title: Is vaginal mucosal graft the excellent substitute material for urethral reconstruction in female-to-male transsexuals?
abstract: OBJECTIVE
  Construction of a neourethra is always considered to be a difficult part in phalloplasty, especially for the female-to-male (FTM) transsexual patients. We report our experience with prefabricated pars pendulans urethrae using vaginal mucosal graft for phalloplasty in FTM transsexuals.
  
  
  METHODS
  We retrospectively reviewed notes on the 22 FTM patients treated with pedicled-flap phalloplasty with prefabricated pars pendulans urethrae using vaginal mucosal graft between January 2008 and December 2012. Surgical outcome, urological function, and complications were recorded. Histological difference between normal mucosa and skin, and pathological changes of vaginal mucosal graft were also observed.
  
  
  RESULTS
  All the reconstructive penis survived, and patients could void in a standing position finally at a median follow-up of 25.4 ± 6.0 months. Urethral fistula and urethral stricture rates were 31.8 % (7/22 patients) and 4.5 % (1/22 patients), respectively. The occurrence of the urethral stricture was remarkably low compared with previous reports. Our histological results also showed a pronounced similarity between vaginal and buccal mucosa. Morphologically, they resembled urethral epithelium more closely than the forearm skin. Following the free transfer, the vaginal mucosal graft also showed a good revascularization and the inflammatory reaction and the extent of fibrosis of the mucosa decreased to the normal level after a 6-month prefabrication.
  
  
  CONCLUSIONS
  With prefabrication of vaginal mucosal graft, we reconstruct a competent phallic neourethra in these FTM transsexuals. According to its histological similarities and source character, the vaginal mucosa is the excellent substitute material for promising urethral reconstruction in FTM transsexuals.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China.
authors.forename: Ying-Fan
authors.initials: YF
authors.lastname: Zhang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China.
authors.forename: Cai-Yue
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Department of Urology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China.
authors.forename: Chuang-Yu
authors.initials: CY
authors.lastname: Qu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China.
authors.forename: Li-Xuan
authors.initials: LX
authors.lastname: Lu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China.
authors.forename: An-Tang
authors.initials: AT
authors.lastname: Liu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China.
authors.forename: Lie
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China.
authors.forename: Zi-Hao
authors.initials: ZH
authors.lastname: Lin
authors.affiliation: Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China.
authors.forename: Yao-Zhong
authors.initials: YZ
authors.lastname: Zhao
authors.affiliation: Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China. zhuxiaohai1997@126.com.
authors.forename: Xiao-Hai
authors.initials: XH
authors.lastname: Zhu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, China. yueyue1888@hotmail.com.
authors.lastname: Hua-Jiang
mesh_terms: D000328:Adult; D021522:Bioartificial Organs; D005260:Female; D006801:Humans; D008297:Male; D009092:Mucous Membrane; D010413:Penis; D012189:Retrospective Studies; D057830:Gender-Affirming Surgery; D014189:Transsexualism / Q000601:surgery*; D014521:Urethra / Q000601:surgery*; D014621:Vagina; D055815:Young Adult
keywords: Female-to-male transsexual; Prefabrication; Urethral complication; Urethral reconstruction; Vaginal mucosal graft