Genital Reconstructive Surgery in Male to Female Transgender Patients: A Systematic Review of Primary Surgical Techniques, Complication Profiles, and Functional Outcomes from 1950 to Present Day

Dunford, Charlotte; Bell, Kathryn; Rashid, Tina

doi:10.1016/j.euf.2020.01.004

Cited by 31 publications

(28 citation statements)

References 46 publications

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“…The lowest satisfaction outcomes correspond to sexual intercourse, their partner's satisfaction, and the neovaginal depth, having obtained an average depth of 13.7 cm. This result contrasts with the minimum of 11 cm depth described as optimal by the literature (20). In this way, it becomes crucial to clarify patients' expectations and possibilities of achieving them before surgery to obtain satisfactory results.…”

Section: Discussionmentioning

confidence: 65%

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Impact of the initial experience in the penile inversion vaginoplasty technique on satisfaction levels: a pilot retrospective cohort study

Pablos-Rodríguez¹,

Barreda²,

Giadrosich³

et al. 2022

Transl Androl Urol

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Background: There is a growing interest in reporting satisfaction levels of transgender women undergoing vaginoplasty surgery. The lack of information regarding satisfaction during the initial experience of the vaginoplasty technique, and the moderate morbidity related to the surgery, could discourage the immersion of new groups in initiating a program of this kind. Therefore, we aim to report patients' level of satisfaction during our initial experience in the penile inversion vaginoplasty technique.Methods: Retrospective study of patients who underwent penile inversion vaginoplasty in our center between September 2019 and August 2021. Surgery technique, demographic data, preoperative clinical variables, and short and long-term follow-up are described. Six months after surgery, a survey elaborated by the research team was conducted by phone. The score goes from 1 to 5, and it evaluates satisfaction on esthetics, functional, psychosocial, and global aspects.Results: Twenty patients underwent penile inversion vaginoplasty in our center during the described period. The average age was 35.6 years old, the mean body mass index (BMI) was 24.7 kg/m 2 , and they presented low comorbidity. Half of the patients presented at least one complication, most of which were minor. One patient was urgently reoperated due to bleeding, and three patients were reoperated on a scheduled basis from minor surgeries. 90% of the patients answered the questionnaire. The most common answers to all four areas covered (esthetics, functional, psychosocial, and global) were satisfied or very satisfied, resulting in a mean over four points in each one of the sections. Lastly, 94.4% of the patients reported being satisfied with their choice of having undergone surgery.Conclusions: Our initial experience in penile inversion vaginoplasty reveals good satisfaction results at short follow up.

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Section: Discussionmentioning

confidence: 65%

“…This score is consistent with the percentage of regret described in the literature. A recent systematic review (20) shows less than 1% of total regret and 5.5% of some regret.…”

Section: Discussionmentioning

confidence: 97%

Impact of the initial experience in the penile inversion vaginoplasty technique on satisfaction levels: a pilot retrospective cohort study

Pablos-Rodríguez¹,

Barreda²,

Giadrosich³

et al. 2022

Transl Androl Urol

View full text Add to dashboard Cite

show abstract

“…Obese patients appear to be at higher risk of perioperative complications across various surgical fields, but there is conflicting evidence on which adverse outcomes are directly related to obesity itself and which are more attributable to the medical comorbidities associated with obesity 9,15,21 . Nevertheless, many genital reconstructive urologists use elevated BMI as exclusion criteria for GRS candidates 6,7 . Epidemiologic studies have identified transgender patients have higher rates of obesity than the cisgender population 22 .…”

Section: Discussionmentioning

confidence: 99%

Outcomes of penile inversion vaginoplasty and robotic‐assisted peritoneal flap vaginoplasty in obese and nonobese patients

Acar

Alcantar

Millman

et al. 2022

Neurourology and Urodynamics

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Aim: To explore the impact of body mass index (BMI) on the outcomes of gender-affirming vaginoplasty. Methods: A cohort consisting of all gender-affirming vaginoplasties in our practice between September 27th, 2018, and September 1st, 2022 were identified, and data were retrospectively collected. Patients were classified as obese if their BMI was ≥30 kg/m 2 at the time of surgery and nonobese if their BMI was <30 kg/m 2 . Complications were assigned a Clavien-Dindo grade and grouped as Grade ≥2 versus Grade ≤1. Patient-reported functional outcomes of intact erogenous sensation, tactile sensation, ability to achieve penetrative vaginal intercourse, and cosmetic satisfaction were assessed.Results: A total of 58 patients with a mean follow-up time of 6.9 months were included. Seventeen patients (mean BMI = 36.8 kg/m 2 ) were classified as obese and 41 patients (mean BMI = 25.1 kg/m 2 ) were classified as nonobese.No significant differences in outcomes were identified in the obese versus nonobese groups in terms of the incidence of complications. Patient-reported functional outcomes did not differ significantly between the two groups. Conclusions: Similar results can be achieved with gender-affirming vaginoplasty in obese patients when compared to their nonobese counterparts.Eligibility for this procedure should not be restricted based on BMI alone.

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“…Facial feminization maneuvers, bottom surgeries, and other gender-affirming surgery have been described previously. 12 13 14 15 16 17 …”

Section: Methodsmentioning

confidence: 99%

Gender Affirming Surgery in Nonbinary Patients: A Single Institutional Experience

Liu

Chan

et al. 2023

Arch Plast Surg

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Background An increasing number of nonbinary patients are receiving gender-affirming procedures due to improved access to care. However, the preferred treatments for nonbinary patients are underdescribed. The purpose of this study was to investigate the goals and treatments of nonbinary patients. Methods A retrospective study of patients who self-identified as nonbinary from our institutional Gender Health Program was conducted. Patient demographics, clinical characteristics, surgical goals, and operative variables were analyzed. Results Of the 375 patients with gender dysphoria, 67 (18%) were nonbinary. Over half of the nonbinary patients were assigned male at birth (n = 57, 85%) and nearly half preferred the gender pronoun they/them/theirs (n = 33, 49%). A total of 44 patients (66%) received hormone therapy for an average of 2.5 ± 3.6 years, primarily estrogen (n = 39). Most patients (n = 46, 69%) received or are interested in gender-affirming surgery, of which, almost half were previously on hormone therapy (n = 32, 48%). The most common surgeries completed or desired were facial feminization surgery (n = 15, 22%), vaginoplasty (n = 15, 22%), mastectomy (n = 11, 16%), and orchiectomy (n = 9, 13%). Nonbinary patients who were assigned male at birth (NB-AMAB) were more often treated with hormones compared to nonbinary patients assigned female at birth (NB-AFAB) (72% vs. 30%, p = 0.010). Conversely, patients who were AFAB were more likely to complete or desire surgical intervention than those who were AMAB (100% vs. 63.0%, p < 0.021). Conclusion Majority of nonbinary patients were assigned male at birth. NB-AFAB patients all underwent surgical treatment, whereas NB-AMAB patients were predominantly treated with hormone therapy.

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Genital Reconstructive Surgery in Male to Female Transgender Patients: A Systematic Review of Primary Surgical Techniques, Complication Profiles, and Functional Outcomes from 1950 to Present Day

Cited by 31 publications

References 46 publications

Impact of the initial experience in the penile inversion vaginoplasty technique on satisfaction levels: a pilot retrospective cohort study

Impact of the initial experience in the penile inversion vaginoplasty technique on satisfaction levels: a pilot retrospective cohort study

Outcomes of penile inversion vaginoplasty and robotic‐assisted peritoneal flap vaginoplasty in obese and nonobese patients

Gender Affirming Surgery in Nonbinary Patients: A Single Institutional Experience

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