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Post by Roofus » Tue Jul 08, 2008 2:51 pm

The surgery for male-to-female sex reassignment is done by Dr. Meltzer. For unusual or complicated cases, he may involve a urologist.

Penile inversion technique for vaginoplasty

* This surgery is done under general or spinal anesthesia.
* The testicles and the erectile tissue of the penis are removed.
* A vaginal space is created below the urethra (urinary tube).
* The penile skin is used to line the vaginal vault, which eliminates the need for skin grafts in most cases. In patients with a shorter penis (less than 5 inches erect when measuring from the underside), distant grafts may still be avoided if the scrotum is cleared of hair preoperatively.
* The clitoris is formed from the glans of the penis, keeping the nerves that supply it intact. By doing this, Dr. Meltzer can create a sensate clitoris. A small portion of scrotum is used to fashion the labia (the lips of the vagina).
* A cotton stent is placed in the vagina. The stent stays in place for five to six days.


This procedure is not without risks. For the vast majority, the surgery is safe and the recovery uneventful. The rate of satisfaction is very high, but complications can occur and the informed patient must be aware of them.

* Bleeding is a risk of any operation, particularly those procedures involving the pelvis, although the need for a transfusion is exceedingly rare. If you are particularly concerned about transfusion of blood products, then it would be prudent to give a unit of your own blood in advance.
* Infection is also a standard risk, but is very unusual.
* Occasionally, a minor revision of the labia or urethra is needed. These can frequently be done at the time of labiaplasty or at our office.
* An abnormal path between the rectum and vagina is called a rectovaginal fistula. Should this occur, it is possible that one would have both gas and feces come through the vagina. In order to reliably close this communication a temporary colostomy might be required. A secondary operation can close the colostomy three months later. In my own practice, this has been a very rare complication though it is more concerning due to its implications.
* An abnormal communication between the urethra and vagina is also possible, however, this is even more rare. All patients will be able to urinate while sitting; however, it is not unusual to have spraying of the urine until the swelling resolves.
* Though it is very uncommon, there have been reports of nerve injury in the legs, or injury to the muscles (compartment syndrome) associated with positioning of the patient at the time of gynecologic or urologic procedure. If a compartment syndrome of the leg occurs, then the muscles must be surgically released. This is a very unusual complication that we take every precaution to prevent. Special padding and careful positioning of the legs are used in surgery to minimize the risks.

It is very important for a prospective patient to inform Dr. Meltzer of any unusual situations or conditions that may have impact on the procedures.

Referral letters and payment

Dr. Meltzer adheres to the Harry Benjamin International Standards of Care. The SOC requires two referral letters from appropriately credentialed individuals before the patient can have their surgery.

All patients are required to submit a $750.00 non-refundable deposit to schedule any surgery. If you need to cancel or reschedule your surgery date, your will need to give at least eight weeks' notice. Your deposit will reserve your surgery date. Every attempt will be made to honor your date, but circumstances beyond Dr. Meltzer's control may necessitate a date change.

50% of fees are due six weeks prior to surgery and the remaining 50% is due four weeks prior to your surgery. You can pay for your surgery by cashier's check, money order, Visa or MasterCard. Some patients find it convenient to have their bank wire the funds.

Preoperative instructions

Once surgery is scheduled, a patient will receive a letter confirming both the date for the preoperative appointment and the surgery.

1. A patient must stop hormones two weeks prior to surgery.
2. Referral letters from the patient's therapists must be sent directly to our office at least three months before their surgery date.
3. Please contact our patient care coordinator, Carole Barkley, or our practice manager, Linda Takata, via e-mail or by phone at 866-876-6329 or 480-657-7006 to schedule a consultation visit or surgery date with Dr. Meltzer.
4. Medications: Unless otherwise directed by your physician, do not take any Aspirin, Vitamin-E, or non-steroidal anti-inflammatory (i.e.: Advil, Aleve, Ibuprofen) three weeks prior to your surgery, since this interferes with normal blood clotting. If you need a pain medication for general purposes, use Tylenol or if you are in doubt about any medications you are taking, please contact our office. Please see the attached list for products that contain Aspirin, Ibuprofen, or Vitamin E.
5. If you are taking any medications on a regular basis, please let Dr. Meltzer know, especially if you are taking any cardiac or hypertensive medications (such as Beta-Blockers). If your are on several medications, please bring a list with dosage and type to the hospital with you.
6. Take your regular medications as you normally would with a small sip of water, the day of surgery, unless otherwise instructed.
7. Smoking significantly increases the risk of complications during and after surgery. It is in your best interest to stop smoking as soon as possible. You are required to stop smokng no less than one month before surgery. You will need to sign our form stating that you understand this requirement and agree to stop smoking.
8. Please report any signs of a cold, infection or skin lesion anytime prior to your surgery.
9. You may not have anything to eat or drink after midnight before your procedure. Please check with your physician. (Please notify your physician if you are diabetic or have any other concerns regarding this instruction.)
10. On the day of your discharge, please be prepared to have someone drive you or to take a cab. If you have had any prescription pain medication, you cannot drive. In addition, please make sure you will have someone at home to assist you.
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Re: Vaginoplasty

Post by chozen2 » Tue Jul 15, 2008 11:45 am

Where do I sign up :?:
A wise man once said, "As a wise man once said, 'It is better to phail completely and admit you suck, than miss perfection slightly and pretend you pwn.'"
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