[Re-reconstructive surgery in failure of genitoplasty in male-to-female transsexuals]

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. 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. 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. 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

Pattern of compensatory hypertrophy in contralateral testis after unilateral orchiectomy in immature rabbits

Our aim was to evaluate effects of hemicastration in immature rabbits on the histology of the contralateral testis after puberty. Eighteen immature male rabbits were randomly divided into two groups. The first group underwent right or left hemicastration and the second, sham operation. After their puberty, the rabbits underwent the second operation. In the former group the contralateral testis and in the latter, the right or left testis was removed and sent for pathologic examination. The two groups were compared in terms of Leydig cell count, testis volume, and seminiferous tubule count and diameter. The mature rabbits' mean weight at the orchiectomy time, seminiferous tubule count, and seminiferous tubules diameter did not show significant differences between two groups. However, testis volumes and Leydig cell count were significantly higher in the first group with hemicastration prior to puberty. The mean testis volume was 3.24 +/- 2.06 mL in the first group and 1.4689 +/- 0.85701 mL in the second group [P = .03], and the mean Leydig cell count in every 5 microscopic high-power fields was 86.22 +/- 54.96 and 42.00 +/- 18.09, respectively [P = .04]. Our research demonstrated that prepubertal hemicastration in rabbits led to the compensatory hypertrophy in the contralateral testis after puberty and an increase in the number of the Leydig cells

Surgical repair of posterior urethral defects. Review of literature and presentation of experiences

The main objective of the present review article was to study the different aspects of reconstructive surgery for posterior urethral defects by reviewing the published articles and presentation of our experiences in the reconstructive urology division at Shohada-e-Tajrish hospital. The Medline was searched with the keywords of posterior urethroplasty, end-to-end anastomosis, excisional urethroplasty, anastomotic urethroplasty, pelvic fracture, bulboprostatic anastomosis, and urethral repair. The search was limited to papers published from 1980 to September 2008. We selected the relevant published articles in this database and also presented our experience at our reconstructive urology division. Of over 5000 search results, we selected 38 relevant articles with substantial contribution to the subject. Pelvic fracture due to accidents was the most common etiology of pelvic fracture urethral distraction defect that usually involved the membranous urethra. Surgical treatment of this disorder with perineal anastomotic urethroplasty was accompanied by a success rate of 82% to 95% in different studies. The most important complications of this surgery include urinary incontinence and impotence; however, the incidence of these complications has been reduced by using new surgical techniques. Complete preoperative assessment, the use of suitable reconstructive techniques, and in particular, the use of flexible cystoscopy can lead to acceptable outcomes of the surgical repair of pelvic fracture urethral distraction defects