پاسخگویی به بیماران
کلینیک دکتر کهن زاد /بیمارستان پارس/بلوار کشاورز/ تهران / ایران
in female to male transsexuals (one single stage)
Shahryar Cohanzad, MD (Sex-Urologist)
The term "Metoidioplasty" is derived from conjunction of the Greek words meta, "toward"; iodio , "male genitalia ";and plasty , "surgical construction".
This procedure is a technically delicate surgery in female to male transsexuals who desire sexual reasignment without complex multistage surgical construction of a large penis. The objective of this procedure is to create a male appearing and normal functioning External Genitalia, without having the patient traumatized at the same time.
A person with a gender identity disorder is a person who strongly identifies with the other sex. The individual may identify with the opposite sex to the point of believing that he/she is, in fact, a member of the other sex who is trapped in the wrong body."TRANSSEXULISM " is the term to define the "GID"s entering adolescence facing the surgery as the sole treatment option. It strictly differs from "HOMOSEXUALISM" which in fact is an orientation disorder.
Methods and Materials:
22 transsexuals properly fulfilled the DSM-4 criteria:
Repeatedly stated desire to be, or insistence that he or she is the other sex.
In boys, preference for cross-dressing or simulating female attire; In girls, insistence on wearing only stereotypical masculine clothing.
Strong and persistent preferences for cross-sex roles in make believe play or persistent fantasies of being the other sex.
Intense desire to participate in the stereotypical games and pastimes of the other sex.
Strong preference for playmates of other sex.
with 46xx karyotypes; 22 to 29 years of age; All totally aware and consented about the specifications ,outcomes and shortcomings of such procedure, taking masculinization hormonal replacement medication for the period of at least 3 month to maximum of 1 year (Testosterone Enanthate 250mg weekly IM), underwent a extensive surgery including : Bilateral Mastectomies, Hystero-Oophorectomy and construction of the male genitalia (Metoidioplasty) in one single staged procedure (Operative time 4 to 9 hours). The penile shaft was derived from the patient's own "Clitoris" and the "Scrotum" was constructed by its the most compatible analogue the "Labia Majora", associated with the implantation of two prosthetic silicone made "testes".
In contrast to the original technique in which the" urethroplasty" is performed during a second staged surgery and associated with complications( such as fistula and stricture), here I performed a primary repair by end to end anastomosis of the genuine urethra to its newly folded counterpart in two cases. None experienced complications of any kind. Both are "pointers" rather than" sitters" at the present time.
A foley catheter is properly placed. The Labia majora are raised as inferior based flaps. The Clitoris is circumscribedly incised encircling the Labia minora.They are elevated posterior to anterior. Chordee must be dealt with and completely removed. The internal wings of Labia Minora are fused together to produce the pendulous urethra. Primary anastomosis of this pendulous to genuine urethra is to put off for the second stage. Although this ananstomosis has been the part of the surgery in two cases. The Clitoris and Labia Minora are removed anteriorly and the outer wings are fused in the midline to cover the ventral aspect of the the penis.
The inferior based Labia Majora are raised in a V-Y fashion to accommodate the required space for the Implanted Testes.
Finally another V-Y incision is required to scale up the attempts to produce the the largest penis possible.
Postoperatively in medium duration of 3 year follow up ( 3 month to 4 and half years), all patients have mean 7.5 cm long penis (6 to12 cm) capable of obtaining erections, rigid enough for intromission. One of the patients now possess a 12 cm in length penis indistinguishable from a normal one.
Discussion and Conclusion:
According to the results obtained "Metoidioplasty" seems to have a remarkable status in "Female to Male Sexual Reassignment Surgeries"(SRS) ,without having the patients traumatized or imposing him to bear long term ,highly expensive and above all sometimes less than equally satisfactory multistage techniques . It is possible to provide conditions necessary for" natural, totally sensate and orgasmic" intercourse in one single stage.
Female External Genitalia Pre-Operatively.
Female body habitus Pre-Operatively.
Male External Genitalia Post-Operatively.
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