title: Modified Preparation of the Neurovascular Bundle in Male to Female Transgender Patients.
abstract: BACKGROUND
  The main objective of gender reassignment surgery (GRS) in male to female (MtF) transgender people is to create a functional and aesthetic vagino-clitoral complex. Here we report on a modified preparation of the neurovascular bundle (NVB).
  
  
  METHODS
  Between May 2011 and September 2014, 96 consecutive MtF transgender patients underwent GRS at our department. Sensitivity of the neoclitoris was assessed afterwards. Results were compared with a historical cohort from our department (2004-2010, n = 119) in which perioperative treatment was the same except for the preparation of the NVB.
  
  
  RESULTS
  In 92 (95.8%) and 78 (81.2%) patients information on neoclitoral sensitivity was available and in 79 (82.3%) and 69 (71.9%) sensitivity was tested semiquantatively after first and second stage procedure respectively. A semiquantitative grading system correlated significantly with intermedium-term ability to achieve orgasms (p = 0.036). The modification led to a reduction in operation time by an average of 61 min. With the modified technique, we had a higher rate of postoperative local hematoma but with no need for further intervention.
  
  
  CONCLUSIONS
  Preparation is safe and time saving both preserving the neoclitoral sensitivity and promoting a preferably feminine aspect of the mons pubis. Semiquantitative testing of sensitivity correlates with the intermedium-term capability of achieving orgasms.
authors.affiliation: Department of Urology, University Hospital Essen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Hess
authors.forename: Yasmine
authors.initials: Y
authors.lastname: Hess-Busch
authors.forename: Janine
authors.initials: J
authors.lastname: Kronier
authors.forename: Herbert
authors.initials: H
authors.lastname: Rübben
authors.forename: Roberto
authors.initials: R
authors.lastname: Rossi Neto
mesh_terms: D000328:Adult; D002987:Clitoris / Q000294:innervation*; D015331:Cohort Studies; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D009948:Orgasm; D010413:Penis / Q000601:surgery; D059035:Perioperative Period; D011184:Postoperative Period; D015203:Reproducibility of Results; D012189:Retrospective Studies; D057830:Gender-Affirming Surgery / Q000379:methods*; D063106:Transgender Persons; D014189:Transsexualism / Q000601:surgery*; D055815:Young Adult