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Gender Affirmation Surgery (Vaginoplasty) for the Transgender Woman

Introduction Vaginoplasty is a surgery that aims at creating a female vulva and vaginal canal in transgender women (individuals assigned male at birth who identify as women) seeking gender affirmation with genital surgery. The surgery involves deconstruction of the male external genitalia and creation of a neoclitoris, labia, vestibule, vagina, and urethra. The most commonly performed procedure is a modification of the penile inversion vaginoplasty. This…

Surgical Management of Refractory Overactive Bladder and Detrusor Compliance Abnormalities

When conservative and drug therapies for overactive bladder and/or detrusor compliance abnormalities fail, patients can be considered for one of three accepted modalities of surgical treatment: (1) sacral nerve stimulation (sacral neuromodulation [SNM]); (2) injectable bladder neuromodulation with neurotoxins, most notably botulinum toxin (BoTN); and (3) bladder augmentation. Uses, indications, and techniques for these three modalities continue to evolve as experience and understanding of each are…

Managing Ureteral Injury During Pelvic Surgery

Injury to the lower urinary tract will occur in approximately 1% to 2% of women undergoing major gynecologic surgery. Although the risk of injury increases with increasing difficulty of the primary operation (e.g., large uterus, excessive bleeding, prolapse procedures, malignancy, endometriosis), more than 50% of injuries occur during uncomplicated procedures. Furthermore, in the absence of cystoscopy, most injuries are undetected during the primary operation, leading to…