DOCSLIB.ORG

Phalloplasty and Urethral

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Phalloplasty and Urethral plastol na og A y Golpanian et al., Anaplastology 2016, 5:2 Anaplastology DOI: 10.4172/2161-1173.1000159 ISSN: 2161-1173 Review Article Open Access Phalloplasty and Urethral (Re)construction: A Chronological Timeline Samuel Golpanian, Kenneth A Guler, Ling Tao, Priscila G Sanchez, Klara Sputova and Christopher J Salgado* Division of Plastic Surgery, DeWitt Daughtry Family, University of Miami, Miami, FL, USA Abstract Since the first penile reconstruction in 1936, various techniques of phalloplasty and urethroplasty have been developed. These advancements have paralleled those in the field of plastic and reconstructive surgery and offer a complex patient population the opportunity of restoration of cosmetic and psychosexual function. The continuous evolution of these methods has resulted in constant improvement of the surgical techniques in use today. Here, we aim to describe a historical overview of phalloplasty and urethral (re)construction. Keywords: Phalloplasty; Urethroplasty; Reconstruction; Transgen- gender reassignment over the next 40 years. Various fasciocutaneous der; Surgery and extended pedicle island flaps were also developed during this time. Nonetheless, they continued to have suboptimal functional and Introduction aesthetic results due to their significant limitations in sensory recovery Phalloplasty is a complex surgical task. Successful creation or primarily [10,13,14]. restoration of the penis must meet certain cosmetic and functional Throughout the 1970’s other innovations were introduced in the field thresholds. The ideal neophallus should be sensate, hairless, and similar of penile reconstruction. In 1971, Kaplan et al. [15] developed a method in color to the surrounding skin. It should have an inconspicuous scar, that provided sensation to the neophallus. Their method involved maintain rigidity for sexual intercourse, and allow for micturition upon using a pedicled medial thigh flap, based on the femoral branches of standing. A single-stage procedure with minimal donor-site morbidity the genitofemoral nerve, to create the penile shaft and a turned-in is highly desirable, albeit the potential complications that may arise. flap from the median raphe of the scrotum to construct the urethra. Moreover, patient management should not only cover the surgery This technique was initially used for patients who underwent penile but also the psychosocial aspects of the treatment. Unfortunately, no amputation due to penile cancer. In 1972, Orticochea [16], a Colombian single reconstructive method to date has successfully achieved all of physician, first used a pedicled tube flap involving the gracilis muscle to these goals. Penile (re)construction may be required for a variety of provide an erection in patients who required reconstruction secondary reasons such as gender reassignment trauma, and cancer resection [1- to trauma and/or surgical ablation. In addition, the obturator nerve, 4]. Less common applications for phalloplasty include the following: which supplies sensation to the inner aspect of the thigh, was included congenital defects, infectious diseases, as well as other pathologies and allowed the neophallus to experience erogenous, thermal, pain, such as hidradenitis suppurativa and lichen sclerosis [5-8]. Older and tactile sensations. A neourethra was also created. Patients reported reconstructive methods were lengthy and multi-staged. However, as satisfactory results in sexual performance and were even able to achieve the field of plastic surgery has progressed over the last century, so have orgasm. Despite these benefits, this technique consisted of five stages the reconstructive techniques for (re)construction of the phallus and and included complications such as urethral fistulas and stenosis in urethra. The introduction of microsurgical free flaps, in particular, has addition to muscle-related problems with the gracilis muscle. made a tremendous impact on the options available for phalloplasty. That same year, Mc Gregor et al. [17] developed the groin flap In this article we present the methods of phalloplasty and urethral which was later adapted by Puckett, et al. [18] in 1976 for penile (re)construction that have been developed in chronological order, reconstruction, including a Scott penile inflation device to produce starting from the initial reports in the literature to the most recent and an erection. Previously, silicone rubber rods, bone, or cartilage were commonly used techniques. used to provide penile rigidity, but were found to erode through the Re(construction) of the Phallus soft tissue, as the neophallus takes some time to become sensate (9- 12 months). Moreover, the constant rigidity served as a source of The first total penile reconstruction was described in 1936 by embarrassment to the patient [19] and led to the creation of the Scott Bogoras [9], a Russian physician. He called this peniplastica totalis. prosthesis. Initially, the development of a constricting scar around the He used abdominal wall to create a random pattern, tubed, pedicle flap and combined this with autologous rib cartilage graft to provide rigidity to the flap. This created the first penile reconstruction which *Corresponding author: Christopher J Salgado MD, Professor of Surgery, could achieve successful coitus [10]. His technique required four Division of Plastic, Aesthetic & Reconstructive Surgery, Clinical Research Building, 1120 NW 14th Street, 4th Floor, Miami, FL 33136, USA, Tel: 305-243-4500; Fax: stages, and did not create a competent neourethra or an aesthetically 305-243-4535; E-mail: [email protected] pleasing appearance. However, it was certainly innovative in nature. Received: August 01, 2016; Accepted: September 13, 2016; Published: Reconstruction of the urethra within a flap remained a challenge until September 20, 2016 a decade later, in 1946, when Maltz [11] introduced a new step of Citation: Golpanian S, Guler KA, Tao L, Sanchez PG, Sputova K, et al. (2016) inserting an outside-in tubular flap within the tubed abdominal pedicle Phalloplasty and Urethral (Re)construction: A Chronological Timeline. Anaplastology graft. Gillies [12] improved and popularized this method by performing 5: 159. doi: 10.4172/2161-1173.1000159 the first female-to-male reassignment procedure on British physician, Copyright: © 2016 Golpanian S, et al. This is an open-access article distributed Laurence Michael Dillon. Although this method involved [13] separate under the terms of the Creative Commons Attribution License, which permits operative steps, it remained the standard technique for female-to-male unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Anaplastology, an open access journal Volume 5 • Issue 2 • 1000159 ISSN: 2161-1173 Citation: Golpanian S, Guler KA, Tao L, Sanchez PG, Sputova K, et al. (2016) Phalloplasty and Urethral (Re)construction: A Chronological Timeline. Anaplastology 5: 159. doi: 10.4172/2161-1173.1000159 Page 2 of 8 inflation cylinder in the penis posed a problem. However, this was complications, such as fistulas and strictures. However, poor sensory easily resolved by instructing the patients to only partially inflate the recovery remains a disadvantage of the ALT flap. cylinders and to massage the neophallus during the healing phase. In 2007, Perovic et al. [30] reported on the use of the latissimus In 1978, Horton et al. [20] introduced the first single-stage total dorsi free flap for phalloplasty in an effort to counter previous penile reconstruction using bilateral gracilis muscle flaps for the limitations encountered with other reconstructive forms. This flap penile shaft and a full thickness skin graft for the urethra. In addition is easily elevated and has a very long pedicle allowing for an easier to successfully completing penile and urethral reconstruction with and direct anastomosis. There is also minimal donor-site functional minimal morbidity, they also achieved aesthetically favorable results. weakness and scarring. The authors reported an 80% patient satisfaction Advances in microsurgery over the next decade led to the development rate with no flap loss or partial skin necrosis. The latissimus dorsi of the first free flap phalloplasty in 1982 by Song et al. [21] Puckett et al. free flap also provides sufficient length to create an adult sized penis [22] also employed the free flap phalloplasty with a successful outcome size in prepubertal children optimizing results and ensuring a better in two of their patients, while the third required a staged procedure psychosexual development [31]. In the same year, Wang et al. [32] and secondary to flap loss. In 1984, Chang et al. [23] were the first to report Yang et al. [33] reported the use of a free scapular skin flap for penile the tube-within-a-tube radial forearm free flap (RFFF). This flap reconstruction, although this was first described in 1997 by Rohrich et provided soft, hairless forearm skin, with uniformly thin subcutaneous al. [34] as a combined reconstruction with a latissimus dorsi free flap tissue and a long vascular pedicle. They used autologous rib cartilage for penile and perineal reconstruction. Due to the scapula’s complex to provide rigidity since they believed that acrylic or silicone implants anatomical configuration, they preferred to use a penile implant were prone to erode through the soft tissue after several years. Seven of to provide adequate rigidity. Both investigators achieved favorable their patients had successful
Load more

Recommended publications
  • Phallo-After-Meta.Pdf
    SURGEON'S CORNER The Surgical Techniques and Outcomes of Secondary Phalloplasty After Metoidioplasty in Transgender Men: An International, Multi-Center Case Series Muhammed Al-Tamimi, MD,1,2,3 Garry L. Pigot, MD,2,3 Wouter B. van der Sluis, MD, PhD,1,3 Tim C. van de Grift, MBA, MD, PhD,1,3,4 R. Jeroen A. van Moorselaar, MD, PhD,2 Margriet G. Mullender, MBA, PhD,1,3,4 Romain Weigert, MD,5 Marlon E. Buncamper, MD, PhD,1,3,4,6 Müjde Özer, MD,1,3,4 Kristin B. de Haseth, MD,1,4 Miroslav L. Djordjevic, MD, PhD,7 Christopher J. Salgado, MD,8 Maud Belanger, MD, PhD,9 Sinikka Suominen, MD, PhD,10 Maija Kolehmainen, MD,10 Richard A. Santucci, MD,11 Curtis N. Crane, MD,11 Karel E. Y. Claes, MD,12 Stan Monstrey, MD, PhD,12 and Mark-Bram Bouman, MD, PhD1,3,4,6 ABSTRACT Introduction: Some transgender men express the wish to undergo genital gender-affirming surgery. Metoi- dioplasty and phalloplasty are procedures that are performed to construct a neophallus. Genital gender-affirming surgery contributes to physical well-being, but dissatisfaction with the surgical results may occur. Disadvantages of metoidioplasty are the relatively small neophallus, the inability to have penetrative sex, and often difficulty with voiding while standing. Therefore, some transgender men opt to undergo a secondary phalloplasty after metoidioplasty. Literature on secondary phalloplasty is scarce. Aim: Explore the reasons for secondary phalloplasty, describe the surgical techniques, and report on the clinical outcomes. Methods: Transgender men who underwent secondary phalloplasty after metoidioplasty were retrospectively identified in 8 gender surgery clinics (Amsterdam, Belgrade, Bordeaux, Austin, Ghent, Helsinki, Miami, and Montreal).
    [Show full text]
  • From Circumcision Injury to Penile Amputation
    Hindawi Publishing Corporation BioMed Research International Volume 2014, Article ID 375285, 6 pages http://dx.doi.org/10.1155/2014/375285 Review Article Traumatic Penile Injury: From Circumcision Injury to Penile Amputation Jae Heon Kim,1 Jae Young Park,2 and Yun Seob Song1 1 Department of Urology, Soonchunyang University Hospital, College of Medicine, Soonchunhyang University, Seoul, Republic of Korea 2 Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea Correspondence should be addressed to Jae Young Park; [email protected] and Yun Seob Song; [email protected] Received 24 April 2014; Revised 16 August 2014; Accepted 16 August 2014; Published 28 August 2014 Academic Editor: Ralf Herwig Copyright © 2014 Jae Heon Kim et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The treatment of external genitalia trauma is diverse according to the nature of trauma and injured anatomic site. The classification of trauma is important to establish a strategy of treatment; however, to date there has been less effort to make a classification for trauma of external genitalia. The classification of external trauma in male could be established by the nature of injury mechanism or anatomic site: accidental versus self-mutilation injury and penis versus penis plus scrotum or perineum. Accidental injury covers large portion of external genitalia trauma because of high prevalence and severity of this disease. The aim of this study is to summarize the mechanism and treatment of the traumatic injury of penis.
    [Show full text]
  • Patients' Guide to Phalloplasty Techniques
    Guide to phalloplasty techniques 1 Patients’ Guide to Phalloplasty Techniques The St Peter’s Andrology Centre is an independent unit offering gender reassignment surgery to female-to-male patients funded by the NHS, primarily at the Hospital of St John and St Elizabeth’s in London. The surgical team is the same as that which operates on the NHS at University College Hospital and the same treatment protocols are observed. This document outlines the various procedures performed at our unit. HYSTERECTOMY AND MASTECTOMY Many patients have already had hysterectomy and mastectomy (chest surgery) performed before being referred to us for phalloplasty surgery. Mastectomy is normally the first operation undergone by patients but there is no absolute reason why it cannot be undertaken at any stage in the process. We do not provide this service at present however. In patients undergoing pubic phalloplasty (see below) we commonly perform open hysterectomy during the course of the procedure. If an open operation is necessary prior to phalloplasty, we prefer this to be done through a midline skin incision so that the possibility of a pubic phalloplasty is not compromised later. If a radial artery phalloplasty has already been decided on then a Pfannenstiel incision (transverse suprapubic) is perfectly acceptable although a laparoscopic procedure is preferable. Laparoscopic surgery leaves fewer scars and has a faster recovery which is important as patients will be having multiple operations later. We do not perform hysterectomy on its own but can refer patients to a gynaecologist who offers laparoscopically assisted vaginal hysterectomy. It is possible to have a laparoscopic hysterectomy after having had a radial artery phalloplasty but it is easier if it is done before we connect up the neourethra (new urine tube) to the bladder.
    [Show full text]
  • Understanding the Market for Gender Confirmation Surgery in the Adult Transgender Community in the United States
    Understanding the Market for Gender Confirmation Surgery in the Adult Transgender Community in the United States: Evolution of Treatment, Market Potential, and Unique Patient Characteristics The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Berhanu, Aaron Elias. 2016. Understanding the Market for Gender Confirmation Surgery in the Adult Transgender Community in the United States: Evolution of Treatment, Market Potential, and Unique Patient Characteristics. Doctoral dissertation, Harvard Medical School. Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:40620231 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA Scholarly Report submitted in partial fulfillment of the MD Degree at Harvard Medical School Date: 1 March 2016 Student Name: Aaron Elias Berhanu, B.S. Scholarly Report Title: UNDERSTANDING THE MARKET FOR GENDER CONFIRMATION SURGERY IN THE ADULT TRANSGENDER COMMUNITY IN THE UNITED STATES: EVOLUTION OF TREATMENT, MARKET POTENTIAL, AND UNIQUE PATIENT CHARACTERISTICS Mentor Name and Affiliation: Richard Bartlett MD, Assistant Professor of Surgery, Harvard Medical School, Children’s Hospital of Boston Collaborators and Affiliations: None ! TITLE: Understanding the market for gender confirmation surgery in the adult transgender community in the United States: Evolution of treatment, market potential, and unique patient characteristics Aaron E Berhanu, Richard Bartlett Purpose: Estimate the size of the market for gender confirmation surgery and identify regions of the United States where the transgender population is underserved by surgical providers.
    [Show full text]
  • Techniques and Considerations of Prosthetic Surgery After Phalloplasty in the Transgender Male
    See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/334054813 Techniques and considerations of prosthetic surgery after phalloplasty in the transgender male Article in Translational Andrology and Urology · June 2019 DOI: 10.21037/tau.2019.06.02 CITATIONS READS 2 462 5 authors, including: Andrew Cohen Joseph J. Pariser The Brady Urological Institute at JHBMC University of Minnesota Twin Cities 111 PUBLICATIONS 319 CITATIONS 104 PUBLICATIONS 476 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Field Research in the Operating Room View project Computational Fluid Model: Urethral Strictures View project All content following this page was uploaded by Joseph J. Pariser on 29 August 2019. The user has requested enhancement of the downloaded file. 282 Review Article Techniques and considerations of prosthetic surgery after phalloplasty in the transgender male Audry Kang1, Joshua M. Aizen1, Andrew J. Cohen2, Gregory T. Bales1, Joseph J. Pariser3 1Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA; 2Department of Urology, UCSF School of Medicine, San Francisco, CA, USA; 3Department of Urology, University of Minnesota, Minneapolis, MN, USA Contributions: (I) Conception and design: All authors; (II) Administrative support: All authors; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Audry Kang, MD. Department of Surgery, Section of Urology, The University of Chicago, 5841 South Maryland Ave.
    [Show full text]
  • Gender-Affirming Surgery: Phalloplasty and Metoidioplasty
    UCHealth Integrated Transgender Program Gender-Affirming Surgery: Phalloplasty and Metoidioplasty Thank you for choosing the UCHealth Integrated Transgender Program – Anschutz Medical Campus at the University of Colorado Hospital. We are excited that you are taking these steps to affirm who you are. We want to help you as you move toward a physical appearance that fits with your gender identity. This booklet gives you the information to learn about gender-affirming surgeries and what to expect as a patient with our program. Please feel free to contact our office with questions or to talk with one of our providers any time. Table of contents. What is gender-affirming surgery? Who is a good candidate for gender-affirming surgery? Genital reconstruction surgery—male genitalia Phalloplasty surgery types and stages Metoidioplasty surgery Risks and complications of surgery Preparing for surgery What to expect after surgery and discharge from the hospital Follow-up appointments Checklist for surgery What is gender-affirming surgery? Gender-affirming surgery is a “standard of care” treatment to reduce gender dysphoria. Standard of care means that doctors and medical experts believe this is the best treatment for a medical condition. Gender dysphoria can happen when a person’s gender identity is not the sex that was assigned to them at birth. The goal of gender-affirming surgery is to change the features of the body which often cause this dysphoria. The surgeries will create body features that match your gender identity. These surgeries cannot be reversed. Many studies have shown that surgery, along with hormone therapy, can lessen gender dysphoria in many people.
    [Show full text]
  • Transgender Terminology
    Transgender Terminology Agender Individuals: People who identify as genderless or gender-neutral. Cisgender Individuals: People who identify with the gender that was assigned to them at birth (i.e., people who are not transgender). Cisgender Privilege: The set of conscious and unconscious advantages and/or immunities that people who are or who are perceived as gender conforming benefit from on a daily basis. Crossdressers: Individuals who, regardless of motivation, wear clothing, makeup, etc. that are considered by the culture to be appropriate for another gender but not one’s own (preferred term to “transvestites”). Drag or In Drag: Wearing clothing considered appropriate for someone of another gender. Drag Kings and Drag Queens: Female-bodied crossdressers (typically lesbians) and male-bodied crossdressers (typically gay men), respectively, who present in public, often for entertainment purposes. FTM Individuals: Female-to-male transsexual people, transsexual men, transmen, or transguys— individuals assigned female at birth who identify as male. Some transmen reject being seen as “FTM,” arguing that they have always been male and are only making this identity visible to other people (instead, they may call themselves “MTM”). Gender: The beliefs, feelings, and behaviors that a specific culture attributes to individuals based on their perceived sex. It involves gender assignment (the gender designation of someone at birth), gender roles (the expectations imposed on someone based on their gender), gender attribution (how others perceive someone’s gender), and gender identity (how someone defines their own gender). Gender Affirming Surgery: Surgical procedures that change one’s body to conform to one’s gender identity. These procedures may include “top surgery” (breast augmentation or removal) and “bottom surgery” (altering genitals).
    [Show full text]
  • Gender Dysphoria Treatment – Community Plan Medical Policy
    UnitedHealthcare® Community Plan Medical Policy Gender Dysphoria Treatment Policy Number: CS145.I Effective Date: March 1, 2021 Instructions for Use Table of Contents Page Related Community Plan Policies Application ..................................................................................... 1 • Blepharoplasty, Blepharoptosis, and Brow Ptosis Coverage Rationale ....................................................................... 1 Repair Definitions ...................................................................................... 3 • Botulinum Toxins A and B Applicable Codes .......................................................................... 4 • Cosmetic and Reconstructive Procedures Description of Services ................................................................. 8 • Gonadotropin Releasing Hormone Analogs Benefit Considerations .................................................................. 9 Clinical Evidence ........................................................................... 9 • Panniculectomy and Body Contouring Procedures U.S. Food and Drug Administration ........................................... 14 • Rhinoplasty and Other Nasal Surgeries References ................................................................................... 14 • Speech Language Pathology Services Policy History/Revision Information ........................................... 16 Commercial Policy Instructions for Use ..................................................................... 16 • Gender Dysphoria Treatment
    [Show full text]
  • Novel Surgical Techniques in Female to Male Gender Confirming Surgery
    638 Review Article Novel surgical techniques in female to male gender confirming surgery Miroslav L. Djordjevic Department of Urology, School of Medicine, University of Belgrade, Belgrade, Serbia Correspondence to: Miroslav L. Djordjevic, MD, PhD. Department of Urology, School of Medicine, University of Belgrade, Tirsova 10, 11000 Belgrade, Serbia. Email: [email protected]. Abstract: The current management of female to male (FTM) gender confirmation surgery is based on the advances in neo phalloplasty, perioperative care and the knowledge of the female genital anatomy, as well as the changes that occur to this anatomy with preoperative hormonal changes in transgender population. Reconstruction of the neophallus is one of the most difficult elements in surgical treatment of female transsexuals. While there is a variety of available surgical techniques, their results are not equally acceptable to all patients. The preference for a particular surgical technique mostly depends on the patient’s desires and expectations. Nevertheless, the surgeon’s duty is to fully inform the patient about all the advantages and disadvantages, as well as all complications that might occur after surgical procedure—and even to talk them out of a desired surgical technique if there are contraindications. Metoidioplasty is a technically demanding surgical procedure used in FTM transsexuals who desire a gender reassignment surgery (GRS) without undergoing a complex, multi-staged surgical creation of an adult-sized phallus. Metoidioplasty is viable in cases where the clitoris seems large enough after androgen hormonal treatment. Since the clitoris plays the main role in female sexual satisfaction, its impact on the outcome of FTM transgender surgery is predictable.
    [Show full text]
  • What to Expect: Phalloplasty at Michigan Medicine
    What to Expect: Phalloplasty at Michigan Medicine Department of Surgery Table of Contents: What should I expect during my consultation appointments? …………………………………………………..3 How can I prepare for surgery and plan for my recovery period?………………………………………………...5 How do I prepare for the hospital? ....................................7 What should I expect in the hospital?….............................7 What can I expect upon returning home?.........................9 Surgery timeframe: 150 miles or less…….......................11 Surgery timeframe: More than 150 miles .......................13 Who do I call if I have questions?…..................................16 Department of Surgery 2 What to Expect: Phalloplasty at Michigan Medicine What should I expect during my phalloplasty consultation appointments? The following information explains what you can expect on the day of your phalloplasty consultation appointment at the Plastic Surgery clinic. You will also have consultations with the Urology surgeon and the Obstetrics and Gynecology (OB/GYN) surgeon at their clinics. • Arrive at Plastic Surgery 15 minutes prior to your scheduled appointment time. Before the appointment, you will have forms to fill out in the waiting room, and the check-in staff will make a copy of your insurance card, if you will be using insurance to pay any part of the cost. During your appointment you will be seen by a team that will include medical students, physician’s assistants, nurses, and Plastic Surgery Residents. • You will, of course, also see the attending Plastic Surgeon who leads the team and who will be personally involved in all aspects of your care. • Your consultation will include your medical history and a physical examination to determine whether or not you are a good candidate for gender confirmation surgery.
    [Show full text]
  • Gender Reassignment Surgery Model Ncd
    GENDER REASSIGNMENT SURGERY MODEL NCD I. Indications, Limitations of Coverage and/or Medical Necessity 1 II. Documentation Requirements 4 III. Providers of Gender Reassignment Surgery 5 IV. Common CPT Codes 5 V. ICD-9 and ICD-10 Codes 8 VI. References 9 Written by Transgender Medicine Model NCD Working Group. Contact: Anand Kalra, Transgender Law Center ([email protected]). Gender Reassignment Surgery Model NCD | 1 I. Indications, Limitations of Coverage and/or Medical Necessity The purpose of this National Coverage Determination is to implement the U.S. Department of Health and Human Services Departmental Appeals Board’s 2014 decision overturning NCD 140.3 (Transsexual Surgery). The U.S. Department of Health and Human Services Departmental Appeals Board (“DAB”) considered categories of evidence as outlined in the Medicare Integrity Program Manual § 13.7.1 when it determined that the previously extant prohibition on “transsexual surgery” in NCD 140.3 was unreasonable.1 Implementing a policy to provide access to Gender Reassignment Surgery is centered in improving population health outcomes among transgender Medicare beneficiaries. The Medicare Integrity Program Manual § 13.7.1 provides that NCDs should be based on published authoritative evidence and general acceptance by the medical community. Summarized, this means treatments should follow: Evidence-based best practice derived from definitive studies such as meta-analyses, randomized clinical trials, or clinical evidence Best practice as accepted by the medical community, as supported by sound medical evidence based on: o Scientific data or research studies published in peer-reviewed medical journals; o Consensus of expert medical opinion (i.e., recognized authorities in the field); or o Medical opinion derived from consultations with medical associations or other health care experts.
    [Show full text]
  • Penile Allotransplantation for Total Phallic Loss Due to Ritual Circumcision: Proof of Concept
    Penile allotransplantation for total phallic loss due to ritual circumcision: Proof of concept A van der Merwe MR Moosa Penile allotransplantation for total phallic loss due to ritual circumcision: Proof of concept André van der Merwe Presented in fulfillment of the requirements for the degree of Doctor of Philosophy Division of Urology Faculty of Medicine and Health Sciences Stellenbosch University South Africa Primary supervisor Professor MR Moosa Department of Medicine Faculty of Medicine and Health Sciences Stellenbosch University South Africa December 2020 Stellenbosch University https://scholar.sun.ac.za TABLE OF CONTENTS PAGE 1. Declaration, Acknowledgments and Summary. ............................................................. 2 2. Doctoral Office approval .......................................................................................... 7 3. Human Research Ethics approval ........................................................................... 8 4. General Introduction ............................................................................................... 10 5. Chapter 1. Penile allotransplantation for penis amputation following ritual circumcision: a case report with 24 months of follow-up…………………………….17 6. Update on the status of the first penile transplant recipient at six years and six months ............................................................................................ 28 7. Chapter 2. Lessons learned from the world's first successful penis allotransplantation .......................................................................................
    [Show full text]