V9-06 ROBOT ASSISTED PENILE INVERSION VAGINOPLASTY: A NOVEL TECHNIQUE

Abstract

You have accessJournal of UrologyInfertility, ED, and Reconstruction Lower Tract (II)1 Apr 2017V9-06 ROBOT ASSISTED PENILE INVERSION VAGINOPLASTY: A NOVEL TECHNIQUE Temitope Rude, Kiranpreet Khurana, Aaron Weinberg, Jamie Levine, Michael Stifelman, and Lee C. Zhao Temitope RudeTemitope Rude More articles by this author , Kiranpreet KhuranaKiranpreet Khurana More articles by this author , Aaron WeinbergAaron Weinberg More articles by this author , Jamie LevineJamie Levine More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , and Lee C. ZhaoLee C. Zhao More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2442AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Gender confirmation surgery is an essential component in the management of gender identity disorder. However, short vaginal length, vaginal stenosis, or complications in the perineal dissection are significant limitations of current techniques in male to female surgery. Here we describe our technique for the robot assisted penile inversion vaginoplasty that addresses these needs. METHODS The patient is prepped and draped in low lithotomy position. The penis is degloved through a circumcision incision. The neurovascular bundle, urethra and corpora cavernosa are dissected out. A six cm bulbar perineal incision is then made, and the dissection is carried to the bulbar urethra. The dissected urethra, neurovascular bundle, glans and corpora are delivered through this incision. The bilateral corpora are transected at their most proximal limit and overswen. The penile skin is inverted and gently retracted to allow a two cm incision above the neovagina for the neoclitoris. Immediately below this, an incision for the neomeatus is made. The urethra is brought through this incision and sutured to the skin. The remaining urethral tissue is used as an inlay onto the incised dorsal epithelial surface of the penile skin. The robotic portion of the surgery uses 4 port incisions: periumbiical Gelport with two pre-placed robotic trocars, right and left lateral ports, and an assistant port in the upper right abdomen. The dissection is from the posterior prostate, staying above Denonviller's fascia to reach the endopelvic fascia. Under direct vision, the endopelvics are opened sharply from below and opened to a width of two fingerbreadths. The neovagina is passed into robotic field and pexed to the anterior reflection of the posterior peritoneum. The peritoneal reflection is then closed. The neoclitoris is fashioned from the glans penis and approximated. Labia majora and minora are fashioned with local skin flaps. A foley catheter is left indwelling as well as a vaginal stent. RESULTS The index case required 7 hours of surgical time with an estimated blood loss of 100 mL. The vaginal length was greater than 15 cm. The patient was discharged home on post-operative day three, with no complications. The patient endorses sensation at the neoclitoris and anterior neovagina, and finds the vaginal depth satisfactory CONCLUSIONS Our novel method for robot assisted penile inversion vaginoplasty is an important step in optimizing outcomes for our patients. This technique achieves maximal vaginal length in a safe and reproducible manner. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1058 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Temitope Rude More articles by this author Kiranpreet Khurana More articles by this author Aaron Weinberg More articles by this author Jamie Levine More articles by this author Michael Stifelman More articles by this author Lee C. Zhao More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...