Medical advances in transsexualism and the legal implications.
Harish D, Sharma BR.
Department of Forensic Medicine, Government Medical College, Chandigarh, India.
Transsexualism is a condition wherein an individual's psychological gender is the opposite of his or her anatomic sex. The general belief now among behavioral scientists and physicians is that it is an identifiable and incapacitating disease, which can be diagnosed and successfully treated by reassignment surgery in carefully selected patients. Although many advances have been made in the reassignment surgery techniques, phalloplasty still remains a major challenge; to date, no ideal technique has been developed. The new gender created by the reassignment surgery has, in turn, led to many legal complications for postoperative transsexuals because states and the judiciary have not recognized the new gender. However, with wider acceptance of transsexuals by society, this outlook has changed for the better, with many states amending their laws in accordance with the advances in medical sciences. But in many developed and the developing countries, transsexuals are not given a legal identity, thereby adding to their agonies and miseries.
Obtaining rigidity in total phalloplasty: experience with 35 patients.
Hoebeke P, de Cuypere G, Ceulemans P, Monstrey S.
Department of Pediatric Urology, Ghent University Hospital, Ghent, Belgium.
PURPOSE: The combination of a neourethra and erection prosthesis in a single neophallus in the female-to-male transsexual remains a challenge. The outcome reported in the literature is disappointing. We report our experience with 35 patients. MATERIALS AND METHODS: Between August 1996 and December 2001, 35 patients underwent implantation surgery. A 1-piece hydraulic Dynaflex prosthesis (American Medical Systems, Minnetonka, Minnesota) was used in 10 patients, while a 3-piece hydraulic CXM and CX (American Medical Systems) prosthesis was placed in 9 and 16, respectively. The 1-piece model was withdrawn from the market in 1997. Thereafter a 3-piece prosthesis was implanted. RESULTS: Of 10 patients in the 1-piece group prosthesis implantation was uneventful in 8. In 2 patients with technical failure the prosthesis was replaced, including 1 in whom the new prosthesis was removed due to infection and successfully replaced by a 3-piece prosthesis. To date at a mean followup of 3.5 years 9 patients have a 1-piece hydraulic prosthesis in place. In the 3-piece prosthesis group of 25 patients implantation was uneventful in 20. In 1 patient infection and partial necrosis of the neophallus developed, 2 had infection, in 1 a cylinder perforated the tip of the phallus and in 1 technical failure occurred. Of the latter 4 patients the prosthesis was replaced successfully in 2 patients, while the other 2 are on the waiting list. The patient with partial necrosis of the phallus is no longer a candidate for an erection prosthesis. To date at a mean followup of 1.8 years 23 patients have a 3-piece hydraulic prosthesis in place. A single patient in the 1-piece group has a 3-piece CX prosthesis. CONCLUSIONS: Good results were observed after implantation of the Dynaflex prosthesis in patients who underwent total phalloplasty. This model is no longer available today. For the more complex 3-piece CX and CXM prostheses implantation results are comparable to those of the 1-piece model.
A new technique for augmentation phalloplasty: albugineal surgery with bilateral saphenous grafts--three years of experience.
Austoni E, Guarneri A, Cazzaniga A.
Division of Urology, University of Milan, Ospedale S Giuseppe, Via S Vittore 12, 21123, Milan, Italy. firstname.lastname@example.org
OBJECTIVES: Penile augmentation surgery is a highly controversial issue due to the low level of standardisation of surgical techniques. The aim of the study is to illustrate a new technique to solve the problem of enlarging the penis by means of additive surgery on the albuginea of the corpora cavernosa, guaranteeing a real increase in size of the erect penis. METHODS: Between 1995 and 1997, 39 patients who requested an increase in the diameter of their penises underwent augmentation phalloplasty with bilateral saphena grafts. The patients considered eligible for surgery were patients with either hypoplasia of the penis or functional penile dysmorphophobia. All the patients included in our study presented normal erection at screening. The average penis diameter in a flaccid state and during erection was found to be 2.1cm (1.6-2.7 cm) and 2.9 cm (2.2-3.7 cm), respectively.Before surgery the patients were informed of the experimental nature of the surgical procedure. The increase in volume of the corpora cavernosa was achieved by applying saphena grafts to longitudinal openings made bilaterally in the albuginea along the whole length of the penis. RESULTS: No major complications and specifically no losses of sensitivity of the penis or erection deficiencies occurred during the post-operative follow-up period. All the patients resumed their sexual activity in 4 months. A measurement of the penile dimensions was carried out 9 months after surgery. No clinical meaningful increases in the diameter of the flaccid penis were documented. The average penis diameter during erection was found to be 4.2 cm (3.4-4.9) with post-surgery increases in diameter varying from 1.1 to 2.1cm (p<0.01). CONCLUSIONS: The penile enlargement phalloplasty technique with albuginea surgery suggested by the authors definitely is indicated for increasing the volume of the corpora cavernosa during erection. Albuginea surgery with saphena grafts has been found to be free from aesthetic and functional complications with excellent patient satisfaction.
Complete phalloplasty using the free radial forearm flap for correcting micropenis associated with vesical exstrophy.
De Fontaine S, Lorea P, Wespes E, Schulman C, Goldschmidt D.
Plastic Surgery and Urology Departments, University Hospital Erasme, Brussels, Belgium.
PURPOSE: We present a new surgical technique for reconstructing the penis in a man with micropenis associated with vesical exstrophy. MATERIALS AND METHODS: A free radial forearm flap was used to create a penis of normal length and diameter. The flap was wrapped around the native micropenis. A penile prosthesis was then inserted in the flap to provide erection. RESULTS: The flap was well vascularized and no skin damage was observed 6 years after reconstruction. The patient achieved sexual intercourse on a regular basis. He is satisfied with the result. CONCLUSIONS: Free transfer of the radial forearm flap may be done in select men with micropenis associated with vesical exstrophy for penile reconstruction. An inflatable prosthesis may be inserted in the flap to provide erection. The results of this technique have remained stable in the long term. This method provides a new tool for phalloplasty in these difficult cases.
Transsexualism--general outcome and prognostic factors: a five-year follow-up study of nineteen transsexuals in the process of changing sex. Arch Sex Behav. 1996 Jun;25(3):303-16. PMID: 8726553 [PubMed - indexed for MEDLINE]
Review of the literature on techniques for phalloplasty with emphasis on the applicability in female-to-male transsexuals. J Urol. 1993 Oct;150(4):1093-8. Review. No abstract available. PMID: 8371361 [PubMed - indexed for MEDLINE]
Phallic construction in female-to-male transsexuals using a lateral upper arm sensate free flap and a bladder mucosa graft. Ann Plast Surg. 1993 Sep;31(3):275-80. PMID: 8239421 [PubMed - indexed for MEDLINE]