Jayaram, Stuteville & Bush, 1978
Dept. of Plastic and Reconstructive Surgery, Cook County Hospital and Loyola University Medical Center, Chicago, IL, USA

This surgical-urological joint publication is different from all other follow-up studies about which it is reported here. This publication seems to us worth mentioning because it documents the frequently extremely poor quality of sex reassignment surgery (comp. Hore et al., 1975). Surgical complications are compared to those primary surgeries made by their own team and those made by a team somewhere else and the results of the corrective surgeries are represented.

• Sample
• Type of Complications
• Type of Treatment
• Follow-Up Study Period
• Evaluation Fields and Criteria
• Results
• Authors' Conclusion
• Indication Recommendations
• Remarks

Type of Complications
In their own primarily operated group eight complications happened to six of 22 females: continuous bleeding (n=3), infection (n=1), diarrhea (n=3), incontinence (n=1). They were not so severe that corrective surgery had to be done.
In the group operated elsewhere 18 females had 69 severe complications, resp., cosmetically unsatisfying results, namely the loss of the vaginal lining (n=3), introital stenosis (n=4), vaginal stenosis (n=16), meatal stenosis (n=5), fistula urethro-vaginal (n=3), redundant labia (n=12), scanty labia (n=4), urinary meatus placed too high (n=10), vaginal orifice too posterior (n=3), gaping vagina (n=5), retained corpora cavernosa (n=4).

Type of Treatment
As corrective surgery the following procedures were done: new forming of the vagina and lining with skin; widening of entrance stenosis by Y-V skin plastic; widening of the urethra constriction, resp., placing the urethra exit in an anatomically adequate place; labia plastic; closing of the urethro-vaginal fistula; removal of the rest of erectile tissue.

Follow-up Study Period
The follow-up study period is not specified. Probably the data refers to the time immediately before, resp., at secondary surgery.

Evaluation Fields and Criteria
The evaluation criteria were the functionality and aesthetic of the vagina and vulva.

Results
For all correctively operated and followed up the results were, in accordance to the judgment of the authors, satisfactory.

Authors' Conclusion
It is the desire of the authors to give recommendations for primary surgery and post-surgical care. It is important to them to remark that it is useless to maintain parts of the functionless erectile tissues because they only displace with sexual excitement the vagina. They also rightly highlight the major importance of a cosmetically satisfactory medical result. To insure state-of-the-art post-surgical care the surgery should be done in the place of residence if possible. The patients should wear, especially in post-surgical times, a dilator.

Remarks
Notably is the indication that 12 of the 18 females operated elsewhere (15 in other cities of the USA, three abroad) were residents of Chicago who wanted to circumvent the long waiting time and mostly the severe local indication criteria.