoebeke P, Selvaggi G et al (2009) Penile reconstruction: is the radial forearm forearm flap really the standard technique? Plast Reconstr Surg 124(2):510–518

    Article  CAS  PubMed  Google Scholar 

  18. Fang RH, Kao YS, Ma S et al (1999) Phalloplasty in female-to-male transsexuals using free radial osteocutaneous flap: a series of 22 cases. Br J Plast Surg 52:217–222

    Article  CAS  PubMed  Google Scholar 

  19. Byun JS, Cho BC, Baik BS (1994) Results of one-stage penile reconstruction using an innervated radial osteocutaneous flap. J Reconstr Microsurg 10:321–331

    Article  CAS  PubMed  Google Scholar 

  20. Rohrmann D, Jakse G (2003) Urethroplasty in female-to-male transsexuals. Eur Urol 44(5):611–614

    Article  PubMed  Google Scholar 

  21. Biemer E (1998) Penile construction by the radial arm flap. Clin Plast Surg 15(3):425–430

    Google Scholar 

  22. Filipas D, Fisch M, Fichtner J et al (1999) The histology and immunohistochemistry of free buccal mucosa and full-skin grafts after exposure to urine. BJU Int 84(1):108–111

    Article  CAS  PubMed  Google Scholar 

  23. Zaino RJ, Robboy SJ, Bentley R et al (2004) Diseases of the vagina. In: Kurman R (ed) Blaustein’s pathology of the female genital tract, 4th edn. Springer, New York, pp 131–136

  24. El-Sherbiny MT, Abol-Enein H, Dawaba MS et al (2002) Treatment of urethral defects: skin, buccal or bladder mucosa, tube or patch? An experimental study in dogs. J Urol 167(5):2225–2258

    Article  CAS  PubMed  Google Scholar 

  25. Levine LA, Elterman L (1998) Urethroplasty following total phallic reconstruction. J Urol 160(2):378–382

    Article  CAS  PubMed  Google Scholar 

  26. Glim JE, van Egmond M, Niessen FB et al (2013) Detrimental dermal wound healing: what can we learn from the oral mucosa? Wound Repair Regen 21(5):648–660

    Article  PubMed  Google Scholar 

  27. Zhang Y, Lu L, Zhang W et al (2010) A simple and effective method for phalloplasty in female-to-male transsexuals. Plast Reconstr Surg 126(5):264e–265e

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Thanks to Benjamin G. Huey from Medical School of Emory University for his careful reading on grammar and expression of English, Dr. Yueju Su from Department of Mathematics & Statistics in Georgia State University for her statistical assistance. This work was supported by Grant Nos. 10ZR1439200, 2006079 of the Natural Science Foundation of Shanghai and 81100950 of Natural Science Foundation.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

All human have been approved by the Ethics Committee of Second Military Medical University and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study have been omitted.

Author information

Author notes

    Authors and Affiliations

    1. Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China

      Ying-Fan Zhang, Cai-Yue Liu, Li-Xuan Lu, An-Tang Liu, Lie Zhu, Hui Wang, Zi-Hao Lin, Yao-Zhong Zhao, Xiao-Hai Zhu &  Hua-Jiang

    2. Department of Urology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China

      Chuang-Yu Qu

    Authors
    1. Ying-Fan Zhang
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Cai-Yue Liu
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Chuang-Yu Qu
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Li-Xuan Lu
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. An-Tang Liu
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Lie Zhu
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Hui Wang
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Zi-Hao Lin
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Yao-Zhong Zhao
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Xiao-Hai Zhu
      View author publications

      You can also search for this author in PubMed Google Scholar

    11. Hua-Jiang
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding authors

    Correspondence to Xiao-Hai Zhu or Hua-Jiang.

    Additional information

    Ying-Fan Zhang and Cai-Yue Liu have contributed equally to this work and share co-authorship.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Zhang, YF., Liu, CY., Qu, CY. et al. Is vaginal mucosal graft the excellent substitute material for urethral reconstruction in female-to-male transsexuals?. World J Urol 33, 2115–2123 (2015). https://doi.org/10.1007/s00345-015-1562-z

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00345-015-1562-z

    Keywords

    Search

    Navigation