[Modern concept for treatment of the female-to-male transsexual]

The experience of our multidisciplinary team in surgical treatment of female-to-male trans-sexualism is presented, and our treatment concepts described in detail. In addition, our preferred technique of neourethra formation using a prefabricated free fibula flap is described.

From 1996 to 2003, thirty-four patients underwent gender reassignment surgery as a staged procedure. The neourethra was constructed using an anterior vaginal flap and the prefabricated free fibular flap.

There were four complete losses of the prefabricated fibular flap (11.7%). The neourethra stricture rate was 20.5% and the fistula formation rate was 14.7%. In 82.3% of the patients, the ability to micturate while standing was achieved.

This modern concept reduces the complication rate and improves the quality of patient outcome.