Faculty Profiles - NAMBA Yuzaburo

Papers - NAMBA Yuzaburo

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性別不合に対する診断と治療のガイドライン第５版 Invited Reviewed

安部恵一郎, 難波祐三郎

日本精神神経学会、日本GI（性別不合）学会 1 - 42 2024.10

Trans men can achieve adequate muscular development through low-dose testosterone therapy: A long-term study on body composition changes. International journal

Yusuke Tominaga, Tomoko Kobayashi, Yuko Matsumoto, Takatoshi Moriwake, Yoshitaka Oshima, Misa Okumura, Satoshi Horii, Takuya Sadahira, Satoshi Katayama, Takehiro Iwata, Shingo Nishimura, Kensuke Bekku, Kohei Edamura, Morito Sugimoto, Yasuyuki Kobayashi, Masami Watanabe, Yuzaburo Namba, Yosuke Matsumoto, Mikiya Nakatsuka, Motoo Araki

Andrology 2024.4

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Transgender individuals undergo the gender-affirming hormone therapy (GAHT) to achieve physical changes consistent with their gender identity. Few studies are available on the long-term safety and efficacy of GAHT. OBJECTIVES: To investigate the long-term physical effects and the safety of the testosterone therapy for trans men and to assess the impact of differential hormone dose. MATERIALS AND METHODS: Trans men who initiated GAHT between May 2000 and December 2021 were included in this retrospective analysis. Physical findings (body mass index, body fat percentage (BFP), lean body mass (LBM), and grip strength), blood testing results (hemoglobin, hematocrit, uric acid, creatinine, total cholesterol, triglycerides, and total testosterone), and menstrual cessation were recorded. We assessed the effects of testosterone on body composition changes and laboratory parameters, comparing a low-dose group (≤ 62.5 mg/wk) to a high-dose group (> 62.5 mg/wk). RESULTS: Of 291 participants, 188 patients (64.6%) were in the low-dose group and 103 (35.4%) in the high-dose group. Cumulative menstrual cessation rates up to 12 months were not significantly different between groups. Both groups showed a decrease in BFP and an increase in LBM during the first year of therapy, followed by a slight increase in both over the long term. The high-dose group exhibited greater LBM gains during the first year. Higher hormone doses and lower initial LBM values were associated with LBM increases at 3 and 6 months (3 mo, P = 0.006, P < 0.001; 6 mo, P = 0.015, P < 0.001). There were no long-term, dose-dependent side effects such as polycythemia or dyslipidemia. CONCLUSION: Long-term GAHT for trans men is safe and effective. Low-dose testosterone administration is sufficient to increase LBM in trans men. Higher testosterone doses can lead to an earlier increase in muscle mass.

DOI： 10.1111/andr.13640

PubMed

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陰茎形成術における当院での工夫キセル型皮弁 Reviewed

今井利郎, 難波祐三郎

日本GI（性別不合）学会誌 16 ( 1 ) 176 - 176 2023.12

健康保険適用後のGID診療の現状健康保険適用後における岡山大学病院のGID診療の現状 Reviewed

渡部紫秀, 難波祐三郎

日本GI（性別不合）学会誌 16 ( 1 ) 143 - 146 2023.12

性同一性障害患者へのこれからの形成外科的アプローチ Invited Reviewed

難波祐三郎

形成外科 66 152 - 155 2023.6

Trans womenの外陰部女性化術とS状結腸造腟術における希釈式自己血輸血の有用性

林昌伸, 渡邊敏之, 渡部紫秀, 賀来隆二, 佐古智子, 寺石文則, 木股敬裕, 難波祐三郎

GID(性同一性障害)学会雑誌 15 ( 1 ) 193 - 193 2022.12

男性型胸郭形成術後の血種形成症例に対して、局所麻酔注入法を用いて血種除去を施行した２症例 Reviewed

渡部紫秀, 難波祐三郎

日本GI（性別不合）学会誌 15 ( 1 ) 133 - 137 2022.12

Genital feminizing surgery without vagina as a safe, aesthetic and cost-effective option for gender affirming surgery for transwomen Reviewed

Shiho Watanabe, Toshiyuki Watanabe, Kiyoshi Yamada, Yuzaburo Namba, Yoshihiro Kimata

Acta Medica Okayama 76 ( 5 ) 597 - 603 2022.10

術後の悪心・嘔吐予防目的で使用されたメトクロプラミドとハロペリドールの併用により錐体外路症状を呈した１例 Reviewed

知原佑樹, 難波祐三郎

形成外科 65 ( 9 ) 1102 - 1106 2022.9

Authorship：Corresponding author Language：Japanese Publishing type：Research paper (scientific journal) Publisher：克誠堂出版(株)

性別違和の患者(27歳、女性から男性への性転換者)に対し、性別適合手術(gender affirming surgery:GAS)の一環として全身麻酔下に尿道延長術を施行後、PONV(術後悪心・嘔吐)の予防目的にメトクロプラミドを用い、さらに不穏の緩和目的にハロペリドールを投与した結果、錐体外路症状の急性症状であるジストニアを発症した症例について報告した。GAS希望者の全身麻酔を伴う治療では、抗精神病薬内服歴や男性ホルモン使用歴などを確認し、錐体外路症状を発症しやすい素因があることを念頭に置いて治療を行う必要があると考えられた。

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性同一性障害/性別違和の外科治療（性別適合手術） Invited Reviewed

難波祐三郎

精神医学 64 ( 8 ) 1142 - 1148 2022.8

Intraoperative local instillation anesthesia using injection technique from J-VAC^TM drain for postoperative pain relief in male-type chest wall contouring surgery Reviewed

Toshiyuki Watanabe, Sho Komagoe, Yuzaburo Namba, Yoshihiro Kimata

Journal of Plastic Surgery and Hand Surgery 1 - 4 2022.2

A Case of a Transwoman with Colorectal Cancer after Flap Vaginoplasty Reviewed

Shiho Watanabe, Fuminori Teraishi, Sari Fujimoto, Toshiyuki Watanabe, Sho Takeda, Shuhei Narita, Koya Yamashita, Kunitoshi Shigeyasu, Shunsuke Kagawa, Yuzaburo Namba, Yoshihiro Kimata

Journal of Plastic and Reconstructive Surgery 2 ( 3 ) 98 - 101 2022

女性から男性へのトランスジェンダーにおける陰茎形成術のためのBMIに基づく皮弁選択アルゴリズム

渡邊敏之, 難波祐三郎, 木股敬裕

日本マイクロサージャリー学会学術集会プログラム・抄録集 48回 348 - 348 2021.12

医療スタッフが知っておきたい性的マイノリティーと医療 Invited Reviewed

難波祐三郎

医学のあゆみ 279 ( 4 ) 260 - 263 2021.10

Flap Selection Algorithm Based on the Body Mass Index for Phalloplasty in Female-to-Male Transgender: Techniques and Outcomes

Toshiyuki Watanabe, Yuzaburo Namba, Yoshihiro Kimata

Journal of Reconstructive Microsurgery Open 06 ( 02 ) e57 - e62 2021.7

Publishing type：Research paper (scientific journal) Publisher：Georg Thieme Verlag KG

<title>Abstract</title>
Background Various phalloplasty methods have been reported; however, a consensus has not been reached. Therefore, we suggest an alternative algorithm for an ideal phalloplasty considering the factors that affect flap selection.

Methods We retrospectively examined 32 phalloplasty cases of female-to-male transgender. Flaps used for phalloplasty were classified into three groups as follows: (1) radial forearm (RF) group, (2) anterolateral thigh (ALT) group, and (3) flap combination (FC) group. Statistical analyses were performed to determine the significance of age and body mass index (BMI) as well as differences in the rates of postoperative complication, reoperation, esthetic acceptability, tactile or erogenous sensibility, and the ability to urinate while standing.

Results Ten cases were included in the RF group and 7 and 15 cases in the ALT and FC groups, respectively. With respect to BMI, the RF group (mean [standard deviation (SD)] = 25.9 [3.3]) showed significantly higher BMI than the ALT (21.7 [0.9]) or FC group (22.2 [4.5]). The RF (mean [SD] = 3.7 [0.4]) and ALT groups (3.5 [0.9]) had significantly higher esthetic acceptability evaluation scores (from 1 to 4) than the FC group (2.5 [1.2]). Moreover, the RF and ALT groups were superior than the FC group in terms of tactile or erogenous sensibility rates.

Conclusion BMI effected flap choices for phalloplasty because of the correlation between BMI and skin thickness. FC becomes an option between ALT flap and RF flap in terms of flap choice based on BMI. Our alternative algorithm for an ideal phalloplasty based on BMI will be useful for objective flap choices.

DOI： 10.1055/s-0041-1732373

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形成外科専攻医への推奨論文１００選 Invited Reviewed

難波祐三郎

形成外科 64 48 - 48 2021.6

私の心に残る１症例 Invited Reviewed

難波祐三郎

形成外科 64 ( 4 ) 432 - 435 2021.4

GID・FTMに対する乳房切除術と乳頭縮小術の一期的手術についての検討

櫻井透, 渡邊敏之, 木股敬裕, 難波祐三郎

形成外科 64 ( 3 ) 310 - 316 2021.3

Language：Japanese Publisher：克誠堂出版(株)

性同一性障害(GID)のfemale-to-male(FTM)に対し、乳輪下半周切開法による乳房切除術と乳頭縮小術を一期的に行った94例188乳房を対象に、手術記録とカルテを用いて、術後経過を調査した。また、術後1ヵ月の記録写真を用いて術後の乳頭の状態を評価した。その結果、術後に乳頭壊死を認めた症例はなかった。乳頭の表皮壊死を3例3乳頭(1.6%)、乳頭の埋没を2例2乳頭(1.1%)に認め、表皮壊死は保存的治療で治癒した。乳頭の埋没で追加治療の希望はなく、経過観察となった。後に余剰皮膚切除などの修復術を追加した症例は6例12乳房であった。術後に血腫が原因で緊急手術となったのは6例6乳房で、いずれも乳頭の合併症(乳頭表皮壊死、乳頭埋没)は認めなかった。合併症の発症率と、年齢、ホルモン治療歴、喫煙歴、BMIの関連は、合併症例が少なく、統計学的に指摘できなかった。GID・FTMに対する乳房切除術と乳頭縮小術の一期的手術は有用と考えられた。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J00398&link_issn=&doc_id=20210225230010&doc_link_id=%2Fad3ksgke%2F2021%2F006403%2F015%2F0310b0316%26dl%3D3&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2021%2F006403%2F015%2F0310b0316%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

有茎ALT皮弁を用いた陰茎形成術の経験

難波祐三郎, 渡辺敏之, 木股敬裕

形成外科 63 ( 9 ) 1159 - 1165 2020.9

直腸-S状結腸造腟術における術後の腸管縫合不全に対し保存的治療が有効であった1例

川本幸司, 渡邊敏之, 木股敬裕, 難波祐三郎, 杉本盛人, 母里淑子, 永坂岳司

日本形成外科学会会誌 40 ( 4 ) 196 - 197 2020.4

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