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Operative Steps

1.Patient placed in the lithotomy position wearing TED stockings and inflatable boots.
2.Peno-scrotal flaps marked, infiltrated with 1/100,000 adrenaline solution and raised.
3.Vaginal space made. Check to exclude inadvertent rectal injury.
4.Removal of testes.
5.Penile flap further mobilised.
6.Urethra divided.
 7.Clitoris fashioned from portion of glans penis and dorsal neurovascular bundle.
 8.Crura of penis divided and oversewn flush with pelvic bone.
9.Clitoris fashioned on penile flap.
10.Urethra spatulated, shortened and brought through penile skin flap and anastomosed.
11.Urethra plicated and catheter placed.
12.Penile-scrotal skin flaps sewn and inverted into vaginal space.
13.Drains placed.
14.Scrotal flaps fashioned to create labia majora.
15.Clitoral hood fashioned using V-Y plasty.
16.Vaginal pack placed and compressive dressing applied.