Penile Microdissection: A Live Donor Feasibility Study in Feminizing Gender-Affirming Surgery.

Area of Science:

• Urology
• Gender-affirming care
• Microsurgery

Background:

• Femininizing gender affirmation surgery involves creating female genitalia.
• Standard procedures often involve the removal of penile structures such as the glans and corpora cavernosa.
• The potential utility of these removed penile tissues for other reconstructive purposes remains an area of investigation.

Purpose of the Study:

• To evaluate the feasibility of utilizing preserved penile structures (corpora cavernosa, glans, and urethral remnants) from gender-affirming vaginoplasty for potential live-donor penile transplantation.
• To assess the safety and efficacy of microvascular penile dissection during gender-affirming vaginoplasty.

Main Methods:

• A retrospective analysis of 41 patients undergoing penile microvascular dissection and gender-affirming vaginoplasty between March 2021 and February 2023.
• Detailed measurement and assessment of the preserved corpora cavernosa, glans, and anterior urethral remnants.
• Follow-up evaluation of patient outcomes and satisfaction.

Main Results:

• The corpora cavernosa were completely preserved in all cases.
• The length of the remaining anterior urethra ranged from 12.70 cm to 16.40 cm.
• The mean glans remnant volume was 85.37% of the total volume, indicating substantial preservation.
• All patients reported satisfactory outcomes following gender-affirming vaginoplasty.

Conclusions:

• Microvascular penile dissection in gender-affirming vaginoplasty is a safe and straightforward procedure.
• The preserved penile structures (corpora cavernosa, glans, and anterior urethra) are viable for potential use in live-donor penile transplantation.
• This technique offers a promising avenue for optimizing tissue utilization in reconstructive surgery.