Dr. Lubos Kliniken - Andre konsultasjon om falloplastikk
Dette er en transkripsjon av min første konsultasjon om falloplastikk med Dr. Markovsky hos Dr. Lubos Kliniken Bogenhausen i Tyskland. For mer informasjon om klinikken, se Nedre kirurgi: Del 5 - De tyske klinikkene
Transkripsjonen er på engelsk. Under konsultasjonen ble det vist noen visuelle eksempler i form av bilder og/eller tegning på ark. Dette kommer dessverre ikke frem i transkripsjonen. Unødvendige ord og setninger har blitt fjernet i etterkant.
Her er lenker til alle konsultasjonene jeg har hatt i kronologisk rekkefølge:
- Første konsultasjon med UKMP
- Første konsultasjon med Dr. Lubos Kliniken
- Andre konsultasjon med Dr. Lubos Kliniken
- Andre konsultasjon med UKMP
Transkripsjon
Dersom du vil ha transkripsjonen i PDF-format kan den lastes ned her.
Sted: Dr. Lubos Kliniken Bogenhausen
Dato: 03.06.2024
00:00:06 Doctor Hello. 00:00:08 Doctor It is quite a time that we talk or that we saw each other, but it's not very long ago that I finally wrote something, right? 00:00:16 Levi Yes, yes. 00:00:17 Levi It's absolutely. 00:00:18 Levi It wasn't any rush anyway, so. 00:00:20 Doctor Yeah, you know, but I do not like it myself if I have some state, some things on my desk, but whatever. 00:00:29 Doctor And me as a patient, I would not like it if I wait for something which is important for me. 00:00:35 Levi 00:00:36 Doctor But anyhow, okay, so what can I do for you today? 00:00:40 Levi Yes. 00:00:40 Levi So since we last talked, I have a lot of new questions, and I have written them all down. 00:00:46 Levi So if you don't mind, I'll just go through them one by one. 00:00:51 Levi I have realized it's important to me to not bury my clitoris. 00:00:57 Levi So what I'm wondering is, I don't think I asked this directly enough last time, but the setup that I want is no burial of the clitoris, no vaginectomy, but urethral lengthening. 00:01:10 Levi Is that something you are comfortable doing? 00:01:14 Levi In that case, I was also just wondering, where does the urethra go if it's not along the clitoris? 00:01:24 Doctor The urethra stays in the place where it usually is. 00:01:29 Doctor When we bury the clitoris, the clitoris goes out of the way. 00:01:34 Levi Okay. 00:01:35 Levi So it's just kind of pushed to the side or something? 00:01:37 Doctor Pushed to the side or something. 00:01:42 Doctor You have to know some things about that kind of procedure. 00:02:02 Doctor Even with that procedure, we should do a urethral lengthening and a stretching mobilization of the clitoris in advance. 00:02:11 Levi Okay. 00:02:12 Doctor Not with the phalloplasty. 00:02:18 Doctor We then need to dissect the preformed urethra from the clitoris. 00:02:33 Doctor So this is potentially more damage to this new urethra and to the clitoris itself. 00:02:44 Levi Oh, really? 00:02:45 Doctor If we. 00:02:47 Doctor If we compare it with a clit pen, with a deepithelialized clitoris, which is buried. 00:02:58 Levi Right. 00:02:59 Doctor Because we need to divide the urethra from the clitoris. 00:03:02 Levi Yeah. 00:03:03 Levi Okay. 00:03:03 Doctor Because the urethra should go along in the middle and the clitoris needs to move to the side. 00:03:09 Doctor So we need to dissect that a bit, that we have some tissue that can go to the side. 00:03:21 Levi What are the consequences for the clitoris then? 00:03:24 Doctor Maybe more damage to the tissue and to the nerves, maybe less sensitivity. 00:03:31 Levi Right. 00:03:32 Levi Okay. 00:03:33 Levi I didn't know that. 00:03:34 Levi That's because the reason that I want to preserve the clitoris is because I'm scared of losing sensation in my genitals. 00:03:41 Doctor Yeah. 00:03:42 Doctor So I do not have a picture with a clitoris out with a non buried clitoris, but I can I can simulate somehow. 00:03:57 Doctor Let me see. 00:03:59 Doctor [Draws on paper] 00:04:12 Doctor So this will be the situation after the phalloplasty with a buried clitoris. 00:04:18 Levi Right. 00:04:19 Doctor And because we want to have the unithra in the middle with no dangerous tissue above it. 00:04:27 Doctor Because if there's some problem with the urethra, we need to cut in the middle. 00:04:31 Levi Right. 00:04:31 Doctor So this is why we need to move the clitoris to the side. 00:04:35 Doctor Okay. 00:04:36 Doctor Clitoris behind the urethra. 00:04:39 Doctor So the clitoris would be maybe, depending on how long it is, how long we can prepare or prepare a pedicle to move it to the side. 00:04:53 Doctor It would be somewhere here. 00:04:56 Doctor It was here. 00:04:57 Doctor And then maybe it would be here or here or here. 00:05:01 Doctor Somewhere at the side of the scrotum or at the base of the phallus. 00:05:10 Levi Right. 00:05:12 Doctor And it will look like the clitoris looks like now. 00:05:17 Levi Right. 00:05:18 Levi But will it be visible when everything is hanging down? 00:05:23 Levi Okay, that's. 00:05:24 Doctor It's not. 00:05:24 Doctor Because we cannot leave it here. 00:05:26 Doctor No, because then it would be in front of the urethra. 00:05:30 Doctor And if there should be a problem with the urethra, we should not bend the clitoris. 00:05:37 Doctor Bend the. 00:05:38 Doctor We have the urethra around the clitoris. 00:05:41 Levi Okay. 00:05:42 Doctor And if the clitoris is in front of the urethra and there's a problem with the urethra, where to cut exactly. 00:05:48 Levi Then I have a lot to think about. 00:05:50 Levi Because then it might. 00:05:52 Levi Doesn't sound like it'll help a lot to leave the clitoris in terms of sensitivity either. 00:05:57 Doctor What I can tell is that almost none of our patients want to have the clitoris outside. 00:06:06 Levi Right. 00:06:08 Doctor But not because we tell them this will happen. 00:06:10 Doctor This will happen. 00:06:11 Doctor This is what they show up here with. 00:06:19 Doctor I had some patients from our clinic and some from other clinics that. 00:06:26 Doctor But this is quite some years ago that had the clitoris still outside and who wanted to have it buried then. 00:06:34 Levi Right. 00:06:38 Doctor There are not many patients who say that they want to have the clitoris removed out of the grave. 00:06:52 Levi Like, take it out later? [Doctor:] Which is not possible. 00:06:54 Levi Yeah, I understand. 00:06:56 Levi But just theoretically, to just cover all bases, if I were to decide to leave it out and change my mind later, it's impossible to take it back in. 00:07:06 Doctor Yeah, but not really back in. 00:07:09 Doctor But what we would do then is it would be situated. 00:07:13 Doctor Let's just say it would be situated here. 00:07:16 Doctor What we would do then is to de epithelialize. 00:07:19 Doctor So that means to take off the surface skin of the clitoris and then just close the skin over it. 00:07:30 Doctor Okay. 00:07:31 Levi So it wouldn't really go along the penis either. 00:07:34 Doctor No, no, no. 00:07:35 Doctor It's much too complicated and much too dangerous to cut open all that to get the clitoris somewhere there. 00:07:43 Levi But if I bury it immediately, it will go along the phallus. 00:07:47 Doctor Yeah. 00:07:48 Levi Okay. 00:07:48 Levi This is important information for me. 00:08:09 Doctor [Draws on paper] If we look from the side. 00:08:11 Levi Right. 00:08:12 Levi Okay, so it's kind of. 00:08:13 Doctor This is the urethra and the up. 00:08:18 Doctor The downside. 00:08:18 Levi Yeah, the downside. 00:08:20 Doctor The downside of the clitoris looks into the urethra like this. 00:08:25 Doctor And the clitoral gland is behind the anastomosis, the junction of the urethra from the prolonging that was done before to the phallus. 00:08:41 Doctor And the clitoris gland itself is here. 00:08:45 Doctor Maybe it makes a knick like this, or, you know, it's not positioned in an exact position. 00:08:52 Doctor It's not possible. 00:08:53 Doctor But it is there. 00:08:54 Levi But it's. 00:08:55 Levi Yeah, it makes sense when you're. 00:08:57 Levi I think I just have to think a little bit about it. 00:09:01 Doctor I'll show you that. 00:09:03 Doctor This picture here, this is the downside of the clitoris. 00:09:07 Levi Yeah. 00:09:07 Doctor Because the klitpen is put like this. 00:09:12 Doctor This is the clitoral gland, and this is the downside. 00:09:14 Doctor And the rest of the clitoris stays here behind the anastomosis. 00:09:21 Doctor And if you want to remove? 00:09:25 Doctor Not remove. 00:09:25 Doctor If you want to have the clitoris outside, then we need to dissect the urethra from the clitoris. 00:09:35 Doctor And the clitoris then is put somewhere here. 00:09:37 Levi Yeah. 00:09:38 Doctor That suture in the skin. 00:09:40 Levi It seems quite complicated to do that, actually. 00:09:43 Levi And, yeah, there's a good chance I might not want it outside anyway, if that's the whole consequence of it. 00:09:53 Levi But this is really good information for me, and I have to think a little bit about it. 00:09:59 Levi But, yeah, let's see. 00:10:01 Levi I have some more questions. 00:10:03 Levi The type of scrotoplasty that you do, what is the name of it? 00:10:08 Levi I've heard that there are several types. 00:10:11 Doctor We call it vy. 00:10:14 Levi Yeah, I've read about vy. 00:10:15 Levi And there is another. 00:10:17 Levi I don't really remember which one, but that is the one where you kind of leave things more or less where they are. 00:10:23 Levi Is that it, or is it where the scrotum is? 00:10:28 Doctor I mean, you know, that depends on the anatomy. 00:10:32 Doctor What we try to do is to get as much tissue from down between the legs to the front. 00:10:41 Levi Right. 00:10:42 Doctor Sometimes it's just this way. 00:10:47 Doctor Sometimes it's that we take flaps from down here and flip them up. 00:10:54 Doctor It's this and this. 00:10:55 Doctor But both results in. 00:10:57 Doctor We make a cut like that, bring tissue up, and that cut gets a form like this. 00:11:05 Levi Right. 00:11:05 Doctor V y. 00:11:07 Levi Okay. 00:11:07 Levi That's where the word comes from. 00:11:09 Levi Because I think I would be a little bit uncomfortable if it's too far between my legs. 00:11:16 Doctor You don't want to have a colpectomy. 00:11:19 Levi I don't know what that is. 00:11:20 Doctor Closure of the vagina? 00:11:22 Levi No. 00:11:22 Doctor Okay, so then it's something completely different anyhow. 00:11:27 Levi Okay. 00:11:30 Doctor Then it's a modification of that vy. 00:11:36 Doctor I do not have a picture of it. 00:11:38 Doctor I just give you a picture of the V y. 00:11:41 Doctor And sometimes if these flaps are very long, we put them in the middle. 00:11:46 Doctor We cannot do this like that and put it together in the middle if there still is the vagina. 00:11:52 Doctor Because the vagina is still there. 00:11:54 Levi Of course. 00:11:55 Doctor Okay. 00:11:55 Doctor So the shape, it's just different. 00:12:02 Doctor And it's not a standard procedure. 00:12:05 Doctor I mean. 00:12:05 Doctor Yeah, it's more or less the same. 00:12:08 Doctor Same, but different. 00:12:10 Levi Right. 00:12:11 Doctor Okay. 00:12:11 Levi You don't. 00:12:12 Doctor I mean, you can imagine that we cannot do it exactly the same because there still is the vagina. 00:12:17 Levi Yeah. 00:12:17 Levi And I suppose it would have to, like, split in the middle there. 00:12:21 Doctor Yeah. 00:12:21 Doctor So we need two flats, definitely. 00:12:24 Doctor Right and left from the vaginal entrance, and then flip them to the front as good as much as possible. 00:12:35 Levi Okay. 00:12:36 Levi You don't happen to have any pictures? 00:12:38 Doctor No. 00:12:38 Levi Okay. 00:12:39 Doctor That's quite rare. 00:12:40 Levi Yeah, I understand. 00:12:41 Levi It's. 00:12:43 Levi Yeah. 00:12:43 Levi I'm a little particular with what I want. 00:12:46 Levi Let's see. 00:12:49 Levi So I think you said. 00:12:50 Doctor But the procedure itself is. 00:12:54 Doctor So if there is no vagina, the phallus is here. 00:13:02 Doctor We make an incision like this and put all the tissue up. 00:13:07 Doctor Try to put all the tissue upwards. 00:13:08 Doctor If there's the vagina, we would make kind of the same incision. 00:13:14 Doctor But then to here and to here, and put these flaps and flip them around. 00:13:20 Doctor So on. 00:13:21 Doctor So. 00:13:22 Doctor Okay. 00:13:23 Doctor And then suture that and that together. 00:13:28 Levi Okay. 00:13:30 Levi I suppose the vaginal entrance will be smaller. 00:13:34 Doctor It will be smaller even after the forming of the klitpen. 00:13:42 Levi Okay. 00:13:43 Levi My question is, if it becomes too small, I heard some surgeons are willing to do surgery to open it up again later. 00:13:51 Doctor If you need it to be open for sexual intercourse, then it must be opened. 00:14:01 Doctor But there will be scarring, and it might be that it's not as wide and not as stretchable as it was before. 00:14:12 Doctor And of course there will be scars. 00:14:14 Levi Yeah, fine with that. 00:14:17 Levi I've just been curious about that. 00:14:18 Levi Like, is it possible? 00:14:19 Levi Is it is? 00:14:21 Levi Because if. 00:14:22 Levi My thought was that if the hole becomes too small to use anyway, then I might as well remove it. 00:14:28 Levi But I would like to keep it somewhat usable, if it's possible. 00:14:34 Doctor It is. 00:14:34 Doctor Generally. 00:14:35 Doctor It is, but it's not to make it very easy. 00:14:39 Doctor It's not the same as it is before. 00:14:40 Levi Yeah. 00:14:42 Doctor It is smaller, and if we widen it again, it is small, and there are scars around it. 00:14:49 Doctor And if we widen it, that means we have to do some incisions and suture them, and then there will be scars again, and it might not be as flexible, as wide as it was before. 00:15:02 Levi Okay, I understand. 00:15:06 Levi I think you talked about this last time, but I don't remember. 00:15:12 Levi With the staging, you do the klitpen first, and then you connect the urethra immediately after on the next stage. 00:15:24 Doctor Yeah, we connect it, but we leave it open. 00:15:27 Doctor You know, it's like a tube, a continuous tube, but with a longitudinal incision. 00:15:37 Levi Yeah. 00:15:37 Levi So there's a hole underneath that area. 00:15:42 Doctor You pee out here so that the anastomosis can heal, and the urethra in the phallus can heal without being used every day. 00:15:59 Levi Okay. 00:16:00 Doctor If there's been. 00:16:00 Doctor I mean, there are a lot of problems with the anastomosis here, or sometimes with the. 00:16:06 Doctor With the urethra in the phallus. 00:16:10 Doctor If there are problems. 00:16:12 Doctor I mean, you do not like it anyway, but they do not affect your ability to pee. 00:16:19 Levi Yeah, that makes a lot of sense. 00:16:21 Doctor And if it should heal perfectly so that the next time you can put a probe inside and see it's wide enough, then we can just close it. 00:16:35 Doctor Okay. 00:16:36 Doctor But if there are problems, you do not like them, but they don't affect your micturition. 00:16:42 Levi That sounds good. 00:16:45 Levi I think I'm almost through with it. 00:16:47 Levi I just have a question. 00:16:50 Levi I've been doing some electrolysis, and I'm wondering how far up I should go. 00:16:54 Levi You can kind of see the area where I've been removing hair. 00:16:59 Doctor This area here, actually, is not important. 00:17:01 Doctor That here. 00:17:06 Levi Right. 00:17:07 Doctor Show me the other arm. 00:17:10 Doctor Well, to be honest, I don't think that you need much electrolysis at all. 00:17:15 Doctor But it's not a wrong thing if you do it. 00:17:22 Doctor This is not exactly what I'm drawing here. 00:17:25 Doctor This is just to give you an impression. 00:17:35 Levi Hmm. 00:17:36 Doctor This is. 00:17:37 Doctor That's a u. 00:17:40 Doctor Yeah. 00:17:40 Levi So this is the important part. 00:17:42 Doctor That's the important part because that's the urethra. 00:17:45 Doctor And you see, that's about 4 cm if it's exactly that way, or it's not that exact. 00:17:53 Doctor But that part here, this is the skin that stays in place. 00:18:01 Doctor That part here would be the surface of the phallus. 00:18:06 Doctor So if there should be hair, you can remove them afterwards on your own with, I don't know, shaving or silk appeal by brown or whatever with some. 00:18:19 Doctor Something. 00:18:20 Doctor But you cannot do that here. 00:18:21 Doctor So this is more important. 00:18:23 Levi Okay, so I'll focus on this area. 00:18:24 Doctor Yeah. 00:18:25 Doctor And of course not exactly on this area, but a bit. 00:18:29 Levi Yeah. 00:18:29 Levi I'm thinking maybe I'll do a little bit further, just in case. 00:18:32 Levi But I was wondering, should I have some more removed? 00:18:36 Levi I mean, if it happens that you need more skin, does that ever happen? 00:18:41 Doctor No, we do not go further than those 4 cm here. 00:18:46 Levi Okay. 00:18:47 Doctor If we need more skin, we take it from the skin transplant like this. 00:18:58 Levi Okay. 00:18:58 Levi The skin transplant being the skin you. 00:19:00 Doctor Fetch from the skin that we use to cover that. 00:19:03 Levi Yeah. 00:19:05 Doctor Part of this was... 00:19:10 Doctor Look at this. 00:19:12 Doctor Anyhow, we use a skin transplant because we sometimes we. 00:19:18 Doctor Maybe it would be possible in your case, because it's very soft tissue, that we could close the phallus directly, but then it's a bit tight and of course the circumference is smaller. 00:19:32 Doctor So the consequence is not that we enlarge the flap, because an enlargement of the flap also means the flap, more flap tissue must be, there must be blood flow. 00:19:48 Doctor But what is missing is covered by the skin that we take from the skin plant that we use anyhow to cover that here. 00:19:56 Doctor Okay. 00:19:56 Doctor And this is on the downside of the fellow, so you do not see it in everyday life. 00:20:01 Levi Okay. 00:20:02 Levi But anyway, I should do like a couple of centimeters. 00:20:06 Doctor Yeah, yeah, yeah, yeah, yeah. 00:20:07 Doctor I mean, it's better to do more. 00:20:08 Levi Than too little, but then I won't focus too much on this. 00:20:12 Doctor No, that's the important part. 00:20:15 Levi I understand. 00:20:17 Levi So, yeah, this is like a fixed size. 00:20:20 Doctor Not really fixed. 00:20:21 Levi Okay. 00:20:23 Doctor Smaller is always possible. 00:20:25 Doctor Larger is not always possible. 00:20:27 Levi Okay. 00:20:28 Levi But if I said that I would prefer that you took an extra centimeter if you're able to. 00:20:34 Levi Is that something you take into consideration? 00:20:36 Doctor Yes, but it's the thing, the most important thing is the length of the vessels here. 00:20:43 Levi Okay. 00:20:44 Doctor Because we could make the nicest and the longest and the best phallus ever. 00:20:49 Doctor But if those vessels are too short, we do not have good possibilities to connect them with the blood vessels down there. 00:20:57 Doctor And so there is a problem with the blood flow and then it's all for nothing. 00:21:03 Levi Yeah, I wouldn't take any chances there. 00:21:06 Doctor Yeah, yeah, yeah. 00:21:07 Levi At the same time, you know, who doesn't prefer having a bigger size if you're able to? 00:21:12 Levi So it's just. 00:21:14 Levi Yeah, I think that is all the questions I had, actually. 00:21:18 Doctor Okay. 00:21:19 Levi I've gone through the list at least, so I'm going to get you asked for a document saying exactly which. 00:21:28 Doctor The one thing from the. 00:21:29 Doctor I don't know who. 00:21:30 Doctor I guess it was a hormone specialist from the. 00:21:35 Doctor From the Rijks hospital in. 00:21:36 Doctor In Oslo. 00:21:38 Levi You need a letter from the hormone. 00:21:39 Doctor No, not. 00:21:40 Doctor But the one you sent me. 00:21:42 Levi Oh, no, that's from the chief doctor at the hospital. 00:21:45 Doctor Really? 00:21:45 Levi Yes. 00:21:45 Doctor Okay. 00:21:46 Doctor You know, the thing is. 00:21:47 Doctor The thing is that just. 00:21:48 Doctor He was saying a lot about the hormonal treatment or what is to be done if the. 00:21:53 Doctor If the hemoglobin is too high or whatever, but. 00:21:56 Doctor And that you fit the. 00:22:01 Doctor The conditions for gender reassignment surgery. 00:22:07 Doctor I would need to know a bit more what these. 00:22:10 Doctor You know, I don't know. 00:22:10 Doctor Does he mean the w path conditions or what kind of conditions is meant by that? 00:22:19 Levi I will ask him for the specific document that he is referring to because he referred to some sort of standard. 00:22:25 Doctor Okay. 00:22:26 Levi I will ask exactly for that study. 00:22:28 Doctor I wrote you that letter in German, didn't I? 00:22:31 Levi I think you did, but I used Google translate, so that's fine. 00:22:34 Doctor But at the end of that letter, where do I have it? 00:22:40 Doctor At the end of the letter, there is a box saying at least. 00:22:46 Doctor I mean, it's the German guideline, but it's quite close to the wpath guidelines. 00:22:53 Doctor It says what needs to. 00:22:54 Doctor What the statement needs to say that we need to know the diagnosis. 00:22:59 Doctor We need to know that you're informed. 00:23:02 Doctor I know that you're informed, so that's fine. 00:23:04 Doctor And we need the recommendation, the referral for the specific treatment. 00:23:12 Levi Okay, so. 00:23:15 Doctor Levi is transgender, and he's been going through psychotherapy, not treatment, but, you know. 00:23:28 Doctor And the only way to cope the problems he's having with the gender dysphoria is to do gender reassignment surgery. 00:23:36 Doctor Something like that. 00:23:38 Doctor That's it. The box says... 00:23:39 Levi I will go through the letter and I'll write a letter and get the specifics. 00:23:46 Levi Yeah, yeah, yeah. 00:23:49 Doctor It's. 00:23:49 Doctor We know it's. 00:23:50 Doctor You know, it's not five pages. 00:23:51 Doctor It's a bit more than two lines. 00:23:53 Levi Yeah, yeah, I understand. 00:23:55 Levi But I will get that to you and you'll get it by email. 00:23:58 Doctor All right. 00:24:01 Levi Thank you so much for answering. 00:24:04 Doctor No worries. 00:24:05 Levi And you'll hear from me soon. 00:24:07 Doctor Okay, bye bye. 00:24:08 Doctor Bye bye.
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