Surgery 138(6):971–977 discussion 977-978, Tsai SD, Kawamoto S, Wolfgang CL, Hruban RH, Fishman EK (2015) Duodenal neuroendocrine tumors: retrospective evaluation of CT imaging features and pattern of metastatic disease on dual-phase MDCT with pathologic correlation. Purpose: The identified instruments' validity in the transgender population was assessed for adherence to international guidelines for development and validation of health outcomes instruments. Color Doppler US and MR imaging are indicated to identify the course of the vascular pedicle of the vessels in the penoid and of the neourethra in patients undergoing prosthesis insertion. Of 3 patients who wished to ultimately stand to void, 2 were able to do so at follow-up. The evidence for GRS complications and functional outcomes is of low level. Potential ramifications of long-term hormone use combined with chronic health conditions of aging create a unique set of health issues for TGNC individuals considering GAS in their later years. Introduction: PubMed Central The difference in genotype does not explain the high complication rate in the transsexual group as eight in the vaginal agenesis or aplasia group had Morris syndrome (testicular feminisation (XY)). Mining companies constructed rail infrastructure to take iron ore to ports on the Orinoco river. Nowadays, great importance is also given by patients to the reconstruction of the clitoro-labial complex; this is also reconstructed with tissue coming from glans penis, penile skin envelop and scrotal skin. Our experience in reconstructive surgery of the penis in 136 cases is reported. Lengthening of the female urethra to male dimensions may cause urethral fistulae, urethral strictures and meatal stenoses. The choice of the method had to be made depending on the patient's condition and prediction of the operative results. Clinical implications: *Baudewijntje Kreukels, VU Amsterdam Vulvoplasty patients were older and had higher body mass index than those seeking vaginoplasty. Ann Surg 231(6):890–898, CAS The Sidor plant was designed to make use of hydro-electricity from the Caroni, a tributary of the Orinoco, to process iron ore which had been hitherto exported. The present study compared the uroflowmetry (UFM) parameter results between transgender males and age-matched cisgender females. The transsexuals therefore had an extended recovery period including several admissions and visits to the outpatient clinic. PROMs are a powerful assessment tool, and standardised definitions of adverse events and functional outcomes should be a priority of future research. Functionally, the majority of the patients were able to lubricate the neovagina and have painless intercourse with a potential for orgasm. Linda has provided with adeptness and respect when employed on highly sensitive projects while still ensuring a holistic improvement in security is achieved. The maximum tumor diameter were 11–30 mm in ampullary and 10–100 mm in non-ampullary NETs, respectively. One low-grade complication (bladder spasms) was reported. - Genital embryology and anatomy Jpn J Clin Oncol 44(3):224–231, Kachare SD, Liner KR, Vohra NA, Zervos EE, Fitzgerald TL (2014) A modified duodenal neuroendocrine tumor staging schema better defines the risk of lymph node metastasis and disease-free survival. SIDOS UK Ltd (Security in design offers solutions) based in Bedfordshire are Security Consultants in Crime and Terrorism Risks. In this paper, we present a review of the various methods to line the neovagina in male-to-female transsexuals. The necessary program involves much more than surgery, and is described herein. A single-center, retrospective cohort study was performed from January 2013 to January 2018. J Clin Oncol 26(18):3063–3072, Article With prefabrication of vaginal mucosal graft, we reconstruct a competent phallic neourethra in these FTM transsexuals. The UFM parameter results and postvoid residual urine volume (PVR) were compared between groups. Gender-affirming genital surgery consults were reviewed from March 2015 until December 2017, and patients scheduled for or who had completed vulvoplasty were interviewed by telephone. Since its first description more than 20 years ago, phalloplasty using a free sensate flap is commonly considered as the gold standard for phallic reconstruction in female-to-male (FTM) transsexuals. He interprets his artist name as " s uper- i ntelligentes D rogen o pfer" (super-intelligent drug victim). The aim of this study was to identify the literature in which structured patient-reported outcome measures have been used to evaluate the results of gender confirmation surgery, and to systematically evaluate the validity of these instruments. Psychiatric screening was a mandatory prerequisite. The purpose of this chapter is to explore the physiological and anatomical issues that affect older transgender, gender nonconforming (TGNC), and non-binary individuals who are eager to have gender-affirming surgery (GAS) later in life or individuals who have completed GAS and may be dealing with residual complications. Is vaginal mucosal graft the excellent substitute material for urethral reconstruction in female-to-male transsexuals? Best results are obtained by a multidisciplinary team including urologists, plastic surgeons, and gynecologists. Results: All rights reserved. World J Gastroenterol 19(39):6693–6698, Tsujimoto H, Ichikura T, Nagao S, Sato T, Ono S, Aiko S, Hiraki S, Yaguchi Y, Sakamoto N, Tanimizu T, Yamamoto J, Hase K (2010) Minimally invasive surgery for resection of duodenal carcinoid tumors: endoscopic full-thickness resection under laparoscopic observation. So far, the authors have been unable to develop a satisfactory method for primary construction of the labia minora. The excess scrotal skin formed the labia. Seitdem galt bei Mann-zu-Frau geschlechtsangleichenden Eingriffen die penile Invaginationsmethode lange Zeit als goldener Standard. [5] In early 2009 compensation of around $1.65bn was nearly agreed for the nationalisation of Ternium's 59.7% stake, with Ternium also keeping a 10% stake in the company. . Gender-affirming vaginoplasty aims to create the external female genitalia (vulva) as well as the internal vaginal canal; however, not all patients desire nor can safely undergo vaginal canal creation. Implanters should have a thorough understanding of neophallic reconstructive technique prior to proceeding with device placement. The most common complication was stenosis of the neo-meatus (14.4%). Most participants underwent phalloplasty with urethral lengthening using a radial forearm flap. Results: J Hepatobiliary Pancreat Sci 22(3):181–196, TNM (2009) Classifacation of Malignat Tumours. The penile skin inversion technique is the most researched surgical procedure. Multiple microsurgical anastomosis was performed, and the donor site was coated with a skin graft from the thigh of partial thickness. The two groups differed as the patients with vaginal agenesis or aplasia had remarkably few complications compared with the transsexual group. Plastic and reconstructive surgery of the genital area. Age, BMI, and HRT are not associated with complications and thus should not dictate timing of surgery. For the male-to-female individual, a more in-depth description is provided of facial feminizing surgery (FFS), of breast augmentation, as well as of the different techniques for vaginal reconstruction. *GuyT'Sjoen, Ghent University Hospital Purpose of Review Although minor modifications were made throughout the years, the basic surgical technique remained the same over this 17.5-year period. A systematic review of the current literature was performed to identify structured patient-reported outcome measures used to evaluate the outcome of gender confirmation surgery. Key Clinical Message Tax calculation will be finalised during checkout. Secondary construction of the labia minora was performed 27 times, and a skin reduction of the labia majora was performed 20 times. °specific indications: Fournier’s’ gangrene, penile cancer Stricture formation occurred in 35 (63%) phalloplasty and 5 (63%) metoidioplasty cases. van de Grift TC, Pigot GLS, Boudhan S, et al. Mean follow-up time was 23 months (range 12 to 71). Purpose: He attended the Home Office Crime Reduction College for both Crime Reduction and Architectural liaison. Follow-up period ranged from 6 months to 35 months. Age, BMI, and HRT were not associated with complications. Results: °complete phallic reconstruction: radial forearm phalloplasty, alternative phalloplasty No 'penile fracture' was noted. Methods: A total of 26 transgender males who received GHT for longer than 1 year and the same number of age-matched cisgender females were enrolled. Am Surg 80(8):821–826, Carter JT, Grenert JP, Rubenstein L, Stewart L, Way LW (2009) Neuroendocrine tumors of the ampulla of Vater: biological behavior and surgical management. Vaginoplasty using pedicled penile skin with a urethral flap is a good alternative to other methods of vaginoplasty in male-to-female sex reassignment surgery. Endocrinological part: Postoperative trans women in sexual health clinics: Managing common problems after vaginoplasty, Urethral Anatomy and Urethral Reconstruction in Phalloplasty and Metoidioplasty, Sex reassignment of transsexual people from a gynecologist's and urologist's perspective, Robotic Excision of Vaginal Remnant/Urethral Diverticulum for Relief of Urinary Symptoms Following Phalloplasty in Transgender Men, Systematic review of studies reporting perioperative and functional outcomes following male-to-female gender assignment surgery (MtoF GAS): A call for standardization in data reporting, Reconstrucción fálica total con colgajo libre antebraquial radial tras amputación peneana iatrogénica, Complications of the Neovagina in Male-to-Female Transgender Surgery: A Systematic Review and Meta-analysis with Discussion of Management: Systematic review of neovaginal complications, Transgender Physiology, Anatomy, and Aging: A Provider’s Guide to Gender-Affirming Surgeries, Urologic Complications After Phalloplasty or Metoidioplasty, Does Depth Matter? We suggest more robust ways of reporting complications, and the impact on patients' quality of life should be investigated. Data were collected when they applied for surgery and at least 1 year after surgery. Boston: Little Brown; 1973. p. 117–61. Most patients were able to develop strong support systems and showed a marked decrease in suicidal tendencies postoperatively. The operation should result in a normal appearing introitus, a vaginoplasty allowing for sexual intercourse and a sensitive clitoris. This chapter addresses access and insurance barriers to GAS, multiple chronic conditions of older transgender individuals compared to their cisgender counterparts, potential issues of polypharmacy and hormone therapy, and physical preoperative contraindications prior to top surgery, including breast augmentation or mastectomy, and bottom surgery, including vaginoplasty, phalloplasty, and metoidioplasty. Prejudice sometimes will betray us. J Sex Med 2018;XX:XXX-XXX. Current techniques of transmasculine genital surgery are based on a knowledge of urethral anatomy and physiology and advances learned through phalloplasty procedures and management of urethral complications. Google Scholar, Soga J (2003) Endocrinocarcinomas (carcinoids and their variants) of the duodenum. volume 402, pages925–933(2017)Cite this article. The procedure may include the reconstruction of the urethra. In: Horton C, editor. Neovaginal stenosis was the most frequent complication in both techniques. Yet, gender identity problems are relatively frequent. °disorders of sex development (DSD) Evidence acquisition: In this article a review is given of gender role behaviour and gender identity in patients with DSD and is discussed how these problems may be addressed in the psychological counselling of parents and children. The main conclusions are that vaginal width and subjective evaluation of functional aspects were clearly better after penile and scrotal skin inversion, especially when there was adequate dilatation by the patient. - Reconstruction of male genitalia in the female-to-male (FTM) transsexual The evaluation of the LUT after the surgical approach of male-to-female transsexuals is similar to other areas of incontinence and includes a clinical approach with history, bladder diary, self-completed questionnaire, urodynamic studies, and radiographic imaging of the lower urinary tract which may provide important information for the treating clinician. Primary connection of the pars fixa and pars pendulans urethrae often leads to formation of fistulas at the level of the anastomosis. Based on a questionnaire battery, assessing psychosocial aspects, the ENIGI PSY STEERING COMMITTEE wishes to: In the follow-up, special attention was paid to the patients' reactions to the surgery and to the anatomical and functional results. Post-void dribbling was reported by 79% of the FTM transsexuals, and 16% of the MTF group reported some form of incontinence. We experienced a 21% rate of vaginal stenosis with 40% of these patients fully functional after a corrective operation. More than 90% of the patients were satisfied with the cosmetic result and capacity for orgasm; 58% reported having sexual intercourse. Evidence acquisition: The castration procedure used between 1972 and 1977 included removal of both the testes and the spermatic cord. After surgery, transmen were more sexually active (masturbation and with a partner) and used their genitals more frequently during sex compared with before surgery (31-78%). Different techniques have been adopted during decades. In this paper the various methods are described and discussed. Malignancies of the vagina and ovaries are rare. They did not complain because the vagina was unimportant in their sexual activities. In female-to-male transgender individuals breast cancer may develop, sometimes in residual mammary tissue after reductive mammoplasty. In most patients with disorders of sex development (DSD) gender role behaviour and gender identity develop in accordance with the assigned gender. Vulvoplasty is a form of gender-affirming feminizing surgery that does not involve creation of a neovagina, and it is associated with high satisfaction and low decision regret. Shortening of the male urethra to female dimensions is usually uneventful. During the first operation, the penile abscess was drained, the necrotic residues were debrided and placement of hypogastric drainage. Breast reduction, hysterectomy, and phalloplasty including vaginectomy should be rather attempted in a two-session procedure than in a one-stage approach. To read the full-text of this research, you can request a copy directly from the authors. All rights reserved. Of all 63 patients included, 8 (13%) underwent metoidioplasty and 55 (87%) phalloplasty (27 (43%) free radial forearm flap (FRFF), 19 (30%) anterolateral thigh (ALT flap, 9 (14%) superficial circumflex iliac artery perforator flap (SCIP)). 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. J Gastrointest Surg 7(6):773–776, Hartel M, Wente MN, Sido B, Friess H, Buchler MW (2005) Carcinoid of the ampulla of Vater. Morphologically, they resembled urethral epithelium more closely than the forearm skin. The hypothesis is tested that decreased T in aging men might result from increased E2 negative feedback. Operative techniques and results of the use of the superficial inferior epigastric pedicled skin flap, rectus abdominis myocutaneous pedicled flap and radial forearm free flap for phalloplasty are presented and discussed. A proximal segment of the corpora cavernosa was retained to reconstruct a clitoris. Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE, Abdalla EK, Fleming JB, Vauthey JN, Rashid A, Evans DB (2008) One hundred years after "carcinoid": epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States.