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How to manage complications of genitourinary reconstructive surgery

Pubblicato il 10/01/2009

Autore: Prof. Edoardo Austoni



How to manage complications of genitourinary
reconstructive surgery

It seems to me that this topic is interesting to many
urology professionals. The discussion can offer a
thorough update on the matter, considering the
growing importance of technology in this kind of
surgery. The discussion is divided in two parts. The
first one concerns "Penile Surgery" (chaired by Prof.
E. Austoni and Dr. E. Palminteri) whereas the second
one will focus on "Pelvic surgery"(chaired by Prof. S.
Loening, and Prof. Dr. K.D. Sievert).
In the course of the first part of the discussion, several
issues will be discussed.

Female-to-male reassignment surgery

In his presentation "Complications after female-to
male genital reassignment surgery", Prof. M. Sohn
emphasises that penile reconstruction in female-tomale
genital reassignment surgery has reached an
important milestone in transsex-surgery. Most centres
now use abdominal pedicled flaps or free radial
forearm flaps for this purpose. He will provide some
detail on how penile and urethral reconstructions can
be performed in one or two operative procedures.
According to Prof. Sohn, urethral problems, as
postoperative stenoses or fistula are the most
common complication in this type of surgery.
Complete flap loss should be a rare complication and
should not occur in more than 5% of cases. Corrective
surgery can be performed in one or two sessions.
Nevertheless, the recent large volume studies show a
significant percentage of patients return to perineal
urethrostomy after failed fistula or stenoses repair.
Penile prosthesis implantation in a reconstructed
penis is accompanied by a higher complication rate
than in impotent men. The missing corpora cavernosa
has to be reconstructed, mostly from Dacron material.
Penile prosthesis and testicle prosthesis implantation
can be performed in one or two sessions. Infection or
erosion rates of up to 20% have to be expected. Free
radial forearm flaps with superselective nerve
coaptation emerge as the most promising approach
for this group of patients. Despite numerous
complication possibilities, the majority of patients do
not regret to have undergone such complex
procedures.

Autore: Prof. Edoardo Austoni



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