Bartholin gland cyst in a transgender male: case report of a rare occurrence.

This case report highlights the importance of a wide differential diagnosis in transgender patients. A 77-year-old transgender (female-to-male) with recurrent urinary tract infections (UTI) and obstructive voiding difficulties presented with a perineal cyst. Further examinations, including computed tomography (CT) and puncture, revealed that the patient had a symptomatic Bartholin gland cyst, a phenomenon that normally only affects women. In his gender confirmation surgery (GCS) 30 years before, the patient's female labia minora and Bartholin glands were used to lengthen the urethra for the phalloplasty. This explains the unusual location and the prolonged time to the correct diagnose. We decided to perform an incision of the fluid collection from perineal. A follow-up sonography after one month revealed a remaining cyst size of 6 mL, which was assumed to be residual fluid or newly produced liquid; however, the patient has not had any UTIs since the incision of the cyst. Our case seems to be the first description of a symptomatic Bartholin gland cyst in a trans man. This stresses the importance of an expanded understanding of sex/gender concepts, and underlines one of the many possible diagnostic pitfalls when treating trans people.

Suture techniques and cartilage grafts in nasal tip surgery: An algorithm in primary and secondary rhinoplasty.

OBJECTIVE: In most primary and secondary rhinoplasties, the adjustment of the nasal tip in terms of position, projection, and configuration is mandatory. Usually, this is one of the most challenging parts of the operation. The aim of this study was to present a step-by-step algorithm that evaluates popular techniques for a predictable outcome. PATIENTS AND METHODS: A single-surgeon retrospective review of primary and secondary rhinoplasty patients was undertaken for nasal tip refinement. An overview of popular and clinically relevant suture techniques and cartilage grafts is provided, in particular, concerning the position, projection, and rotation. On the basis of clinical examples, we will present different indications, the latest operative treatment options, and long-term results. RESULTS: Between 2013 and 2018, we devised an algorithm based on 322 patients. Ninety patients (28%) were admitted for primary rhinoplasties and 232 patients for secondary rhinoplasties (72%). Our patients reported overall high satisfaction rates, and no further revisions were required. CONCLUSIONS: Preoperative analyses and the knowledge of different suture techniques and cartilage grafts for nasal tip surgery are crucial factors for a successful postoperative outcome.