Vaginal Canal Reconstruction in Penile Inversion Vaginoplasty with Flaps, Peritoneum, or Skin Grafts: Where Is the Evidence?

Salibian, Ara A.; Schechter, Loren S.; Kuzon, William M.; Bouman, Mark‐Bram; Sluis, Wouter B. van der; Zhao, Lee C.; Bluebond-Langner, Rachel

doi:10.1097/prs.0000000000007779

Cited by 26 publications

(30 citation statements)

References 56 publications

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“…3 Short genital length can be an indication for sigmoid colon vaginoplasty or additional fullthickness skin graft of abdominal or scrotal skin, [4][5][6][7][8] as there is insufficient genital skin to line the vaginal canal using penile-inversion techniques. 9 Each has drawbacks, including risks related to bowel anastomosis, and visible scarring if extragenital skin graft is used. Depending on the technique used, penoscrotal hypoplasia can also affect reconstruction of vulvar subunits.…”

mentioning

confidence: 99%

“Case Control Analysis of Genital Hypoplasia Prior to Gender Affirming Vaginoplasty: Does the Robotic Peritoneal Flap Method Create Equivalent Vaginal Canal Outcomes?”

Blasdel

Kloer

Parker

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Insufficient genital tissue has been reported as a barrier to achieving depth in gender-affirming vaginoplasty. The authors sought to characterize vaginal depth and revision outcomes in patients with genital hypoplasia undergoing robotic peritoneal flap vaginoplasty. Methods: Retrospective case-control analysis of patients undergoing robotic peritoneal vaginoplasty between September of 2017 and August of 2020 was used. All 43 patients identified as having genital hypoplasia (genital length <7 cm) were included with 49 random controls from the remaining patients with greater than 7 cm genital length. Baseline clinical characteristics and perioperative variables were recorded to identify potential confounders. Outcomes measured included vaginal size reported at last visit and undergoing revision surgery for depth or for vulvar appearance. Results: Patients were well matched other than median body mass index at the time of surgery, which was greater in the hypoplasia cohort by 3.6 kg/m2 (P < 0.0001). Patients had a median of 1-year of follow-up, with a minimum follow-up of 90 days. No significant differences in outcomes were observed, with a median vaginal depth of 14.5 cm (interquartile range, 13.3 to 14.5 cm), and a median width of dilator used of 3.8 cm (interquartile range, 3.8 to 3.8 cm). No depth revisions were observed, and an 11% (n = 10) rate of external revision occurred. Conclusions: Patients with genital hypoplasia had equivalent dilation outcomes in a case-control analysis with consistent follow-up past 90 days. The robotic peritoneal flap vaginoplasty technique provides vaginal depth of 14 cm or greater regardless of genital tissue before surgery. Further investigation with patient-reported outcome measures is warranted. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

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confidence: 99%

“Case Control Analysis of Genital Hypoplasia Prior to Gender Affirming Vaginoplasty: Does the Robotic Peritoneal Flap Method Create Equivalent Vaginal Canal Outcomes?”

Blasdel

Kloer

Parker

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…We echo the sentiments of Salibian et al that "the ideal neovaginal lining should be a moist, distensible, hairless epithelium with a donor site that is sufficient to resurface the neovagina and results in minimal morbidity" (19). With promising innovations in tissue engineering and surgical materials, and new research emerging to educate clinicians about novel approaches to common and frustrating surgical problems, we look forward to seeing the field of genderaffirming genital surgery closer to that ideal each day.…”

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confidence: 80%

Considerations for secondary vaginoplasty

Shoham¹,

Pang²,

Satterwhite³

2022

Transl Androl Urol

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“…Our series results as detailed above compare favorably with previously published reports of complications during neovaginoplasty such as rectal injury (0.4–4.5% cases), 14 15 23 24 25 26 27 28 29 urethral injury (1.1–3.6% cases), 27 30 postoperative bleeding requiring transfusion (4.8%), 30 minor necrosis (24.6% cases) 30 and major necrosis (0.6% cases), 30 reoperation (1.5%), 30 introital/vaginal stenosis (1.2–12%), 31 32 and urethral meatus stenosis (1–39%). 24 27 This may be due to the use of a refined procedure with many modifications in place in this cohort, surgeries by a single surgical team consisting of a senior and junior plastic surgeon and a GI surgeon with assigned tasks and set protocols.…”

Section: Discussionmentioning

confidence: 99%

Achieving Correct Axis and Good Depth in Gender Affirming Vaginoplasties by Penile-Perineoscrotal Flap Vaginoplasty

Gupta

2022

Indian J Plast Surg

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Objectives Vaginoplasty as a part of feminizing genitoplasty (FG) in transwomen helps alleviate gender dysphoria and improves mental health, sexual and psychosocial functioning, and quality of life in these individuals. Penile inversion technique (PSFV) remains the gold standard procedure for FG with least morbidity but has inherent limitations often resulting in inadequate depth and incorrect (posteroinferior) vaginal axis, precluding sexual intercourse. Material and Methods Over the past 27 years, the senior author has refined his technique considerably incorporating several modifications penile perineo-scrotal flap vaginoplasty (PPSFV) to overcome the limitations in PSFV. Most of these modifications were in place by March 2015. Out of 630 primary FGs, retrospective review of all PPSFV with minimum 6 months follow-up operated during the period March 2015 to July 2020 was done for intra and postoperative complications. Results There were 183 patients who underwent PPSFV during the study period. Average follow-up was 31 (6–62) months. There were no cases of injury to bladder, rectum, urethral stenosis, or neovaginal prolapse. Average operative time was 4 hours and eight (4.37%) patients required blood transfusion. The vaginal depth was 13 to 14 cm or more in 159 (86.88%), 10 to 12 cm in 17 (9.29%), and 7.5 to 9 cm in seven (3.82%) patients. Ten (5.46%) patients complained of intravaginal hair growth. Touch up procedures in the form of anterior commissure and labia plasty were required in 13 (7.10%) patients. All (100%) patients had good clitoral sensitivity and preserved posterosuperior vaginal axis. One-hundred thirty nine (75.96%) patients were able to have satisfactory penetrative sexual intercourse, while 39 (21.31%) had not attempted intercourse and five (2.73%) complained of poor sexual experience on account of inadequate vaginal dimensions. Conclusion PPSFV addresses the limitations in PSFV and results in good vaginal depth and posterosuperior axis, which facilitates penetrative sexual intercourse, at the same time, avoiding potential complications of procedures such as intestinal vaginoplasties.

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Vaginal Canal Reconstruction in Penile Inversion Vaginoplasty with Flaps, Peritoneum, or Skin Grafts: Where Is the Evidence?

Cited by 26 publications

References 56 publications

“Case Control Analysis of Genital Hypoplasia Prior to Gender Affirming Vaginoplasty: Does the Robotic Peritoneal Flap Method Create Equivalent Vaginal Canal Outcomes?”

“Case Control Analysis of Genital Hypoplasia Prior to Gender Affirming Vaginoplasty: Does the Robotic Peritoneal Flap Method Create Equivalent Vaginal Canal Outcomes?”

Considerations for secondary vaginoplasty

Achieving Correct Axis and Good Depth in Gender Affirming Vaginoplasties by Penile-Perineoscrotal Flap Vaginoplasty

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