Surgical Outcomes Following Gender Affirming Penile Reconstruction: Patient-Reported Outcomes From a Multi-Center, International Survey of 129 Transmasculine Patients

Robinson, Isabel S.; Blasdel, Gaines; Cohen, Oriana; Zhao, Lee C.; Bluebond-Langner, Rachel

doi:10.1016/j.jsxm.2021.01.183

Cited by 33 publications

(29 citation statements)

References 44 publications

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“…In a prior study, metoidioplasty patients reported moderate growth of the phallus with an average of 1.7 cm during arousal. 22 This finding is consistent with our results in that the ability to have an erection is achievable post-metoidioplasty. We have further characterized this ability, showing that the majority of patients would be interested in improving their erections from a EHS score of 1 or 2 (ie, “penis is larger but not hard” or “penis is hard but not hard enough for penetration,” respectively) to a higher EHS score.…”

Section: Discussionsupporting

confidence: 93%

The Sexual Goals of Metoidioplasty Patients and Their Attitudes Toward Using PDE5 Inhibitors and Intracavernosal Injections as Erectile Aids

et al. 2022

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Background Following metoidioplasty, transmen (TM) experience sexual function challenges including erectile dysfunction, which is typically treated in cisgender men with phosphodiesterase-5 inhibitors (PDE5i) and intracavernosal injections (ICI). Aim We aim to evaluate sexual function post-metoidioplasty and explore attitudes toward using PDE5i and ICI as potential erectile aids Methods All patients who had metoidioplasty completed at the Gender Surgery Program in Vancouver, British Columbia were contacted. Participants completed an electronically accessible self-constructed questionnaire consisting of 39 items on erectile function, orgasm, and penetrative intercourse which also captured Erection Hardness Scores (EHS). Data were analyzed via t-test and 1-way ANOVA. Outcomes Our outcomes were the importance of erectile function, ability to orgasm, penetrative intercourse, and attitudes towards using PDE5i and ICI post-metoidioplasty. Results Fifteen out of 22 patients completed the survey (median age 32 years). Most had metoidioplasty within the past 2 years. The participants ranked the ability to orgasm and to achieve or maintain erections significantly higher than penetrative intercourse (P <.001, P =.005 respectively). Most participants reported facing challenges with penetrative intercourse (87%) and erectile function (80%). In contrast, a smaller proportion reported challenges with orgasm (33%). With regards to EHS, 83% of participants described their erections as either “larger but not hard,” or “hard but not hard enough for penetration.” A total of 47% of the participants had previously tried PDE5i, but none had used ICI. Although 87% were willing to use PDE5i, only 40% were willing to try ICI to improve their erections. Patients reported lack of knowledge and understanding among primary care physicians as barriers to accessing treatment for sexual dysfunction. Clinical Translation The results of this study can facilitate decision making for TM undergoing genital gender-affirmation surgery and provide potential options for improving erectile function post surgery. Strengths & Limitations This study represents the first assessment of sexual function and use of erectile aids in post-metoidioplasty patients. The results of this study are limited by the small sample size and enrolment from a single surgical center. Conclusion Metoidioplasty patients surveyed fail to achieve a fully rigid erection without treatment, typically retain the ability to orgasm, and are generally willing to try PDE5i.

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Section: Discussionsupporting

confidence: 93%

The Sexual Goals of Metoidioplasty Patients and Their Attitudes Toward Using PDE5 Inhibitors and Intracavernosal Injections as Erectile Aids

et al. 2022

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“…In their series of 97 patients, Vukadinovic et al reported standing urination and satisfactory sexual function (reaching orgasm) in all patients undergoing metoidioplasty [34] . These outcomes correlated with overall satisfaction and QoL scores.…”

Section: Patient Satisfaction Following Metoidioplastymentioning

confidence: 96%

“…Jolly et al [15] , Veerman et al [32] , 2020 LR 5 (62.5%) 4 (50%) 1 (12.5%) Vukadinovic et al [34] , Hysterectomy and bilateral salpingo-oophorectomy were performed in approximately 25% of the patients, and urethral lengthening was performed with a buccal mucosa graft and fasciocutaneous labial flaps in over 90% of patients. In an earlier report from 2009 by the same group using the same technique, urethral stricture and fistula rates were 2% and 9%, respectively [19] .…”

Section: Urinary Complicationsmentioning

confidence: 99%

“…), the additional procedures did not seem to increase the risk of urethral complications [23] . However, Danker et al [33] report that insertion of testicular implants at the time of scrotoplasty and urethroplasty was associated with an increased risk of infection and may lead to an increased rate of stricture and/or fistula formation [34] .…”

Section: Urinary Complicationsmentioning

confidence: 99%

“…They note that dribbling and spraying occurred in 16% of patients; every case resolved spontaneously, and no patients required surgical revision. In their study of 97 patients undergoing single-stage metoidioplasty with vaginectomy, urethroplasty, scrotoplasty, and testicular implant insertion, Vukadinovic et al reported that 18% of patients (n = 17) experienced urinary dribbling or spraying [34] . All 17 patients were managed nonoperatively.…”

Section: Urinary Complicationsmentioning

confidence: 99%

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A narrative review of outcomes following metoidioplasty: complications and satisfaction

Jahromi¹,

Spellman²,

Horen³

et al. 2022

Plast Aesthet Res

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Metoidioplasty consists of lengthening and straightening the hormonally hypertrophied clitoris. The goals of the procedure include masculinizing the external genitalia and enabling standing micturition. Metoidioplasty may be performed as a stand-alone procedure or an interval procedure prior to phalloplasty. While most often performed with urethral lengthening, metoidioplasty may also be performed as a “simple release” (i.e., without urethral lengthening). Secondary procedures typically include scrotoplasty and placement of testicular implants. While satisfaction with this procedure is high, complications can occur. Complications are commonly categorized as either urologic (i.e., strictures and fistula) or wound healing (i.e., wound disruption, infection, bleeding, etc.). This narrative review discusses postoperative outcomes, including both satisfaction and complications. Published data on complications include fistula and stricture rates from 0%-50% and 0%-63%, respectively. Overall satisfaction with appearance ranges from 48%-100%, and patient ability to void while standing ranges from 67%-100%. Metoidioplasty is a safe and effective procedure for transgender men. Further research regarding surgical techniques and outcomes will help reduce complications and improve overall patient satisfaction.

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Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide

et al. 2023

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ImportanceGender-affirming care is a key clinical area that can benefit from implementation of patient-reported outcome measures (PROMs). Identifying barriers to and enablers of PROM implementation is needed to develop an evidence-based implementation strategy.ObjectiveTo identify (1) PROMs previously implemented for gender-affirming care and constructs measured, (2) how patients completed PROMs and how results were reported and used, and (3) barriers to and enablers of PROM implementation.Evidence ReviewIn this systematic review, PubMed, Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science were searched from inception to October 25, 2021, and updated on December 16, 2022. Gray literature was searched through gray literature database, online search engine, and targeted website searching. Inclusion criteria were (1) original articles of (2) a formally developed PROM or ad hoc instrument administered for gender-affirming care to (3) patients accessing gender-affirming care. The Critical Appraisal Skills Programme tool was used to evaluate quality of included studies. This review was registered on PROSPERO (CRD42021233080).FindingsIn total, 286 studies were included, representing 85 395 transgender and nonbinary patients from more than 30 countries. A total of 205 different PROMs were used in gender-affirming care. No studies described using an implementation science theory, model, or framework to support PROM deployment. Key barriers to PROM implementation included issues with evidence strength and quality of the PROM, engaging participants, and PROM complexity. Key enablers of PROM implementation included using PROMs validated for gender-affirming care, implementing PROMs able to be deployed online or in person, implementing PROMs that are shorter and reduce patient burden, engaging key stakeholders and participants as part of developing an implementation plan, and organizational climate.Conclusions and RelevanceIn this systematic review of barriers to and enablers of PROM implementation in gender-affirming care, PROM implementation was inconsistent and did not follow evidence-based approaches in implementation science. There was also a lack of patient input in creating implementation strategies, suggesting a need for patient-centered approaches to PROM implementation. Frameworks created from these results can be used to develop evidence-based PROM implementation initiatives for gender-affirming care and have potential generalizability for other clinical areas interested in implementing PROMs.

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Surgical Outcomes Following Gender Affirming Penile Reconstruction: Patient-Reported Outcomes From a Multi-Center, International Survey of 129 Transmasculine Patients

Cited by 33 publications

References 44 publications

The Sexual Goals of Metoidioplasty Patients and Their Attitudes Toward Using PDE5 Inhibitors and Intracavernosal Injections as Erectile Aids

The Sexual Goals of Metoidioplasty Patients and Their Attitudes Toward Using PDE5 Inhibitors and Intracavernosal Injections as Erectile Aids

A narrative review of outcomes following metoidioplasty: complications and satisfaction

Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide

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