Fresh human cadaver vaginoplasty surgical prosections to guide surgical technique, post-operative care, and the design of a novel neovaginal dilator and douching device
1: Cedars-Sinai Medical Center, United States
Objectives: Gender affirming vaginoplasty surgical techniques vary, and their description is often limited to "how to", but less often "why"- or "why not". Answers to the latter can be especially enriching for surgeons. We highlight here several observations about genetic male pelvic anatomy as it relates to vaginoplasty for MtF transgender women, and describe how studies using anatomic dissection and histology support specific techniques and care guidelines.
Methods: 1. We review the anatomic basis for a sharp peri-prostatic surgical approach for creation of the neovaginal cavity, compared to the traditional sub-bulbar approach; 2. We describe anatomic dissection findings using 15 fresh cadavers on which we performed vaginoplasty surgery (penile inversion), imaging, and sagittal sectioning,; 3. We describe anatomic findings using fresh cadavers after vaginoplasty surgery to highlight challenges associated with common douching techniques
Results: Anatomic dissection and immunohistochemistry results showed that the sharp dissection we describe is associated with incision through significantly fewer blood vessels and sensory-motor nerves as compared to the traditional surgical approach. Imaging studies in living trans women and fresh cadavers after vaginoplasty suggest that the shape of the neovaginal cavity is S-shaped. We describe a novel dilator-douche design we have developed (U.S. Patents Pending). Findings also suggest that it is less likely that the apex of the vaginal vault is effectively irrigated with douching using conventional douche devices and techniques.
Conclusions: Our anatomic findings suggest that a sharp surgical approach upon the apex of the prostate gains access to a surgical plane anterior to DVF as distally as possible, poses less risk to immediate or delayed injury to the rectum, and injures fewer collateral nerves (many of which are likely sensory) during direction of the neovaginal space. The neovagina in a transgender woman is S-shaped, and reflects the shape of the dilator design we introduce. Our findings also suggest that the deepest part of the neovagina is unlikely to be irrigated with douching. Poor hygiene of the vault may contribute to general poor hygeine of the neovagina, and granulation tissue The novel dilator-douche device design we describe addresses this, as it allows douching to occur through the dilator.
Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.Go Back