re- reconstructive surgery in failure of genitoplasty in male-to-female transsexuals

Background: Various surgical procedures were described for the correction of the external genitalia in male-to-female transsexualism. In all these methods complications such as vaginal stenosis, unpleasant appearance of external genitalia and lack of consent are seen. This paper describes a method of surgery for repair of these complications and success rate of this surgery.Methods: Reconstructive surgery was performed by one surgeon in 16 patients from 2009 to 2011 in Imam Reza Hospital of Mashhad. Mean age 25.75 years of age from 21 to 31 years. Due to the condition of each patient appropriate reconstructive surgery was performed. These surgeries include: clitoroplasty, inverted U flap, labioplasty, urethroplasty, removal of excess skin and increasing depth of vagina. After the surgery, the patients admitted for complete bed rest up to 5 days. They received postoperative prophylaxis medication for anti-thromboembolic events.Results: Only 3 complications were seen in all 16 patients. One hematoma of surgery site, one infection of surgery site and a blood transfusion. Eleven patients had history of vaginoplasty using small intestine and 10 patients with penile and perineal skin. From 3 to 24 months follow up after discharge were done, no patient had a major complication in long-term follow up and were generally satisfied with their sexual intercourse.Conclusion: This study has some limitations. Follow-up of the patients was performed for about one year that longer follow-up for these patients is favorable. Also, evaluation of patients' satisfaction from their intercourse was not performed as systematically with using an standard questionnaire and by a person who is blind to the study. Using this method of restoring external genitalia in the hands of expert surgeon, aesthetic and functional result would be expected very well.