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Surgical treatment of disorders of sexual development
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Rafael V. Pieretti, Patricia K. Donahoe
Partial or complete penoscrotal transposition is often found in cases with penoscrotal and perineal hypospadiac (Figure 80.18). The least severe forms are known as bifid scrotum, prepenile scrotum (Figure 80.19a), and shawl scrotum. The scrotoplasty should be delayed until after the hypospadias repair is completed, to assure vascularization because the distal flaps needed for the hypospadias repair must be divided and displaced during correction of the prepenile scrotum. Six months or more should elapse between the urethroplasty and repositioning of the scrotum. This anomaly is repaired by displacing scrotal skin posteriorly and the penis anteriorly. The base of the penis is advanced forward onto the anterior abdominal wall by creating a square, distally based flap, which circumscribes the base of the penis. The flap is dropped distally to restore normal scrotal length. The abdominal wall is then undermined and swung around the base of the penis to join ventrally in the midline. It is important to mobilize the anterior abdominal wall flaps sufficiently so that midline separation does not occur. See Figure 80.19b–f.
Phalloplasty
Published in James Barrett, Transsexual and Other Disorders of Gender Identity, 2017
A typical metoidioplasty performed in our unit consists of a urethral advancement and V-Y scrotoplasty without clitoral release in order to reduce urethral segmentation and hence worse complications (seeFigure 18.21, plate section). Once healed, two small testicular prosthesis are inserted into the neo-scrotum for cosmesis. There is rarely enough clitoral length to allow the mini-phallus to clear the trouser zip in order to avoid standing up (seeFigures 18.22a, 18.22b).
Pediatric Urogynecology
Published in Linda Cardozo, Staskin David, Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
Angela M. Arlen, Howard M. Snyder, Andrew J. Kirsch
(c) Figure 114.16 This newborn with Ambiguous genitAliA, elevAted 17-hydro-oxyprogesterone And XX chromosomes wAs diAgnosed with congenitAl AdrenAl hyperplAsiA (21-hydroxylAse deficiency): (A) preoperAtive AppeArAnce showing phAllic structure And nonpAlpAble gonAds; (b) prominent scrotAl folds And clitoromegAly; And (c) AppeArAnce 6 months After reduction clitoroplAsty And scrotoplAsty.
Surgical outcomes of testicular prostheses implantation in transgender men with a history of prosthesis extrusion or infection
Published in International Journal of Transgender Health, 2021
Catherine M. Legemate, Freek P. W. de Rooij, Mark-Bram Bouman, Garry L. Pigot, Wouter B. van der Sluis
A former study of our research group reported an explantation rate of 13% after primary prostheses implantation and also found a history of smoking as a predictor for explantation (Pigot et al., 2019). The explantation rate in our population (i.e. after previous explantation due to infection or extrusion) is twice as high. This is most likely the result of the selection of patients who already had complicated healing because of patient-related factors. Furthermore, a lack of enough (good quality) soft tissue to protect the prosthesis during the primary procedure or after infection may be the cause of the higher infection and extrusion rates after reimplantation. The former study also concluded that a trend can be seen toward delayed implantation (Pigot et al., 2019). A mid-scrotal vertical or horizontal incision is made at the scrotophallic transition to create two separate pockets for implantation of the prostheses in case of delayed implantation. Prostheses are closer to the newly created wound if a mid-scrotal incision is used, which might result in higher extrusion rates. During the past years, our scrotoplasty technique has changed requiring more tissue dissection. This could hypothetically lead to a more wound problems. Therefore, testicular prostheses are now implanted at least 6 months after gGAS. Nevertheless, groups in our data were too small to support this hypothesis.