A Single-center Analysis on the Learning Curve of Male-to-Female Penoscrotal Vaginoplasty by Multiple Surgical Measures

Falcone, Marco; Timpano, M.; Ceruti, C.; Sedigh, O.; Oderda, Marco; Gillo, Arianna; Preto, Mirko; Sibona, M.; Garaffa, Giulio; Frea, Bruno; Rolle, Luigi

doi:10.1016/j.urology.2016.07.012

Cited by 25 publications

(32 citation statements)

References 30 publications

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“…Furthermore, in the majority of these patients re‐operation is common and at times expected. The absence of a universally accepted technique forces each surgeon approaching penile‐scrotal vaginoplasty (PSV) to develop their own approach with variations based on personal experience being particularly important according to Falcone et al (). Falcone et al () also show a decrease in incidence of complications as the surgeon develops their technique.…”

Section: Discussionmentioning

confidence: 99%

Complications of the neovagina in male‐to‐female transgender surgery: A systematic review and meta‐analysis with discussion of management

et al. 2017

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Gender-affirmation surgery is often the final gender-confirming medical intervention sought by those patients suffering from gender dysphoria. In the male-to-female (MtF) transgendered patient, the creation of esthetic and functional external female genitalia with a functional vaginal channel is of the utmost importance. The aim of this review and meta-analysis is to evaluate the epidemiology, presentation, management, and outcomes of neovaginal complications in the MtF transgender reassignment surgery patients. PUBMED was searched in accordance with PRISMA guidelines for relevant articles (n = 125). Ineligible articles were excluded and articles meeting all inclusion criteria went on to review and analysis (n = 13). Ultimately, studies reported on 1,684 patients with an overall complication rate of 32.5% and a reoperation rate of 21.7% for non-esthetic reasons. The most common complication was stenosis of the neo-meatus (14.4%). Wound infection was associated with an increased risk of all tissue-healing complications. Use of sacrospinous ligament fixation (SSL) was associated with a significantly decreased risk of prolapse of the neovagina. Gender-affirmation surgery is important in the treatment of gender dysphoric patients, but there is a high complication rate in the reported literature. Variability in technique and complication reporting standards makes it difficult to assess the accurately the current state of MtF gender reassignment surgery. Further research and implementation of standards is necessary to improve patient outcomes. Clin. Anat. 31:191-199, 2018. © 2017 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Complications of the neovagina in male‐to‐female transgender surgery: A systematic review and meta‐analysis with discussion of management

et al. 2017

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“…15 Neovaginal stenosis may refer to introital stenosis or stenosis of the vaginal canal and represents the most frequently reported complication of the vaginal canal. 18,21,31,35 Rates of neovaginal stenosis range from 0% to 12% 14,15,18,20,23,24,[26][27][28][29][30][31][32]36 with introital stenosis ranging from 2.5% to 15%. 14,15,20,24,28,32 Lack of compliance with post-operative dilation is the most common reason cited for both introital and neovaginal stenosis, 15,29,32 but some studies postulate that local infection and ischemia may play a role.…”

Section: Vaginal Canal Complications-stenosis Prolapse Hair Growth and Drainagementioning

confidence: 99%

“…48 When identified at the time of surgery, the rectum is repaired in a layered fashion. 19,26,29,30,37,38 Some authors advocate performing a temporary colostomy, 18 although this is not routinely done.…”

Section: Rectal Injury and Rectovaginal Fistulamentioning

confidence: 99%

“…Goddard et al 26 reported that 25% of patients expressed concerns with the appearance of their labia after surgery. In addition, up to 54.2% of patients (range 20%–54.2%) may pursue secondary surgery for cosmetic reasons 14,18,20,29,30,32,39 . Labiaplasty/labial reduction is the most commonly performed revision procedure (80%), with 10% of procedures performed for clitoral hood reduction, and the remaining 10% performed for clitoral repositioning 18 .…”

Section: Complications Following Vaginoplastymentioning

confidence: 99%

“…Injury to the rectum may occur during dissection of the neovaginal space. Reported rates of rectal injury range from 0% to 6.67% 15,18–20,23–31,34,37,39,48 . Injuries include full‐thickness rectal injuries or injuries to the muscular wall of the rectum 48 .…”

Section: Complications Following Vaginoplastymentioning

confidence: 99%

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Penile inversion vaginoplasty outcomes: Complications and satisfaction

et al. 2021

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Penile inversion vaginoplasty helps to alleviate gender dysphoria and improve quality of life in many transgender individuals. Overall, the procedure is associated with high post-operative satisfaction, even when complications occur. Adverse events related to vaginoplasty are commensurate with other genitourinary reconstructive procedures performed for other diagnoses (ie, cancer or congenital issues). Here, we explore the incidence of complications following vaginoplasty, emphasizing the challenges in defining and managing these adverse events. In addition, outcome measures to assess patient satisfaction will be reviewed.

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Gender‐affirming vaginoplasty: Technical considerations in patients with genital skin deficiency

Huang

Lai

Morgantini

et al. 2022

Neurourology and Urodynamics

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Introduction: Gender dysphoria affects over 1 million American adults. Vaginoplasty is a critical step in gender affirmation, and many patients have insufficient genital skin for full-depth penile inversion vaginoplasty (PIV). We reviewed the literature for technical considerations addressing this and present our data supporting the use of peritoneal flaps (Davydov technique). Materials and Methods:A comprehensive review of modern literature was conducted. Second, we present a retrospective case review of our experience with PIV, including data from procedures utilizing peritoneal flaps. Results: We identified 20 original articles, including retrospective and prospective case and cohort studies. Approaches included the application of local soft tissue grafts and flaps, peritoneal flaps, and intestinal segments. Between June 2018 and February 2021, 47 patients at our institution, underwent PIV for the treatment of gender dysphoria. Nineteen of those patients underwent robotic-assisted peritoneal flap procedure in addition to PIV. In this cohort, the mean follow-up was 200.6 ± 124.8 days. Mean neovaginal depth was 13.1 ± 3.0 cm intra-operatively and 11.0 cm at the last follow-up. Twenty-six percent of complications were Clavien Grade 1 or 2; others included wound dehiscence (30.4%), perianal and urethral fistula (13.0%), and neovaginal stenosis (8.7%). The majority of patients reported satisfactory results in terms of sexual function with intact tactile and erogenous sensation. Almost half were able to have penetrative vaginal intercourse at the last follow-up. We did not aim to perform statistical calculations to compare the outcomes of PIV with and without robotic-assisted peritoneal flap augmentation, as the groups were not constructed in that manner. However, it is evident that anatomical and functional results as well as the distribution of postoperative complications seem similar. Conclusion:Vaginoplasty is indicated in a growing population of patients with a wide range of medical histories and anatomic variations. Genitourinary reconstructive surgeons must have several methods to achieve full-depth Neurourol Urodyn.

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A Single-center Analysis on the Learning Curve of Male-to-Female Penoscrotal Vaginoplasty by Multiple Surgical Measures

Cited by 25 publications

References 30 publications

Complications of the neovagina in male‐to‐female transgender surgery: A systematic review and meta‐analysis with discussion of management

Complications of the neovagina in male‐to‐female transgender surgery: A systematic review and meta‐analysis with discussion of management

Penile inversion vaginoplasty outcomes: Complications and satisfaction

Gender‐affirming vaginoplasty: Technical considerations in patients with genital skin deficiency

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