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 (20042010, 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. (C) 2016 S. Karger AG, Basel