Vesicovaginal fistula repair after a failed Lehoczky's island flap procedure.

Vesicovaginal fistula (VVF) is the most common genitourinary fistula associated with significant, detrimental impact on the quality of life. Surgical repair of VVF may be complex requiring tissue interposition techniques to bring fresh blood supply, minimize recurrence, and improve functional outcomes. The international literature is scarce regarding complications related to interposition tissue. However, caution is particularly recommended in selecting the tissue interposition technique to avoid unexpected and frustrating problems. We present a 57-year-old woman following multiple failed transvaginal and transabdominal VVF repairs involving a labium majus skin island flap (Lehoczky flap) after radical hysterectomy for cervical cancer.

Metoidioplasty: Surgical Options and Outcomes in 813 Cases.

Introduction: Metoidioplasty is a variant of phalloplasty for transmen that includes the creation of the neophallus from a hormonally enlarged clitoris, urethral lengthening and scrotoplasty. The procedure results in male appearance of genitalia, voiding in standing position and preserved sexual arousal, but without possibility for penetrative intercourse. We evaluated outcomes of metoidioplasty at our center, based on latest surgical refinements. Methods: During the period of 14 years (from February 2006 to April 2020), 813 transmen with mean age of 24.4 years and mean body mass index of 24.6, underwent one stage metoidioplasty. Hysterectomy was simultaneously performed in 156, and mastectomy in 58 cases. Hysterectomy, mastectomy and metoidioplasty were done as a one-stage procedure in 46 transmen. Patients are divided in 5 groups, depending on the type of urethroplasty. Postoperative questionnaires were used to evaluate cosmetic and functional outcomes, as well as patients' satisfaction. Results: Follow-up ranged from 16 to 180 months (mean 94 months). Mean surgery time was 170 minutes and mean hospital stay was 3 days. Length of the neophallus ranged from 4.8 cm to 10.2 cm (mean 5.6 cm). Urethroplasty was complication-free in 89.5% of cases, and ranged between 81% to 90.3% in different groups. Urethral fistula and stricture occured in 8.85% and 1.70% of cases, respectively. Other complications included testicular implant rejection in 2%, testicular displacement in 3.20% and vaginal remnant in 9.60% of cases. From 655 patients who answered the questionnaire, 79% were totally satisfied and 20% mainly satisfied with the result of surgery. All patients reported voiding in standing position and good sexual arousal of the neophallus, without possibility for penetrative intercourse due to small size of the neophallus. Conclusion: Metoidioplasty has good cosmetic and functional outcomes, with low complication rate and high level of patients' satisfaction. In transmen who request total phalloplasty after metoidioplasty, all available phalloplasty techniques are feasable.

Overview on metoidioplasty: variants of the technique.

Number of gender dysphoric people increased over the last few decades with positive social acceptance of transpopulation. Genital gender affirming surgeries are of utmost importance in order to adjust body to the mind of these individuals. Creation of the phallus is usually the last step in transmen transition, which remains demanding and challenging for surgeons, with different options for phalloplasty available. The ideal phallus is esthetically appealing, with preserved tactile and erogenous sensation, enables standing micturition and sexual function with minimal donor-site morbidity. Metoidioplasty, as a variant of phalloplasty, uses the hormonally hypertrophied clitoris to create the neophallus. Metoidioplasty can be considered as a method of choice for thin-built individuals looking for male genitalia with preserved erogeneity, in one-stage genital gender affirming surgery. It can be combined together with removal of reproductive organs and vaginectomy. Preoperative consultation with patients and postoperative follow-up as well as multidisciplinary approach are essential for successful treatment.This literature review aims to assess and discuss different metoidioplasty approaches with a special reference to authors' current metoidioplasty technique.

Hand-assisted laparoscopic radical nephrectomy in pregnancy.

PURPOSE: To demonstrate the beneficial results of hand-assisted laparoscopic tumor nephrectomy in pregnancy and to emphasize the proper timing of such surgery for its crucial importance attempting to avoid fatal cancer-related outcomes as a result of late interventions of aggressive tumors. METHODS: A report of a 32-year-old woman with a 61 × 41 mm chromophobe renal cell carcinoma (RCC) successfully treated with laparoscopic transperitoneal hand-assisted nephrectomy during the 20th week of gestation is presented. RESULTS: The fetus was stable during the intervention; the postoperative period was uneventful; she had a normal vaginal delivery at term and gave birth to a healthy female child. The patient remained tumor-free at her 34-month follow-up. CONCLUSION: Although the pure laparoscopic interventions have become recognized in the treatment of RCC over the last decade, these methods have their limitations and dangers as well. The hand-assistance method makes the procedure faster and safer which is especially important during second or third trimester. Renal biopsy may play a specifically important role in predicting the malignant potential of a renal tumor, whereas postponement of this surgery until after delivery, may lead to the mother's death. To our knowledge, this is the first report on hand-assisted laparoscopic nephrectomy in pregnancy.

Surgical solutions for the complications of the Vaseline self-injection of the penis.

INTRODUCTION: Penile girth enhancement by the injection of Vaseline is an existing practice. Many cases develop severe complications that need surgery. AIM: To report on the reconstructive surgical solutions of the complications of Vaseline self-injection and the outcomes. To develop a modification of a one-step reconstruction method involving the use of pedicled scrotal flaps. MAIN OUTCOME MEASURES: The complications and their surgical solutions were classified as regards severity and difficulty. The outcomes were observed and a newly introduced one-step surgical method was investigated. METHODS: Seventy-eight consecutive patients (87.2% of them with a history of imprisonment) were divided into three groups. In group A, aesthetic penile defects or phimosis caused by the Vaseline necessitated circumcision or local excision. In group B, the whole penile skin was involved, and total skin removal and two- or (a newly modified) one-step reconstructive surgery were performed. In group C, both the whole penile skin and the scrotum were involved: complete skin removal and skin grafting or skin pedicled flap transplantation were carried out. RESULTS: In five cases in group B, postoperative skin necrosis made a second operation necessary. There was one intraoperative urethral injury, where a urethral fistula developed and a second urethral reconstruction was performed. There was no major complication with the newly developed one-stage pedicled flap procedure. At the end of the therapy, all the cases were healed. All of the patients reported successful sexual intercourse after the operations and 91% were satisfied with the result. CONCLUSIONS: The complications depend mainly on the amount of Vaseline injected, the hygienic circumstances, and the personal tolerability. In the worst cases, only radical skin removal and skin transplantation can solve the problem. The newly developed one-step arterial branch-preserving scrotal skin flap reconstruction appears to be a suitable and cost-effective solution for these patients.

Hungarian "jailhouse rock": incidence and morbidity of Vaseline self-injection of the penis.

INTRODUCTION: Vaseline self-injection into the penis is currently a popular procedure in prisons. Since such injections are illegal, severe complications of the procedure can often remain hidden. AIM: To identify the incidence, motivation, and morbidity of Vaseline self-injection into the penis among inmates. METHODS: A total of 4,735 inmates at the largest Hungarian prisons were asked to complete a questionnaire relating to their sexual life, whether they had self-injected Vaseline into their penis, the motivation leading them to resort to Vaseline self-injection, any complications observed and the level of satisfaction attained. MAIN OUTCOME MEASURES: A 17-point questionnaire on the circumstances, motivations, and complications of Vaseline self-injection among prisoners. RESULTS: Of the 1,905 responders, 15.7% admitted Vaseline self-injection. Only around one-fifth of the Vaseline injected subjects had not been satisfied with the original size of their penis and their sexual life up to the time of the injection, a proportion similar to that among Vaseline nonusers. While the satisfaction with the sexual life became significantly worse after the Vaseline injection, the satisfaction with the penis size did not change and an erectile dysfunction developed de novo in 21.4% of cases. The most common motivation for self-injection was a recommendation by another inmate; it was rarely recommended by a sexual partner. Complications had developed among 25.4% of the Vaseline users and 50.3% of them were not satisfied with the result of the Vaseline injection. Of the Vaseline users, 22.4% regretted the self-injection, while the rate among those who had developed complications was 53%. CONCLUSIONS: The self-injection of Vaseline into the penile skin proved to be somewhat of a trend among these inmates. The complications depended mainly on the amount of Vaseline injected, the poor hygienic circumstances, and the personal tolerability. Increased awareness is needed for the prevention of this social, psychological, and physical problem.