TCM for penis enlargement
The penis has one visible portion and another located in the perineal region. There is a fixed portion, attached to the bone, in a segment called the ischial tuberosity. The "Total Body Mobilization" (TCM) technique aims to release the entire fixed segment of the penis, causing the entire structure of the penis to be mobilized to the surface, increasing the size of the penis.
Indications for MCT include micropenis, amputated penis and genital reconstruction in trans men. Other, exceptional situations may benefit from the method, after evaluation by the professional.
The figure illustrates the anatomy of the penis and the sections circled in red represent the part attached to the bone, also called the crura.
The technique is published on https://pubmed.ncbi.nlm.nih.gov/35838516/ where you can access a demonstration video
Learn about the reconstructive surgery techniques created by Dr. Ubirajara
TCM for penis enlargement
The penis has a visible portion and another in the perineal region. A fixed portion is attached to the bone in a segment called the ischial tuberosity. The "Total Corporal Mobilization" (TCM) technique aims to release the entire fixed segment of the penis, causing the entire structure of the penis to be mobilized to the surface, increasing the size of the penis.
Indications for performing TCM include micropenis, amputated penis, and genital reconstruction in trans men. Other, exceptional situations can benefit from the method, after evaluation by the professional.
The figure illustrates the anatomy of the penis and the segments circled in red represent the part attached to the bone, also called the crura.
The technique is published at https://pubmed.ncbi.nlm.nih.gov/35838516/ where you can access a demonstrative video.
Corporoplasty for clitoral reduction
Hypertrophy or enlargement of the clitoris can occur for various reasons, mainly due to increased blood levels of testosterone. Occasionally, the clitoris enlarges for no specific reason, also called idiopathic. The most common causes are congenital adrenal hyperplasia and the exogenous use of testosterone for aesthetic purposes.
Clitoral enlargement can generate a series of emotional discomforts that can culminate in female sexual dysfunction. Many women report being embarrassed to undress in front of their partner and to wear a bikini because of their genitalia.
The clitoral reduction techniques carried out to date require the dissection (detachment) of the vascular and nerve bundles that lead to the glans and the excision (removal) of the corpora cavernosa. As a result, there is an increased risk of tingling of the glans or vascular compromise. In addition, the clitoris has an erection and the removal of the corpora cavernosa means that there is no longer any tumescence of the clitoris during arousal.
Dr. Ubirajara has devised a technique that has already been published (ubmed.ncbi.nlm.nih.gov/35263057/), which aims to simplify surgery by not requiring the dissection of nerves and vessels and where it is possible to preserve the clitoral erection (see drawing below). This technique is a modification of the Hodson technique published in the 1990s, but it compares favorably due to its better cosmetic aspect.
Corporoplasty for clitoris reduction
Hypertrophy or enlargement of the clitoris can occur for a number of reasons, most notably an increase in blood levels of testosterone. Eventually, the clitoris enlarges without a specific reason, also called idiopathic. The most frequent causes are congenital adrenal hyperplasia and the exogenous use of testosterone for aesthetic purposes.
Enlargement of the clitoris can generate a series of emotional discomforts that can culminate in female sexual dysfunction. Many women are ashamed of undressing in front of their partner and wearing a bikini because of the mark on their genitals.
So far, the clitoral reduction techniques require the dissection (detachment) of the vascular and nervous bundle that goes to the glans and the excision (removal) of the corpora cavernosa. Consequently, there is an increased risk of glans tingling or vascular compromise. In addition, the clitoris has an erection, and the removal of the corpora cavernosa means that there is no longer any tumescence of the clitoris in arousal.
The Doctor. Ubirajara devised a previously published technique (ubmed.ncbi.nlm.nih.gov/35263057/), which aims to simplify the surgery, not requiring nerve and vessel dissection and where it is possible to preserve the clitoral erection (see drawing below). This technique is a modification of the Hodson technique published in the 1990s, but it compares favorably for its better cosmetic appearance.
Double inlay and onlay flap for urethral stenosis
Most urethral strictures are treated by a surgical procedure, urethroplasty. In long narrowings, the mucosa of the mouth is the tissue most often used to widen the urethra, with a high success rate. However, when the urethra is very thin, the use of just one segment is unsatisfactory and the double graft technique, as proposed by Palminteri et al, is the alternative.
A possible problem with the Palminteri technique is that the graft is placed in the anterior portion of the urethra, and there is no tissue support to nourish and help fix the graft.
In the technique devised by Dr. Barroso (https://pubmed.ncbi.nlm.nih.gov/33848080/), the second graft is placed inlay, i.e. in the narrowed segment itself, providing support for a better "grip" of the graft. See figure.
Double flap in and onlay for urethral stenosis
Urethroplasty is the procedure of choice for the treatment of urethral stenosis. In long strictures, the oral mucosa is the tissue most used to widen the urethra, with a high success rate. However, when the urethra is very thin, using only one segment is unsatisfactory and the double graft technique, as proposed by Palminteri et al., is the alternative.
A possible problem with the Palminteri technique is the placement of the graft in the anterior portion of the urethra, as there is no tissue support to nourish and help with graft fixation.
In the technique devised by Dr Barroso (https://pubmed.ncbi.nlm.nih.gov/33848080/), the second graft is placed inlay, that is, in the narrowed segment itself, providing support for a better "grip" of the graft. See the figure.
Inverted U for hypospadias surgery
In cases where the hypospadias is close to the scrotum, surgery needs to be carried out in two stages, the first for grafting and the second for urethral reconstruction. In the first stage, many patients will need grafts to rectify the penis and pave over the tissue that will form the urethra in the future. This tissue is often the mucosa of the lip or cheek. This tissue is chosen because of its similarity to urethral tissue and because it doesn't leave visible scars in the donor area.
The problem with each graft is its contraction, which in the urethra is around 20%. This is why, in some situations, a new graft has to be used. In the technique devised by Dr. Barroso, a larger area of tissue is removed and grafted in an inverted U shape, doubling the size of the graft and therefore reducing the chances of retraction. This technique is published at: https://pubmed.ncbi.nlm.nih.gov/18996051/
Inverted U for hypospadias surgery
In cases where the hypospadias is close to the scrotum, the surgery must be performed in two stages, the first for grafting and the second for urethral reconstruction. In the first stage, many patients will need grafts to straighten the penis and pave the tissue that will be the urethra in the future. This tissue is often the mucosa of the lip or cheek. This tissue is chosen because of its similarity to the urethral tissue and because it does not leave visible scars in the donor area.
The problem with each graft is its contraction, which in the urethra is around 20%. Therefore, in some situations, a new graft needs to be used. In the technique devised by Dr. Barroso, a larger extension of tissue is taken and grafted in an inverted U shape, doubling the size of the graft and therefore reducing the chances of retraction. This technique is published at the link: https://pubmed.ncbi.nlm.nih.gov/18996051/