Male-to-Female Gender Reassignment Surgery: An Institutional Analysis of Outcomes, Short-term Complications, and Risk Factors for 240 Patients Undergoing Penile-Inversion Vaginoplasty

Levy, Jason A.; Edwards, Daniel C.; Cutruzzula-Dreher, Paulette; McGreen, Brian; Akanda, Shawon; Tarry, Susan; Belkoff, Laurence; Rumer, Kathy L.

doi:10.1016/j.urology.2019.03.043

Cited by 44 publications

(59 citation statements)

References 11 publications

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“…Possible causes for this effect are that patients underwent penile inversion vaginoplasty regardless of penile length, used as a surgical selection criterion in the literature. 7 , 9 – 12 , 14 , 17 Based on the literature and our experience, intraoperative packing of the neovagina and regular and aggressive postoperative dilation regimens are found to be strongly correlated with optimal neovaginal depth and vaginal diameter. Patients are encouraged to dilate multiple times daily for several months.…”

Section: Discussionmentioning

confidence: 83%

“…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.…”

Section: Discussionmentioning

confidence: 97%

“…The most commonly cited shortfall of this reconstruction method is that the neovaginal depth is often insufficient and may require revisions with either enteric mucosa or a full thickness skin graft. 10 , 14 While there remain indications for alternative procedures, primarily based on the amount of donor tissue available, penile inversion is the most widely preformed means of TF genital affirmation in the United States. Consideration must also be given to complications, most significantly, rectovaginal fistula, urinary retention or urethral stenosis, wound dehiscence, or neovaginal prolapse.…”

Section: Introductionmentioning

confidence: 99%

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

Loree

Burke

Rippe

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: To detail the early experience with and results of a transfeminine (TF) genital reconstruction at an established plastic surgery practice in Western New York. Methods: Between June 2016 and June 2019, 30 patients underwent penile inversion vaginoplasty for TF gender reassignment. All patients fulfilled World Professional Association for Transgender Health and NY State criteria for reassignment surgery. All surgeries were carried out at a large, government-owned tertiary care center. Results: There were 30 patients in this retrospective study, with a mean age of 37 years (SD 5.4) and a mean body mass index of 27.3 kg/m 2 (SD 3.2 kg/m 2 ). Nineteen patients never smoked, 4 were former smokers, and 7 were current smokers. Primary surgery was an orchiectomy and modified single-stage penile inversion vaginoplasty. Mean operative time was 6.0 hours. Mean initial hospital stay was 8.2 days. Three of the 30 (10%) patients required transfusion. There were 6 (20%) complications. Three complications (10%) required reoperation: 1 patient for wound dehiscence on postoperative day 7, 1 for rectal perforation identified on postoperative day 10, and 1 for urethrovaginal fistula. All complications were addressed without sequalae. Twenty of the 30 (66%) patients have undergone revision surgery. Indications for revision were prolapse correction/deepening, labiaplasty, clitoral hood construction/revision, meatal asymmetry, urinary fistula repair, and posterior vaginal flap revision. Twenty-one of 28 (75%) revisions were outpatient surgeries. There were no complications from these procedures. Overall satisfaction via survey was 92% (24 respondents). Conclusions: TF gender reassignment is a novel, challenging set of procedures for the specialty of plastic surgery. With appropriate consideration and technique, penile inversion vaginoplasty is a safe, effective means of achieving this goal.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Loree

Burke

Rippe

et al. 2020

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

show abstract

“…Minor wound healing issues are commonly reported following vaginoplasty (range 3.3%-33%), 19,[22][23][24][25][27][28][29][30][31][32] and many resolve without the need for surgical intervention. 23 Wound dehiscence, especially in areas of increased tissue tension (ie, introitus and labia majora), 28 most commonly occurs within the first month following surgery. 19,32 Ferrando reported that of the 17% of their patients (n = 76 patients) who experienced complications, more than 50% of these complications involved wound dehiscence or wound separation.…”

Section: Wound Disruption and Tissue Lossmentioning

confidence: 99%

“…[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.…”

Section: Introductionmentioning

confidence: 99%

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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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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Male-to-Female Gender Reassignment Surgery: An Institutional Analysis of Outcomes, Short-term Complications, and Risk Factors for 240 Patients Undergoing Penile-Inversion Vaginoplasty

Cited by 44 publications

References 11 publications

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

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

Penile inversion vaginoplasty outcomes: Complications and satisfaction

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

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