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I receive in Florence, Prato and Milan

Florence
Matteotti Medical Group
Viale Giacomo Matteotti, 42
50132 - Florence (FI)
Telephone: 055 570224
Florence Castello
Villa Donatello
Via Attilio Ragionieri, 101
50019 - Sesto Fiorentino (FI)
Telephone: 055 50975
Prato
Studi Medici Life
Viale della Repubblica, 141
59100 - Prato (PO)
Telephone: 0574 583501
Milan
Columbus Clinic Center
Via Michelangelo Buonarroti, 48
20145 - Milan (MI)
Telephone: 02 480 801

ANDROLOGICAL SURGERY

Gender reassignment

SURGERY

Surgical androgynoid conversion

Male-to-female (MtF) genital adjustment surgery consists of various procedures including:

VAGINOPLASTY, CLITORIDOPLASTY, LABIOPLASTY and BILATERAL ORCHIECTOMY.
The surgery is performed under general anesthesia and consists of two phases: demolition and reconstruction.

Demolition phase

The demolition phase involves the removal of the original genital organs (castration): testicles, epididymis and funiculus, corpora cavernosa, penile urethra. In the same phase, a space is created between the rectum and the bladder which is used in the next phase to allocate the neovagina.

Reconstructive phase

During the reconstructive phase, the skin of the penis, perineum and scrotum is introflexed like a “glove finger” to line a neo-cavity created between the rectum and bladder. The urethra is dissected at the position of the neoclitoris, spatulated and sutured below the neoclitoris with subsequent placement of a bladder catheter. A portion of the glans is kept to build a clitoris that maintains specific erogenous sensitivity and allows for good erotic sensitivity during sexual intercourse, which is achieved in 70-80% of cases. For this reason, the small part of the glans is isolated while maintaining the connection with the nerves, arteries and veins which ensure sensitivity and nourishment. The urethral bulb and the surrounding corpus spongiosum are also removed so that the latter does not disturb sexual intercourse when it swells. Finally, the vulva, the labia majora and minora and the mons of Venus are modeled to obtain a shape as similar as possible to the corresponding female organ.

Other, less used techniques are available for the creation of the neovagina, including the use of part of the intestine to create the vaginal canal.

The operation requires an average hospital stay of 5-6 days.

Possible complications

The operation involves a part of the body in which there are particularly vulnerable organs, such as the rectum, bladder, skin and urethra.


Lesions on these organs can produce fistulas (that is, communications between the rectum and the neovagina, between the bladder and the neovagina) with consequent loss of urine or feces through the neovagina itself and a series of consequent problems, even serious ones (local or generalized infectious processes). These complications require restorative surgery.


Less serious but more frequent complications are blood loss (haemorrhage) during surgery or post-surgery which may require blood transfusions or new operations to reduce/eliminate bleeding.


Rarely a part of the skin with which the vaginal cavity is lined can be lifeless until it goes into necrosis. In this case, a marked narrowing of the vagina can be determined as the non-viable skin causes a scar that tends to retract. In this case, a subsequent re-surgery of remodeling and enlargement of the neovagina may be necessary.


Very rarely, the skin of the neovagina can undergo a process of necrosis such as to make it necessary to completely remove the neovagina itself. In this case, a subsequent operation to create a neovagina will be necessary.


The healing processes of surgical wounds are not predictable and can result in blemishes or asymmetries of the neovagina.

Behaviors to be observed
before and after the intervention

In the weeks preceding the operation, approximately 3-4 weeks before the patient will be required to suspend the hormonal therapy, therapy which will be resumed according to the doctor’s instructions approximately 2 weeks after complete mobilization after the operation.

After the surgery it is necessary to dress the wounds with an antiseptic until they heal, furthermore the use of a rigid dilator is recommended to be used 2/3 times a day for the first few months and then 1/2 times a day, every day, indefinitely (for life).

After each dilatation it is important to use vaginal douches in order to maintain accurate hygiene and avoid the risk of neovaginal infections.

The first sexual intercourse can be undertaken 1-2 months after the operation.

Rest for 10 postoperative days and abstention from physical activity for about 30 days or in any case in relation to the outcome of the medical opinion at the check-up.

Surgical gyno-android conversion

The interventions for the gyno-android conversion are many and can be carried out in isolation or variously associated with each other.
The conversion includes:

Demolition surgeries: hysterectomy (removal of the uterus), colpectomy (removal of the cervix), and mastectomy (removal of the breasts)

Reconstructive operations: metaidoplasty or clitoridoplasty, phalloplasty, scrotoplasty, urethroplasty.

This technique uses the clitoris, overdeveloped by hormone therapy, to build a micro-phallus, which in some cases can reach 5-7 centimeters in length. It consists in freeing from all the connective lacinias and enhancing the erectile tissue present and building a tract of the urethra up to the apex of the small phallus. Small lengthenings of the neophallus can be achieved by transection of the suspensory ligament and sometimes by removal of the suprapubic fat. This intervention has the advantage of maintaining the erogenous sensitivity of the clitoris, allowing a natural erection and, in many cases, allowing urination in an upright position; however, the small size of the constructed organ makes it, in most cases, unsuitable for penetration. For this reason it is rarely requested by those interested in conversion.

The proposed techniques are numerous; essentially they are divided into those that use local tissue to build the neophallus (suprapubic flap) and those that use free flaps taken from other regions and transferred to the appropriate site with microsurgical techniques (antibrachial flap, anterolateral thigh flap).

The neo-urethra, generally covered with skin with appendages (tissues therefore unsuitable for the passage and stagnation of urine), is burdened by a significant rate of immediate and late complications (infections, strictures, fistulas), which often require repeated corrective operations. For this reason, many patients renounce the construction of the neo-urethra, keeping the original meatus and giving up the possibility of urination while standing.

It consists of creating two pockets at the level of the labia majora, introducing and fixing a silicone prosthesis. Rupture, expulsion and dislocation of the prosthesis are infrequent events.

The prosthesis, of the same type as those used for male erectile dysfunction (semi-rigid, malleable, hydraulic two- or three-component), is housed, through a vertical incision at the base of the neophallus, in a pocket obtained by blunting inside the organ and fixed proximally to the pubis.

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    Florence | Matteotti Medical Group

    Viale Giacomo Matteotti, 42
    50132 – Florence (FI)
    Telephone: 055 570224

    Florence Castello | Villa Donatello

    Via Attilio Ragionieri, 101
    50019 – Sesto Fiorentino (FI)
    Telephone: 055 50975

    Prato | Studi Medici Life

    Viale della Repubblica, 141
    59100 – Prato (PO)
    Telephone: 0574 583501

    Milan | Columbus Clinic Center

    Via Michelangelo Buonarroti, 48
    20145 – Milan (MI)
    Telephone: 02 480801

    Dr. Andrea Cocci

    urologist and andrologist

    The decision to dedicate my professional life to urology and in particular to andrological and reconstructive surgery is the result of a deep passion for anatomy , the art of surgery and in general the diagnostic-therapeutic process which leads to the recovery of the patient. Oncological pathology, infertility, erectile dysfunction, penile diseases or simply prostate disorders irreparably afflict not only the individual but also the couple dimension.

    Receive in:
    Florence, Milan, Prato

    Dr. Andrea Cocci
    Urologist e andrologist

    I am fully convinced that listening to the patient, understanding their needs, evaluating their expectations is the only way to establish a successful and satisfying therapeutic program for both the doctor and the patient.
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