Laparoscopically assisted colocolpopoiesis.
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Colon↗
Biomedical subjects
R B Karim
Publications and source records attributed to R B Karim.
Rectosigmoid neocolpopoiesis for male-to-female transsexuals: Amsterdam experience.
Penile skin inversion is the method of choice for vaginoplasty in male-to-female transsexuals. Rectosigmoid neocolpopoiesis should be considered only when penile skin inversion has become impossible or has not led to functional results. In this paper we describe our technique and the results of colocolpopoiesis in 7 male-to-female transsexuals.
Humans↗
Sensate pedicled neoclitoroplasty for male transsexuals: Amsterdam experience in the first 60 patients.
The results of vaginoplasty by inversion of penile and scrotal skin in male-to-female transsexuals, in general, are satisfying. Cosmetic and functional considerations dictate the construction of a neoclitoris ventral to the urethral orifice. Embryologically, the glans penis and clitoris are homologues and mutual substitution seems to be the logical approach. In this paper, the long-term results in the first 60 patients using the pedicled sensate neoclitoroplasty according to Brown are presented and discussed. It has proven to be a safe technique that leads to satisfying cosmetic and functional results in nearly all patients. It should be considered state of the art in primary gender-confirming surgery for male-to-female transsexuals.
Clitoris↗
Labial masses following vaginoplasty in male transsexuals: the differential diagnosis.
Following vaginoplasty and vulvoplasty for male-to-female transsexualism, a mass may evolve in one of the major labia in a minority of patients. From April of 1989 to April of 1994, we treated seven patients with such masses. The case reports presented illustrate some of the differential diagnoses of this long-term complication. More often than not, the swelling was caused by infection. The funiculus or even testicular rest in itself also may represent the mass. Intralabial urethral fistula appears to be the second cause of swelling, either with or without inflammation. As an exceptional cause we observed a swelling representing a cyst of prostatic origin. In all, the mass could be excised completely.
Adult↗
Neovaginoplasty in male transsexuals: review of surgical techniques and recommendations regarding eligibility.
The surgical aim of genital reassignment surgery in male-to-female transsexuals is to create a perineogenital complex as feminine in appearance and function as possible. In this paper, we present a review of the various methods to line the neovagina in male-to-female transsexuals. These methods may be classified in five categories involving, respectively, application of nongenital skin grafts, penile skin grafts, penile skin flaps, nongenital skin flaps, and pedicled intestinal transplants. Based on this review and our extensive personal experience, we come to certain recommendations regarding the eligibility of these methods.
Female↗
[Chondrosarcoma of the bony thoracic wall].
An 85-year-old man was admitted because of a slowly growing mass in his left flank, which had been present for 16 years. A very large chondrosarcoma was diagnosed, weighing 8.5 kg. After radical resection of the tumour the patient recovered well. No recurrences developed during follow-up.
Aged↗
Evolution of the methods of neovaginoplasty for vaginal aplasia.
The aim of vaginoplasty should be the creation without excessive morbidity of a neovagina that will be satisfying in appearance, function and feeling. The multitude of methods described in the literature indicates the fact that an ideal approach has not yet been found. In this paper the various methods are described and discussed. It is concluded that the non-operative impression technique, the peritoneum pull-through technique and the use of skin grafts are methods of choice. In cases where immediate vaginal reconstruction after oncological surgery is indicated, myocutaneous flaps are preferred. Only in cases in which other methods have failed should recto-sigmoid transplantation be considered.
Colon, Sigmoid↗
Refinements of pre-, intra-, and postoperative care to prevent complications of vaginoplasty in male transsexuals.
In the period of 1980 to 1992, primary genital reassignment surgery was performed for 200 male-to-female transsexuals aged 18 to 71 years. For this, the penile and scrotal skin inversion technique was used. Because, apart from minor complications in 32 patients, neovaginal obliteration was encountered only twice and early in this series, we believe it is worthwhile to report in detail our pre-, intra-, and postoperative measures. Discontinuation of hormonal treatment may prevent venous thrombosis. The preoperative rectal rinse and antibiotics are believed to be of importance to avoid rectovaginal fistulae. A soft and pliable intravaginal Vaseline tampon may prevent sloughing of the inverted skin. Intermittent daily neovaginal dilatation may successfully ensure neovaginal depth and width and, in our opinion, is superior to a long-term continuous intravaginal stent.
Adolescent↗
Unfavorable long-term results of rectosigmoid neocolpopoiesis.
We report on unfavorable long-term results after rectosigmoid neocolpopoiesis in 12 patients, as well as on possible prevention and treatment of these results. To prevent neovaginal introitus stenosis, the rectosigmoid mucosa should be sutured to the perineal skin in an exaggerated interdigital fashion. In cases where introitus stenosis has developed, pedicled transposition flaps from perineum or labia or from the gluteal or inguinal plica region have to be used. Similar flaps also may be applied in cases of rectovagina fistulas. Neuromas at the mucosa-perineal junction often are resistant to therapy. So-called diversion colitis may be manifested by mucous discharge, mucosal bleeding, or discomfort. This disorder may be treated successfully by local application of a solution containing short-chain fatty acids. Loperamidehydrochloride (Imodium) administered half an hour before intravaginal penetration may be helpful to weaken or even prevent neovaginal contractions. Because of the possible higher risk of neovaginal adenocarcinoma, long-term follow-up of these patients is indicated.
Adult↗
The vanished vagina: an unusual case of abdominal mucocele.
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Adult↗
Sculpturing the neoclitoris in vaginoplasty for male-to-female transsexuals.
One of the goals of vaginoplasty for transsexuals is the construction of an aesthetically appealing female perineum. Cosmetic considerations imply the creation of a clitoris-like structure ventral to the urethral orifice. A review of the scarce references on neoclitoroplasty in the literature on vaginoplasty is given. In our hospital, the neoclitoris is usually sculptured to its final appearance during the actual vaginoplasty, employing a free composite graft of the tip of the penile glans to cover the shortened dorsal neurovascular bundle. From the review of the literature and from our experience one may conclude that our technique presents hardly any complications and leads to acceptable results, both functionally and cosmetically. We consider transpositioning of the glans on its long dorsal neurovascular pedicle a technique with too high a risk.
Adolescent↗
[The treatment of axillary hyperhidrosis].
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Aluminum↗
The importance of near total resection of the corpus spongiosum and total resection of the corpora cavernosa in the surgery of male to female transsexuals.
From 1980 to 1989, 13 male to female transsexuals underwent surgery for resection of the corpus spongiosum, performed at the Department of Plastic and Reconstructive Surgery of the Free University Academic Hospital, Amsterdam, The Netherlands. Except for 1, all patients underwent the primary sex-reassignment procedures in institutions other than this hospital. All had difficulties during sexual activities. After repeat surgery with near complete excision of the corpus spongiosum and also in three instances of the corpus cavernosum, improvement was noticed in all patients. The importance of the total elimination of the erectile tissue is emphasized.
Adult↗