Evaluation of BMI as a Risk Factor for Complications following Gender-affirming Penile Inversion Vaginoplasty

Abstract

Background: Gender affirmation surgery (GAS) has a positive impact on the health of transgender patients; however, some centers employ body mass index (BMI) as a strict selection criterion for surgical candidacy. Several single-center studies have found no clear correlation between BMI and complication rates. We conducted a retrospective multicenter study at 2 university-based centers to test the null hypothesis: obesity is not a significant determinant of the risk of acute surgical complications in patients undergoing penile inversion vaginoplasty (PIV). Methods: This is a retrospective chart review of all adult patients at the University of Michigan and the University of Miami undergoing gender-affirming PIV with minimum follow-up time of 3 months between 1999 and 2017. A logistic regression model of analysis is used to examine the predictive factors for surgical complications and delayed revision urethroplasty in our patient sample. Results: One hundred and one patients met inclusion criteria for this study. The mean BMI at the time of procedure was 26.9kg/m 2 (range 17.8–48.2). Seventeen patients (16.8%) had major complications and 36 patients (35.6%) had minor complications. On logistic regression analysis, none of the recorded covariates were significant predictors of delayed revision urethroplasty or major, minor, or any complications. Conclusions: We found that obese patients can safely undergo GAS and that BMI alone should not preclude appropriately selected patients from undergoing GAS. We acknowledge that selection based on overall health and other medical comorbidities is certainly warranted for gender-affirming PIV and all other surgical procedures.

Transfeminine Gender Confirmation Surgery with Penile Inversion Vaginoplasty: An Initial Experience

“…Consistent with the available literature, comorbid conditions and obesity does not appear to correlate with complication rate. 11 , 14 – 16 , 19 , 20 Although formal statistical analysis was not able to be carried out in a cohort this size, body mass index, smoking status, HIV status, and comorbid disease did not show a clear risk for complication.…”

“…The most common procedure to achieve these goals for transfeminine (TF) genital reassignment is penile inversion vaginoplasty. 6 – 16 Alternative procedures, including sigmoid vaginoplasty, are described in the literature. However, these are generally recognized as inferior to penile inversion.…”

Orchiectomy in transgender individuals: A motivation analysis and report of surgical outcomes

“…In this study 11 (26%) individuals underwent orchiectomy because they did not meet institutional requirements. It may well be that these people would face a different surgical course in the future, as having a high BMI is currently being debated as being a risk factor for vaginoplasty surgery complications (Ives et al., 2019 ).…”

Penile inversion vaginoplasty outcomes: Complications and satisfaction

“…17,19,23,24 Reported rates of adverse intraoperative complications, such as rectal or genitourinary injury or need for intraoperative blood transfusion, range from 1.5% to 2.6%. 19,24 Ives et al 22 reported major complications in 16.8% of their patients, with 5% of patients requiring reoperation for bleeding, 7.9% requiring reoperation for wound complications, 2% requiring readmission without reoperation, and 1% developing a venous thromboembolism (VTE). Their relatively high complication rate may be attributable to their broader inclusion criteria for "major complication" compared with other authors.…”

“…[15][16][17] Previous studies found that SARS, 1 of the 3 epidemic coronaviruses to emerge in the past 20 years and that shows similar clinical presentations to COVID-19, 18 could cause orchitis 19 and focal testicular atrophy. 20 Considering the tens of millions of COVID-19 cases and that men are more vulnerable to COVID-19 than women, [21][22][23] it is imperative to determine the effect of COVID-19 on male reproduction. 24 Several studies have been performed on this topic.…”