Added: Lenny Gentner - Date: 14.01.2022 19:37 - Views: 23835 - Clicks: 2867
Literature reports three cases where penile transplantation has been performed for cis-men, with the last two cases being considered successful. To determine whether an en bloc surgical dissection can be performed in a male cadaver, in order to include structures necessary for penile transplantation from a deceased donor male to a recipient with female genitalia in gender affirmation surgery. The study was conducted in the form of explorative dissections of the genital and pelvic regions of three male cadavers preserved in phenol-ethanol solution.
The first two dissections failed to explant adequately all the relevant structures. The third ftm impregnated, which was performed along the pubic arch and through the perineum, succeeded in explanting the relevant structures: it, in fact, allowed for identification and adequate transection of urethra, vessels, dorsal nerves, crura of corpora cavernosa, and bulb of corpus spongiosum, in en bloc explantation of male genitalia.
It is possible to explant the penis and associated vessels, nerves, and urethra en bloc from a cadaver. This study suggests a surgical technique for en bloc explantation aiming for transplantation of the penis from a cadaveric donor male to a recipient with female genitalia. In gender affirmation surgery GAS trans-men patients chose which surgical technique or penis reconstruction best corresponds to their wishes. The choice is normally taken in accordance and following discussion with the surgeon and possibly the mental health professionals [ 12 ].
However, for some of the patients the surgical techniques currently available e. In addition, some patients will incur in complications that will result in poorly functioning genitalia, or simply the outcomes will not be satisfactory [ 34 ]. All the options available today for penile reconstruction for trans-men, in fact, present with multiple drawbacks, with a relative lack of scientific data regarding complications and [ 56 ]; in addition, dissatisfaction and regret after SRS, though infrequent, are correlated with a poor surgical outcome [ 7 ].
Thus, there is ftm impregnated need to explore new surgical options for penile reconstruction for trans-men.
Already init was argued that transplantation could have advantages compared to the current available techniques [ 8 ]; if successful, in fact, a penile transplant has a chance of providing a cosmetic and functional result superior to that of a surgically constructed neophallus. Recent literature reports ftm impregnated allogenic human penile transplantations [ 9 ] performed in cis-men: therefore, none of them was performed for GAS. The first one was performed in China in on a man after traumatic severance of the penis, with the surgery reversed after two weeks due to a negative psychological reaction [ 10 ].
The second was performed in South Africa and reported inon a man who lost his penis in a failed ritual circumcision; have been described as satisfactory, with the recipient reporting natural spontaneous erections ftm impregnated impregnating his partner [ 1112 ]. All three patients were able to void spontaneously through the urethra. Following the first case of penile transplantation, authors in [ 813 ] criticized the approach adopted in patient selection and possibly some aspects of the surgical technique used by the Chinese group.
Nevertheless, penile transplantation was still believed to potentially offer the best outcomes in penile reconstruction [ 8 ]. With this vision in mind, recent research is investigating the anatomical structures and the feasibility of penile transplantation; so far, research has not focused specifically on penile explantation with the purpose of penile construction for trans-men. This study aims to determine whether an en bloc surgical technique can be employed for penile transplantation from a cadaveric donor male to a recipient with female genitalia for trans-men GAS.
Options for explantation of the penis and associated vessels, nerves, and urethra are investigated.
Subjects of the study are three male cadavers preserved in a phenol-ethanol solution. Their ages were not provided, but all subjects were elderly at their ftm impregnated. The cadavers had been dissected for teaching purposes prior to the dissections in this study but had only been moderately dissected in the genital area.
More specifically, the groin area was partially dissected to expose vessels; ftm impregnated abdomens had been opened to show internal organs; and the scrotums had been opened on one side and one spermatic cord was removed. It is not within the purpose of this manuscript to discuss the ethics of penis transplantation. Ethical issues related to penis transplantation have been initially announced by Caplan et al.
The subjects of this study are cadavers willingly donated to Karolinska Institutet for teaching and research purposes. No reservations or caveats regarding genital dissection or transsexual research were made by the donors. The Department of Medical Biochemistry and Cell Biology at the Sahlgrenska Academy, University of Gothenburg, operates under a statutory right to conduct anatomical research on donated bodies. This is replacing and waiving a IRB approval specific for the present study.
The identity of the donors is protected and no identifying information whatsoever has been available to the researchers. The study was conducted in the form of explorative dissections on the genital and pelvic regions of the cadavers, which were placed in a dorsal recumbent position.
On the first specimen, the dissection was begun by identifying the internal iliac vessels in the abdomen. Dissection of the perineal area was carried out in a manner similar to the approach used to reach the prostate during trans-perineal prostatectomy or to create a cavity during vaginoplasty for trans-women: the surgical dissection went through the perineum, above the rectum, and toward the prostate; then perineal structures as pudendal nerves and internal pudendal vessels were located.
While dissecting the groin areas, one of the external pudendal vessels on the left hand side could be identified and dissected with a patch from the femoral artery. Remaining external pudendal vessels could not be identified due to dissection of the cadaver for educational purposes. The testicles and spermatic cords were removed from the scrotum. The next step was to dissect downwards from the abdomen to reach the groin area, in the plane between the urinary bladder and prostate ventrally ftm impregnated the colon and rectum dorsally, in order to be able to pull the pelvic structures vessels, urinary bladder, and prostate, with the ureters transected out through the perineum.
Branches of the internal iliac arteries that appeared to be going to nongenital structures were transected. To free the transplant, the dissection was continued above the penis down to the pubic symphysis. The suspensory ligament of the penis was transected, and the dissection continued along the pubic arch to free the penile bodies and the entire transplant.
The transplant unit was then removed and placed on the back table; next step was to separate the prostate and urinary bladder from the specimen without causing damage to the urethra, nerves, or vessels. At this point, it became visible that the dissection had only spared one iliac branch on each side, and as these spread diffusely in the bladder-prostate complex, it appeared more likely that they were the inferior vesical arteries than the internal pudendal arteries that were intended to be retrieved.
The section of the explant containing the penis and the section containing the bladder and prostate are connected by a cordlike structure described as the deep perineal pouch containing muscular structures, branches of the internal pudendal artery and vein, branches of the perineal nerves, and the membranous urethra. This section was dissected in an attempt to locate structures in order to free the prostate and bladder from the specimen.
The urethra could be identified but not the internal pudendal vessels Figure 1. Thus, the first dissection failed in explanting the necessary structures intact from the male specimen. The second male specimen was dissected more proximally, without removal of the pelvic structures.
It was attempted to explant the genitals and to identify the relevant vessels and nerves without abdominal dissection. The dissection was carried out down to the suspensory ligament of the penis, similarly to the first specimen.
Differently from the first dissection, in the second specimen the corpora were transected. The inguinal dissection was then conducted to free the penis from the perineum, as in the first ftm impregnated. However, upon back table dissection, it was visually determined that relevant vessels and the urethra had dimensions that were considered inadequate for transplantation onto female genitalia. For the dissection of the third male specimen, another approach for explantation was explored. First, external pudendal vessels were attempted to be identified, dissected, and followed to where they spread in the skin.
On the right hand side, one external pudendal artery could be identified and dissected superficial external pudendal artery ; another transected vessel was identified below, likely to be the deep external pudendal artery. One external pudendal vein could also be identified, though it had been transected in the dissections. On ftm impregnated left hand side, one external pudendal artery could be identified, passing below the femoral vein and into the skin. Then, the spermatic cord on the left hand side was identified and cut above the point where the vessels crossed; the testicle was left in place, since it was determined it could just as well be removed at a later stage.
Next, the perineum was dissected. The crura of the corpora cavernosa were located. The bundle of vessels associated with the crura was assumed to contain the internal pudendal vessels. The skin was incised similarly to the dissection of the first male. Dissection was continued above the penis, down to the pubic symphysis, with transection of the suspensory ligament, location of the dorsal penile vein, and dorsal nerves and continued dissection along the pubic arch Figure 2.
The bulb of the corpus spongiosum was identified through locating the bladder and prostate in the abdomen. The deep perineal pouch could be identified between the bulb and the prostate and transected. Vessels, nerves, and soft tissue were transected. The explant was removed and dissected separately on the back table. The dissection of the third male specimen thus succeeded in explanting the relevant structures en bloc, with a note that not all the external pudendal ftm impregnated could be identified due to the state of the cadaver Figures 3 and 4.
Through the dissections of the three male specimens, a method was developed to explant the male genitalia and associated structures en bloc. The dissection of ftm impregnated first specimen was unsuccessful in preserving necessary vessels, due to difficulties in locating the internal pudendal vessels. The dissection of the second specimen failed in preserving adequate lengths of the necessary structures. Finally, in the third specimen, male genitalia were explanted by dissection along the pubic arch and through the perineum to locate the crura of the corpora cavernosa, which were freed from the bone, and the internal pudendal vessels, which were transected.
The suspensory ligament of the penis, the dorsal penile nerves, and the deep dorsal vein were identified and transected just below the symphysis. The prostate and bulb of the corpus spongiosum were identified between and superior to the crura, and the deep perineal pouch containing the membranous urethra was transected.
The external pudendal vessel which could be identified was followed from the femoral artery to where they branched in the inguinal skin, which was included in the transplant. In the third specimen, the internal pudendal vessels were transected close to the crura ftm impregnated the corpora cavernosa.
It was suggested that instead the abdomen could be dissected similarly to in the dissection of the first male specimen, and a greater length of the vessels was preserved, by following the branches of the internal iliac vessels and meeting the dissection of the perineum. Further, if the vessels are transected close to the crura, the posterior scrotal arteries which branch further dorsally in the pelvis will not be included in the explant, and vascularization to the skin of the explant is not entirely guaranteed.Ftm impregnated
email: [email protected] - phone:(160) 148-9556 x 9930
Reproductive Options for Transgender Individuals