Done many years ago, elsewhere. She has recurrent bleeding from the urinary opening and has received the million dollar workup from another urologist unfamiliar with MTF patients, including 2 cystoscopies, flexible and rigid, and MRI and a CT scan, and the obvious left unattended for years. Her urethra opens almost at the top of her pubis rather than underneath which would be normal for a natal female.
She notes during voiding the urinary tube which runs over her pubic bone swells.
Plan… the extended urethra will be opened in the midline, and not discarded, but rather tacked laterally to the sides to create a lubricous vulva with the edges raised to simulate labia minora. Normal labia minora are characterized by the inside being pink and mucosal and the outside being pigmented. Her new meatus if possible will be built up or raised slightly as is typical for a normal female and then spatulated laterally or funnelized so it will always stay patulous or open.
This can be done usually under local anesthesia with some IV sedation. Typically we place Emla or Betacaine ointment on the areas to be injected so the patient will not even feel a needle stick.
Perhaps we’ll be publishing some pre and post op photos.
Harold M. Reed, M.D.