Jochen Hess

Satisfaction with male-to-female gender reassignment surgery.

BACKGROUND The frequency of gender identity disorder is hard to determine; the number of gender reassignment operations and of court proceedings in accordance with the German Law on Transsexuality almost certainly do not fully reflect the underlying reality. There have been only a few studies on patient satisfaction with male-to-female gender reassignment surgery. METHODS 254 consecutive patients who had undergone male-to-female gender reassignment surgery at Essen University Hospitals Department of Urology retrospectively filled out a questionnaire about their subjective postoperative satisfaction. RESULTS 119 (46.9% ) of the patients filled out and returned the questionnaires, at a mean of 5.05 years after surgery (standard deviation 1.61 years, range 1-7 years). 90.2% said their expectations for life as a woman were fulfilled postoperatively. 85.4% saw themselves as women. 61.2% were satisfied, and 26.2% very satisfied, with their outward appearance as a woman; 37.6% were satisfied, and 34.4% very satisfied, with the functional outcome. 65.7% said they were satisfied with their life as it is now. CONCLUSION The very high rates of subjective satisfaction and the surgical outcomes indicate that gender reassignment surgery is beneficial. These findings must be interpreted with caution, however, because fewer than half of the questionnaires were returned.

Modified Preparation of the Neurovascular Bundle in Male to Female Transgender Patients

Introduction: 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). Materials and 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.

Operative Geschlechtsangleichung im Alter

ZusammenfassungHintergrundDie geschlechtsangleichende Operation (GAO) von Mann zu Frau wird zunehmend auch von den älteren Patientinnen nachgefragt.ErgebnisseNach unserem Kenntnisstand wird hier das erste Mal der Zusammenhang von Alter der Patientinnen und peri- und postoperativem Auftreten von Komplikationen untersucht. Anhand der präsentierten Daten kann gezeigt werden, dass eine altersbezogene Beschränkung für diesen Eingriff aufgrund von peri- und postoperativen Komplikationen nicht gerechtfertigt ist.SchlussfolgerungIndividuell sind Gesundheitsstatus und Selbstversorgungsfähigkeit, sowie körperliche bzw. psychologische Einschränkungen zu berücksichtigen werden, um einen erfolgreichen postoperativen Verlauf und subjektive Zufriedenheit der Patientinnen zu erreichen.AbstractBackgroundGender reassignment surgery (GRS) from male to female is increasingly being requested by older female patients.ResultsTo the best of our knowledge this study has for the first time investigated the correlation between the age of patients and perioperative and postoperative complications. The presented data show that an age-related limitation for this intervention due to perioperative and postoperative complications is not justified.ConclusionHealth status and capability for self-sufficiency as well as physical and psychological limitations must be individually considered in order to achieve a successful postoperative course and a subjective satisfaction of patients.BACKGROUND Gender reassignment surgery (GRS) from male to female is increasingly being requested by older female patients. RESULTS To the best of our knowledge this study has for the first time investigated the correlation between the age of patients and perioperative and postoperative complications. The presented data show that an age-related limitation for this intervention due to perioperative and postoperative complications is not justified. CONCLUSION Health status and capability for self-sufficiency as well as physical and psychological limitations must be individually considered in order to achieve a successful postoperative course and a subjective satisfaction of patients.

Characterisation of human urethral rupture thresholds for urinary catheter inflation related injuries

Data on urethral catheter related injuries is sparse. In this study we aimed to characterise urethral diametric strain and urinary catheter inflation pressure thresholds that precede human urethral trauma during urethral catheterisation (UC). Human urethras were obtained from patients undergoing male to female gender reassignment surgery [(n = 9; age 40 ± 13.13 (range: 18-58)) years]. 12Fr urinary catheters were secured in the bulbar urethra and the catheters anchoring balloon was inflated with a syringe pump apparatus. Urethral diametric strain and balloon pressure were characterised with video extensometry and a pressure transducer respectively. Immunohistochemistry, Massons trichrome and Verhoeff-Van Gieson stains evaluated urethral trauma microscopically. Morphological characterisation of the urethral lumen was performed by examining non-traumatised histological sections of urethra and recording luminal area, perimeter and major/minor axis length. Tearing (n = 3) and rupture (n = 3) of the urethra were observed following catheter balloon inflation. The threshold for human urethral rupture occurred at an external urethral diametric strain ≥ 27% and balloon inflation pressure ≥ 120kPa. Significant relationships were identified between urethral wall thickness and the level of trauma induced during catheter balloon inflation (p = 0.001) and between the pressure required to inflate the catheter balloon and the length of the major axis of the urethral lumen (p = 0.004). Ruptured urethras demonstrated complete transection of collagen, elastin and muscle fibres. In conclusion, urethral rupture occurs at an external urethral diametric strain ≥ 27% or with balloon inflation pressures ≥ 120 kPa. Incorporation of these parameters may be useful for designing a safety mechanism for preventing catheter inflation related urethral injuries.

Sexuality after Male-to-Female Gender Affirmation Surgery

Male-to-Female (MtF) gender affirmation surgery (GAS) comprises the creation of a functional and aesthetic perineogenital complex. This study aimed to evaluate the effect of GAS on sexuality. We retrospectively surveyed all 254 MtF transsexual patients who had undergone GAS with penile inversion vaginoplasty at the Department of Urology, University Hospital Essen, Germany, between 2004 and 2010. In total, we received 119 completed questionnaires after a median of 5.05 years since surgery. Of the study participants, 33.7% reported a heterosexual, 37.6% a lesbian, and 22.8% a bisexual orientation related to the self-perceived gender. Of those who had sexual intercourse, 55.8% rated their orgasms to be more intensive than before, with 20.8% who felt no difference. Most patients were satisfied with the sensitivity of the neoclitoris (73.9%) and with the depth of the neovaginal canal (67.1%). The self-estimated pleasure of sexual activity correlated significantly with neoclitoral sensitivity but not with neovaginal depth. There was a significant correlation between the ease with which patients were able to become sexually aroused and their ability to achieve orgasms. In conclusion, orgasms after surgery were experienced more intensely than before in the majority of women in our cohort and neoclitoral sensitivity seems to contribute to enjoyment of sexual activity to a greater extent than neovaginal depth.

MP94-04 MECHANICAL CHARACTERISATION AND RUPTURE PRESSURE OF HUMAN URETHRAS: A FEASIBILITY STUDY PERFORMED IN EXPLANTED TISSUE FROM PATIENTS UNDERGOING GENDER REASSIGNMENT SURGERY

INTRODUCTION AND OBJECTIVES: Vascular endothelial growth factor (VEGF) is a pleiotropic cytokine known for its angiogenesic activity. Clinical studies have shown that tissue and urinary levels of VEGF are elevated among patients with interstitial cystitis/ bladder pain syndrome (IC/BPS). We investigated whether treatment with anti-VEGF neutralizing antibodies reduced pain and voiding dysfunction in the cyclophosphamide (CYP) cystitis model of bladder pain in mice. METHODS: Adult female mice received anti-VEGF neutralizing antibodies (10 mg/kg intraperitoneal B20-4.1.1 VEGF mAb) or saline (control) prior to receiving CYP (150 mg/kg intraperitoneal). Pelvic nociceptive responses were assessed 5, 48, and 96 hours later by applying von Frey filaments to the lower abdominal/pelvic area. Spontaneous micturition was assessed using the void spot assay. A second paradigm where anti-VEGF treatment was given after CYP cystitis was also investigated. RESULTS: Systemic anti-VEGF pre-treatment in mice prior to CYP-induced cystitis significantly reduced the pelvic nociceptive response compared to saline pre-treatment (control). As shown in the figure, pelvic hypersensitivity decreased significantly between 5 and 48 hours post-CYP in the anti-VEGF pre-treatment group (p1⁄40.0051, n1⁄47). By 96 hours post-CYP, pelvic hypersensitivity had decreased by 47.2% from its peak, and was no longer significantly different from the baseline level in mice pre-treated with anti-VEGF (p1⁄40.17). In contrast, pelvic hypersensitivity remained elevated at 5, 48 and 96 hours in the saline pre-treatment group. There was no difference in urinary frequency and mean voided volume between the two groups at 5, 48, and 96 hours. In the second paradigm where anti-VEGF treatment was given after CYP cystitis has been established, pelvic hypersensitivity was still significantly increased at 96 hours compared to baseline (p1⁄40.0007, n1⁄47). CONCLUSIONS: Administration of anti-VEGF neutralizing antibodies reduced pelvic/bladder pain in the CYP cystitis model of bladder pain compared to controls. Further investigation of the use of anti-VEGF antibodies to manage bladder pain or visceral pain in humans is warranted.

Impact of BCL2 polymorphisms on survival in transitional cell carcinoma of the bladder

PurposeTo evaluate the impact of three BCL2 single-nucleotide polymorphisms, i.e., c.−938C>A (rs2279115), c.21G>A (rs1801018), and c.*2203A>G (rs4987853) on survival in patients with transitional cell carcinoma of the bladder.MethodsWe analyzed 179 patients who underwent surgical treatment for bladder cancer at the Clinic of Urology, University Hospital Essen, Germany. Genomic DNA was extracted and genotyped for the polymorphisms. For all polymorphisms, linkage analysis was performed. Kaplan–Meier and Cox regression analyses were used to determine the putative impact of the three polymorphisms on outcome.Resultsc.−938C>A and c.21G>A, but not c.*2203A>G, are in strong linkage disequilibrium (D′ 0.96). We found a significant association between c.−938C>A and relapse-free survival (p = 0.024) with an allele dose effect. In the same way, c.21G>A had a significant impact on both relapse-free survival (p = 0.009) and progression-free survival (p = 0.012), as well as a pronounced allele dose effect. Regression analysis proved c.21G>A and c.−938C>A, to be an independent risk factor in univariate and multivariable analyses.ConclusionsIn our cohort, both c.−938C>A and c.21G>A showed a significant impact on outcome with TCC of the bladder. Due to the linkage disequilibrium of both SNPs, maybe, only one of them could mediate this effect. In multivariable analysis, however, both proved to be independently associated with overall survival. Contrary to other findings which found the c.−938C>A mainly influencing outcome, our data may suggest that the main effect on TCC could be due to the c.21G>A polymorphism.

MP51-17 IS EVERY PT3A-PROSTATE CANCER (PCA) WITH POSITIVE SURGICAL MARGIN A CANDIDATE FOR ADJUVANT RADIATION (ARTX)? INDIVIDUAL RISK ASSESSMENT BASED ON A PATHOLOGICAL GLEASON SCORE PREDICTIVE MODEL – A MULTICENTRE STUDY

Alexander Karl*, Alexander Buchner, Christian Stief, Christiane Tympner, Thomas Kirchner, Ute Ganswindt, Claus Belka, Munich, Germany; Roman Ganzer, Wolf Wieland, Fabian Eder, Ferdinand Hofst€ adter, Regensburg, Germany; David Schilling, Karl-Dietrich Sievert, Arnulf Stenzl, Marcus Scharpf, Falko Fend, T€ ubingen, Germany; Frank vom Dorp, Jochen Hess, Herbert R€ ubben, Kurt Werner Schmid, Essen, Germany; Daniel Porres-Knoblauch, Axel Heidenreich, Birgit Hangarter, Ruth Kn€ uchel-Clarke, Aachen, Germany; Michael Rogenhofer, Bernd Wullich, Arndt Hartmann, Erlangen, Germany; Evi Comploj, Armin Pycha, Esther Hanspeter, Bozen, Italy; Dirk Pehrke, Guido Sauter, Markus Greafen, Alexander Haese, Hamburg, Germany

Operative Geschlechtsangleichung im Alter@@@Surgical gender reassignment in the elderly

ZusammenfassungHintergrundDie geschlechtsangleichende Operation (GAO) von Mann zu Frau wird zunehmend auch von den älteren Patientinnen nachgefragt.ErgebnisseNach unserem Kenntnisstand wird hier das erste Mal der Zusammenhang von Alter der Patientinnen und peri- und postoperativem Auftreten von Komplikationen untersucht. Anhand der präsentierten Daten kann gezeigt werden, dass eine altersbezogene Beschränkung für diesen Eingriff aufgrund von peri- und postoperativen Komplikationen nicht gerechtfertigt ist.SchlussfolgerungIndividuell sind Gesundheitsstatus und Selbstversorgungsfähigkeit, sowie körperliche bzw. psychologische Einschränkungen zu berücksichtigen werden, um einen erfolgreichen postoperativen Verlauf und subjektive Zufriedenheit der Patientinnen zu erreichen.AbstractBackgroundGender reassignment surgery (GRS) from male to female is increasingly being requested by older female patients.ResultsTo the best of our knowledge this study has for the first time investigated the correlation between the age of patients and perioperative and postoperative complications. The presented data show that an age-related limitation for this intervention due to perioperative and postoperative complications is not justified.ConclusionHealth status and capability for self-sufficiency as well as physical and psychological limitations must be individually considered in order to achieve a successful postoperative course and a subjective satisfaction of patients.BACKGROUND Gender reassignment surgery (GRS) from male to female is increasingly being requested by older female patients. RESULTS To the best of our knowledge this study has for the first time investigated the correlation between the age of patients and perioperative and postoperative complications. The presented data show that an age-related limitation for this intervention due to perioperative and postoperative complications is not justified. CONCLUSION Health status and capability for self-sufficiency as well as physical and psychological limitations must be individually considered in order to achieve a successful postoperative course and a subjective satisfaction of patients.