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Shaft-only Phalloplasty with Vaginal Preservation and Vulvo-Scrotoplasty (VPVS)
Wendy Chen, MD, MS; Isabel Cylinder, BA; Alireza Najafian, MD; Daniel D. Dugi, III, MD; Jens U. Berli, MD
University of Pittsburgh Medical Center
2020-01-14
Presenter: Wendy Chen, MD, MS
Affidavit:
Vu T Nguyen
Director Name: Vu T Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose: Genital masculinizing gender-affirming surgery is a growing field in surgery. With a spectrum of gender identity, gender expression, sexual expression, patient desires, and patient tolerance for complications, options for surgery vary accordingly. One such option is a shaft-only phalloplasty. Shaft-only phalloplasty avoids urethral lengthening, but may still be accompanied by hysterectomy, vaginectomy, scrotoplasty, clitoroplasty, and/or perineoplasty.
Methods: We review the technique, decision-making, and post-operative care developed by the senior author for patients who choose shaft-only phalloplasty with vaginal preservation and vulvo-scrotoplasty (VPSV).
Results:
While not absolutely necessary, we prefer to stage masculinization of the genitalia. During the first stage, we create the shaft and site the phallus in close proximity to the clitoral hood. At the second stage, the scrotum is created and the clitoral tissue is either buried or externalized. In order for the scrotum to sit above the vaginal introitus, a vulvoplasty is required, including release of the labia minora at their take of from the clitoral glans, release of the urethral plate, and recreation of a superior vulvar fourchette. A Belgian glansplasty is performed at the same time.
Conclusion: Future studies regarding patient-recorded outcome measures (PROM), aesthetics, sexual function, urologic function, patient satisfaction, and conversion to other options will help surgeons better understand patients pursuing gender-affirming surgery through shaft-only phalloplasty.
