Pd31-12 penile Prosthesis Placement Using an Optimized Method by a Dedicated Transgender Surgery Unit: A Slow Decrease in High Complication Rates

Abstract

INTRODUCTION AND OBJECTIVE:In the last 20 years, techniques in vaginal restorative surgery have evolved. Studies evaluating post-operative outcomes following contemporary surgical approaches in congenital adrenal hyperplasia (CAH) patients with variation in genital anatomy (VGA) remain scarce. Vaginal stenosis (VS) is a complication of vaginal restorative surgery and requires specialized care and management. We reviewed our surgical experience with CAH patients to understand patterns of occurrence, classification, and management of VS at our institution.METHODS: We retrospectively reviewed CAH patients with VGA who underwent primary vaginoplasty from 1996 to 2016. Patient demographics, procedure characteristics, occurrence of VS, and subsequent management were recorded. Prader score was further stratified to a 7-point genital stage. Annual physical exam was performed from post-op to toilet training then after menarche unless clinically indicated. VS was defined as narrowing at the vaginal introitus or inability to use tampons/have penetrative intercourse. VS was further categorized as Suspected (minor narrowing observed on exam without clinical impact, S-VS) or Clinically Significant (severe narrowing requiring intervention once menarche is achieved, CS-VS). Patients without a vaginoplasty or one performed at another institution, identified as male, lost to follow up, or without follow up records were excluded.RESULTS: 130 patients were included for evaluation. Mean age was 3.5 years (0.32-34.5 years). Classic CAH occurred in 94.4%. A genital score of 3 (Prader III) predominated (39,7%). Mean anesthesia and surgery time was 4.3 (2-9.5) and 3.1 (1.1-8.0) hrs, respectively. Mean admission and follow up length was 3.2 days and 4.5 (0.01-17.6) years. S-VS and CS-VS occurred in 13 and 14 patients, respectively. Management of CS-VS included redo vaginoplasty (5, 1 planned but lost to follow-up), expectant management (8). The development of S-VS correlated with procedure type (flap alone p[0.012 and PT þ flap p[0.043) and genital score 7 (p[0.022). CS-VS was only associated with PT (p[0.035). Logistic regression to predict VS was not statistically significant.CONCLUSIONS: VS remains a concern following vaginal restorative surgery in CAH patients. This descriptive study at a CAH center of excellence is an initial step toward characterization of VS. Higher genital score and procedure type was associated with the development of VS. In the future, standardization of the definition of VS will help assess clinical outcomes, defining risk factors, and tailoring management.