Robotic Excision of Vaginal Remnant/Urethral Diverticulum for Relief of Urinary Symptoms Following Phalloplasty in Transgender Men.

Autor: Cohen OD; Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY., Dy GW; Department of Urology, New York, University Langone Medical Center, New York, NY., Nolan IT; Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY., Maffucci F; Department of Urology, New York, University Langone Medical Center, New York, NY., Bluebond-Langner R; Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY., Zhao LC; Department of Urology, New York, University Langone Medical Center, New York, NY. Electronic address: Lee.Zhao@nyulangone.org.
Jazyk: angličtina
Zdroj: Urology [Urology] 2020 Feb; Vol. 136, pp. 158-161. Date of Electronic Publication: 2019 Nov 29.
DOI: 10.1016/j.urology.2019.11.027
Abstrakt: Objective: To describe the technique of robotic remnant vaginectomy/excision of urethral diverticulum in transmen and report postoperative outcomes.
Materials and Methods: Between 2015 and 2018, 4 patients underwent robotic remnant vaginectomy/excision of urethral diverticulum for relief of urinary symptoms. Patients were of mean age 36 ± 10.1 years (range 26-50) at time of vaginal remnant excision, and were 26 ± 9.1 months (range 20-39) post-op following their primary vaginectomy and radial forearm free flap (n = 3) or anterolateral thigh (n = 1) phalloplasty. All had multiple urologic complications after primary phalloplasty, most commonly urinary retention (n = 4), urethral stricture (n = 3), fistula (n = 3), dribbling (n = 2), and obstruction (n = 2). Indication for revision was obstruction and retention (n =3 ) and/or dribbling (n = 2). In each case, the robotic transabdominal dissection freed remnant vaginal tissue from the adjacent bladder and rectum without injury to these structures. Concurrent first- or second-stage urethroplasty was performed in all cases at a more distal portion of the urethra using buccal mucosa, vaginal, or skin grafts. Intraoperative cystoscopy was used in each case to confirm complete resection and closure of the diverticulum.
Results: At mean follow-up of 294 ± 125.6 days (range 106-412), no patients had persistence or recurrence of vaginal cavity/urethral diverticulum on cystoscopic follow-up. Of 3 patients who wished to ultimately stand to void, 2 were able to do so at follow-up.
Conclusion: Robotic transabdominal approach to remnant vaginectomy/excision of urethral diverticulum allows for excision without opening the perineal closure for management of symptomatic remnant/diverticulum in transgender men after vaginectomy.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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