What does an FTM phalloplasty look like

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Title:Gender reassignment operations in woman-to-man transsexuals with phalloplasty - comparison of different surgical techniques and assessment of the surgical resultsOther titles:Sex reassignment surgery in female-to-male transsexuals with phalloplasty - comparison of different surgical techniques, and assessment of surgical resultsLanguage:GermanAuthor:Steinmetz, YvesTags:Woman-to-man transsexuality; free radial lobe; Length of hospitalization and incapacity for work; Follow-up operations; Complication rates; female-to-male transsexual surgery; free radial flap; treatment duration; follow-up operations; rate of complications and hospitalizationGND keywords:Surgical technique; Penile prosthesis; Plastic surgery; Urethra; Urination; Surgical risk; Gender transformation; Late complicationPublication date:2010Day of the oral exam:2010-09-15Summary:
The present work examines the results after phalloplasty in the context of
Operative sex reassignment surgery from woman to man following various techniques
was carried out. 2 treatment groups were compared: 49 patients following
various multi-stage techniques were operated on in contract clinics (group 2) and
37 patients who were operated on using the technique established by Daverio (group 1). Of
Daverio primarily uses a one-step phalloplasty procedure, i. d. Usually at the same time
with hysterectomy, oophorectomy and mastectomy, secondary implantation of
Erectile and silicone testicular prostheses. Of the 49 patients in treatment group 2
After a treatment period of 1 to 10 years, 8 patients switched to the
Treatment group 1, where further treatment and prosthesis implantation took place.
The results of the present work show in the patients operated according to Daverio
of group 1 in 81.1 and 84.5 (with doctor changes) percent achieved the
Overall surgical goal (completed sex reassignment) in a
Overall complication rate of 27 percent. Of the urethral complications only occurred
Fistulas, the fistula rate was 5.7 percent. In 11.4 percent, prosthetic
Complications.
The results in group 2 were significantly worse: reaching the
Overall surgical goal in less than 5 percent with an overall complication rate
79 percent. In some cases, various complications accumulated in one patient.
Urethral complications: 49% fistulas, urethral stenoses / strictures 42.9 percent,
as well as hypospadias or meatus feminius in 20.4%; the urethral complications
were recurrent in over 50 percent of patients. Flap necrosis occurred in 42.9
Percent, infections in 46.9 percent, penoid malposition in 31.4 percent and
Complications in the donor area (lifting defect) occurred in 18.4 percent. To complications with
Stiffening material or prostheses occurred in 22.5 percent.
In group 2, the 8 doctor switchers were initially prone to complications, the
further course after the change of doctor with prosthesis implantation in group 1 developed
inconspicuous.
This is also reflected in the functional, physiological and morphological
Results again:
The patients of group 1 with completed at the time of the last survey
Treatment had one of the requirements in terms of functionality and morphology
Corresponding operation result (obtained ability to orgasm, good tactile sensitivity
and erogenous zone on the penoid, normal and problem-free micturition while standing, normal size
and good appearance of the penoid and scrotum, nudism and sauna use possible,
Ability to cohabit with normal movement).
The patients in group 2 showed results that were functional, physiological and
morphologically does not meet the requirements in every respect, the production
a nice looking and normally positioned penoid and especially one
functioning penile urethra is a persistent problem.
Based on our own results, it is concluded that the surgical results of the
Phalloplasty in F-z-M surgery performed at the contracted clinics with different techniques
are unsatisfactory. On the one hand, this is attributed to the fact that here
various surgical steps are carried out, each of which is a high one
Complication rate, the complications add up. Second are the procedures
due to the variety of methods and the involvement of several surgeons from different
Specialist disciplines little standardized.
In contrast, the one-step procedure established by Daverio cuts across the international market
Comparison of literature better. Here, by summarizing the individual operational
Partial steps in one session not only reduce the complication rate and hospitalization dramatically
reduced, the patients achieve the treatment goal within a very short time
(completed gender reassignment) and can resume their work whatever
is not only beneficial for you personally, but also from an economic point of view. If the
If the indication for an F-z-M operation is made, it must be within a manageable range
Treatment period can be carried out successfully. With this in mind it has
the Daverio approach has proven its worth.
The result of the work is that the Daverio method is currently the most suitable
Represents procedures in the F-z-M operation. This also applies under economic aspects,
because a good result is achieved in a short time.

The present study examined the results after phalloplasty in the context of the surgical
Gender reassignment from female to male, which was carried out by various techniques. We
compared 2 treatment groups: 49 patients were treated by various techniques in longer-term
procedures in contract hospitals of public health insurance (group 2) and 37 patients were
treated by the established technique of Daverio (group 1), in which only the private medical
treatment is possible. From Daverio primarily a one-stage procedure is applied in
phalloplasty, normally simultaneously with hysterectomy, oophorectomy and mastectomy,
secondary is the implantation of silicone testicular prostheses and hydraulic prosthesis for
erection. Of the 49 patients in the treatment group 2 after a treatment period of 1 year and up
to 10 years 8 patients changed to the treatment group 1, where further treatment and
prosthesis implantation was carried out.
The results of this study in group 1 (Daverio patients) show in 81.1 or 84.5 (with doctor
changers) percent the achievement of the completed sex reassignment with a complication
rate of 27 percent. Of the urethral complications occurred only fistulas, the rate of fistulas
was 5.7 percent, and 11.4 percent occurred on prosthetic complications.
The results in group 2 were significantly worse: to achieve the overall aim of the operation in
less than 5 percent with an overall complication rate of 79 percent, with partial cumulative
number of complications in a patient. Urethral complications: 49% of fistulas, as well as
urethral stenosis and strictures at 42.9 percent, situation of hypospadias or meatus feminius
at 20.4%, and the urethral complications were recurrent in more than 50 percent of patients.
Flap necrosis occurred in 42.9 percent, 46.9 percent of infections, malposition of the penoid
of 31.4 percent and complications in the donor area at 18.4 percent. Complications with
prosthetic material or stiffening occurred in 22.5 percent.
In the 8 doctor changers, the course in group 2 was first of complications, the further course
after the change of doctor with prosthesis implantation in group 1, was inconspicuous.
This is also reflected in the functional, physiological and morphological results:
Patients in group 1 with the time of the last survey completed treatment had in terms of
functionality and morphology by the requirements of appropriate surgical results (obtained
orgasm, good tactile sensitivity and erogenous zone on the penoid, normal and smooth
urination while standing, the penoid and the scrotum of normal size and good look, possible
nudism and sauna, ability to cohabitation with normal movement).
The patients in group 2 showed results that functionally, physiologically and morphologically
not meet the requirements in every respect, the production of a good-looking and normally
positioned penoid and in particular a functional penile urethra is a constant problem.
Because of our results it is concluded that the surgical results of phalloplasty in FTMoperation
that has been made to the public health insurance contract hospitals with different
techniques are unsatisfactory. This is firstly due to the fact that in this multi-stage techniques
are different surgical steps, each of which has a high complication rate, the complications
add up. Second, the process due to the diversity of methods and the involvement of several
surgeons from different disciplines are not very standardized. However, in comparison with
the international literature, the one-stage procedure established by Daverio performs better.
There is drastically reduced by the aggregation of the individual operations of steps in a
meeting not only the rate of complications and hospitalization, the patients also can reach the
treatment goal (completed sex reassignment) within a short time, can resume to work, which
is not only for them personally advantageous but also from an economic perspective. If the
indication for female-to-male surgery is made, it must be successfully completed within a
foreseeable period of treatment. In this sense, the approach to Daverio has proven
successful.
Result of the work is that currently the procedure under Daverio is the most appropriate
procedure for FTM surgery. This is also in economic terms, because a good result is
achieved in a short time.
Url:https://ediss.sub.uni-hamburg.de/handle/ediss/3825URN:urn: nbn: de: gbv: 18-48612Document type:dissertationSupervisor:PĆ¼schel, Klaus (Prof. Dr.)Included in the collections:Electronic dissertations and habilitations