THE ROLE OF COLPOCLEISIS WITH URETHRAL LENGTHENING IN TRANSSEXUAL PHALLOPLASTY

OBJECTIVE: Transsexual surgery is an unique area of rarely performed s urgery. This study examines factors that have significance in the prev ention of major morbidity in this unusual surgery: The role of the gyn ecologist in the psychologic, endocrine, and operative management is p resented. STUDY DESIGN: Initial operations were complicated by fistula s at the urethra-to-phallus anastomosis site. After reviewing these co mplications, we modified our approach to include a two-stage procedure allowing for healing before microsurgery and sparing of the anterior vaginal wall during vaginal hysterectomy and colpocleisis. By sparing the anterior vaginal wall, we were able to better. extend the urethra for later phallus attachment. RESULTS: Using the two-stage procedure a t colpocleisis allowed a significant reduction in the fistula rate. (p = 0.0087) with the effective elimination-fistulas, the use of stiffen ers during phalloplasty for better functional results is possible. CON CLUSION: Extending the urethra during colpocleisis allows for better h ealing and significantly decreased fistula formation. Proper blood sup ply for microvascular surgery and adequate tissue for the anastomosis site contribute to better results.