1
|
Stojanovic B, Horwood G, Joksic I, Bafna S, Djordjevic ML. Management of vaginoplasty canal complications. Curr Opin Urol 2024; 34:336-343. [PMID: 38898785 DOI: 10.1097/mou.0000000000001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
PURPOSE OF REVIEW Increasing uptake of gender affirming surgery has allowed for a wider breadth of publication examining complications associated with vaginoplasty. This review aims to provide a comprehensive overview of complications associated with vaginoplasty procedures, focusing on intraoperative, early postoperative, and delayed postoperative complications across different surgical techniques. RECENT FINDINGS Intraoperative complications such as bleeding, injury of the rectum, urethra and prostate, and intra-abdominal injury are discussed, with insights into their incidence rates and management strategies. Early postoperative complications, including wound dehiscence, infection, and voiding dysfunction, are highlighted alongside their respective treatment approaches. Moreover, delayed postoperative complications such as neovaginal stenosis, vaginal depth reduction, vaginal prolapse, rectovaginal fistula, and urinary tract fistulas are assessed, with a focus on their etiology, incidence rates, and management options. SUMMARY Vaginoplasty complications range from minor wound issues to severe functional problems, necessitating a nuanced understanding of their management. Patient counseling, surgical approach, and postoperative care optimization emerge as crucial strategies in mitigating the impact of complications. Standardizing complication reporting and further research are emphasized to develop evidence-based strategies for complication prevention and management in vaginoplasty procedures.
Collapse
Affiliation(s)
- Borko Stojanovic
- Belgrade Center for Urogenital Reconstructive Surgery
- Faculty of Medicine, University of Belgrade, Serbia
| | - Geneviève Horwood
- Belgrade Center for Urogenital Reconstructive Surgery
- Department of Obstetrics, gynecology and newborn care, The Ottawa Hospital, Ottawa, Canada
| | - Ivana Joksic
- Hospital for Gynecology and obstetrics, Belgrade, Serbia
| | - Sandeep Bafna
- Belgrade Center for Urogenital Reconstructive Surgery
- Apollo Hospitals Chennai, India
| | - Miroslav L Djordjevic
- Belgrade Center for Urogenital Reconstructive Surgery
- Faculty of Medicine, University of Belgrade, Serbia
| |
Collapse
|
2
|
Bene NC, Ferrin PC, Xu J, Dy GW, Dugi D, Peters BR. Tissue Options for Construction of the Neovaginal Canal in Gender-Affirming Vaginoplasty. J Clin Med 2024; 13:2760. [PMID: 38792302 PMCID: PMC11122258 DOI: 10.3390/jcm13102760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/03/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Gender-affirming vaginoplasty (GAV) comprises the construction of a vulva and a neovaginal canal. Although technical nuances of vulvar construction vary between surgeons, vulvar construction is always performed using the homologous penile and scrotal tissues to construct the corresponding vulvar structures. Therefore, the main differentiating factor across gender-affirming vaginoplasty techniques is the tissue that is utilized to construct the neovaginal canal. These tissue types vary markedly in their availability, histology, and ease of harvest and have different advantages and disadvantages to their use as neovaginal lining. In this narrative review, the authors provide a comprehensive overview of the tissue types and associated operative approaches used for construction of the neovagina in GAV. Tissue choice is guided by several factors, such as histological similarity to natal vaginal mucosa, tissue availability, lubrication potential, additional donor site morbidity, and the specific goals of each patient. Skin is used to construct the neovagina in most cases with a combination of pedicled penile skin flaps and scrotal and extra-genital skin grafts. However, skin alternatives such as peritoneum and intestine are increasing in use. Peritoneum and intestine are emerging as options for primary vaginoplasty in cases of limited genital skin or revision vaginoplasty procedures. The increasing number of gender-affirming vaginoplasty procedures performed and the changing patient demographics from factors such as pubertal suppression have resulted in rapidly evolving indications for the use of these differing vaginoplasty techniques. This review sheds light on the use of less frequently utilized tissue types described for construction of the neovaginal canal, including mucosal tissues such as urethral and buccal mucosa, the tunica vaginalis, and dermal matrix allografts and xenografts. Although the body of evidence for each vaginoplasty technique is growing, there is a need for large prospective comparison studies of outcomes between these techniques and the tissue types used to line the neovaginal canal to better define indications and limitations.
Collapse
Affiliation(s)
- Nicholas C. Bene
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR 97239, USA
- Transgender Health Program, Oregon Health and Science University, Portland, OR 97239, USA
| | - Peter C. Ferrin
- Department of Surgery, Oregon Health and Science University, Portland, OR 97239, USA
| | - Jing Xu
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR 97239, USA
| | - Geolani W. Dy
- Transgender Health Program, Oregon Health and Science University, Portland, OR 97239, USA
- Department of Urology, Oregon Health and Science University, Portland, OR 97239, USA
| | - Daniel Dugi
- Transgender Health Program, Oregon Health and Science University, Portland, OR 97239, USA
- Department of Urology, Oregon Health and Science University, Portland, OR 97239, USA
| | - Blair R. Peters
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR 97239, USA
- Transgender Health Program, Oregon Health and Science University, Portland, OR 97239, USA
| |
Collapse
|
3
|
Berger LE, Lava CX, Spoer DL, Huffman SS, Martin T, Bekeny JC, Fan KL, Lisle DM, Del Corral GA. The Effect of Obesity on Vaginoplasty Outcomes. Ann Plast Surg 2024; 92:447-456. [PMID: 38319959 DOI: 10.1097/sap.0000000000003808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Some surgeons use body mass index criteria within the patient selection processes before vaginoplasty, thereby limiting access to select obese patients. We sought to better characterize the effect of obesity on postoperative outcomes across multiple vaginoplasty techniques. METHODS A single-center retrospective review of all transfeminine patients undergoing primary vaginoplasty procedures from December 2018 to July 2022 was conducted. Patients were stratified into cohorts according to the World Health Organization Obesity Class criteria. Data regarding demographics, comorbidities, operative details, postoperative complications, and all-cause revision were collected. RESULTS A total of 237 patients met the inclusion criteria. Average follow-up duration was 9.1 ± 4.7 months. Multivariate regression revealed that patients with class I and class II/III obesity were associated with higher odds of developing vaginal stenosis (class I: odds ratio [OR], 7.1 [ P = 0.003]; class II/III: OR, 3.4 [ P = 0.018]) and all-cause revision (class I: OR, 3.7 [ P = 0.021]; class II/III: OR, 4.8 [ P = 0.027]). Undergoing either robotic peritoneal or robotic intestinal vaginoplasty was associated with lower odds of delayed wound healing (peritoneal: OR, 0.2 [ P < 0.001]; intestinal: OR, 0.2 [ P = 0.011]). Lastly, adherence to dilation regimen was negatively associated with development of vaginal stenosis (OR, 0.04; P < 0.001). CONCLUSIONS Patients with obesity may be at a higher risk of developing vaginal stenosis after vaginoplasty, which may ultimately necessitate operative revision. Although patients with obesity may remain surgical candidates, proper preoperative counseling and adherence to postoperative vaginal dilation regimens are critical to optimizing outcomes.
Collapse
Affiliation(s)
| | | | | | | | - Taylor Martin
- Georgetown University School of Medicine, Washington, DC
| | - Jenna C Bekeny
- From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Kenneth L Fan
- From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - David M Lisle
- Division of Colorectal Surgery, Department of General Surgery, MedStar Franklin Square Medical Center, Baltimore, MD
| | - Gabriel A Del Corral
- Department of Plastic and Reconstructive Surgery, MedStar Washington Hospital Center, Washington, DC
| |
Collapse
|
4
|
Mañero Vazquez I, Labanca T, Herrero R. Double longitudinal myotomy in gender-affirming colovaginoplasty: an innovative surgical technique to prevent and treat neovaginal spasms. J Sex Med 2024; 21:342-349. [PMID: 38441522 DOI: 10.1093/jsxmed/qdae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/10/2023] [Accepted: 01/15/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Gender-affirming colovaginoplasty (GACv) presents excellent postoperative results. However, neovaginal spasms, reported as painful cramps, can affect the sexual life of patients. AIM The study sought to describe an innovative surgical technique and evaluate its impact on the prevention and treatment of neovaginal spasms. METHODS This was a single-center prospective observational study with 2 series of patients: (1) patients who underwent GACv with double myotomy (DM) for spasm prevention (series A), in which longitudinal myotomies were performed across the defunctionalized colon, transecting the taenias, and resecting 2 strips of the intestinal muscle layer of approximately 1- to 2-mm wide and tall, leaving intact colonic tissue between strips; and (2) patients who reported neovaginal spasms in whom intravaginal-DM was performed as treatment surgery (series B), in which the posterior wall of the neovagina was dissected from the rectum and transected by longitudinal myotomies, resecting 2 strips of endoluminal mucosa and submucosal muscle of approximately 1- to 2-mm wide and tall, and the colonic mucosa was subsequently closed. OUTCOMES Patient-reported outcomes and neovaginal examination were performed following standardized protocols. RESULTS In series A, 177 patients underwent GACv with the DM technique and were prospectively followed for a median time of 18 months (interquartile range, 13-60 months). No patients reported neovaginal spasms. In series B, 18 patients who reported neovaginal spasms after GACv were treated with intravaginal DM. After a median time of 35 months (interquartile range, 26-45 months), 83% (n = 15 of 18) reported remission of symptoms. CLINICAL IMPLICATIONS Double longitudinal myotomy performed on the derived portion of the colon in colovaginoplasty is an easy-to-perform and safe technique that may prevent and treat postoperative neovaginal spasms. STRENGTHS AND LIMITATIONS Our results presented certain limitations, mainly associated with a low prevalence of neovaginal spasms, which, being of personal perception, can be underdiagnosed. To the same extent, the fact that it is a monocentric experience limits the possibility of extrapolating it to other centers. Moreover, a more trained surgical team may be the cause of fewer postoperative complications. On the other hand, the fact of being a reference center for gender-affirming surgery, having our procedures protocolized, and the prospective nature of the study allowed us to obtain a certain homogeneity and granularity of the results. CONCLUSION DM is a safe procedure and appears to be highly effective for the prevention and treatment of neovaginal spasms after GACv. Routine use of this technique does not increase the operating time or postoperative complications. Multicenter, prospective studies are required to validate our results.
Collapse
Affiliation(s)
- Iván Mañero Vazquez
- Department of Plastic Surgery, IM Gender, IM CLINIC, Institute of Plastic Surgery, Barcelona, 08174, Spain
| | - Trinidad Labanca
- Department of Plastic Surgery, IM Gender, IM CLINIC, Institute of Plastic Surgery, Barcelona, 08174, Spain
| | - Roberto Herrero
- Department of Plastic Surgery, IM Gender, IM CLINIC, Institute of Plastic Surgery, Barcelona, 08174, Spain
| |
Collapse
|
5
|
Sanchez Figueroa N, Zheng E, Kuruoglu D, Martinez-Jorge J. The use of Integra Dermal Regeneration Template in the surgical management of revision penile inversion vaginoplasty: A case series. J Plast Reconstr Aesthet Surg 2023; 87:91-97. [PMID: 37826968 DOI: 10.1016/j.bjps.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/04/2023] [Accepted: 08/12/2023] [Indexed: 10/14/2023]
Abstract
Since its initial design and use for the temporary coverage of severe full-thickness burn defects, Integra® (Integra LifeSciences) Dermal Regeneration Template has been increasingly used all over the body, yielding successful results in coverage of wound beds with insufficient vascularity and suboptimal conditions for proper healing. In this study, we report an institutional case series and outcomes of gender-affirming vaginoplasty revision for vaginal lengthening or reopening of the canal via placement of Integra® to assist in optimizing the wound bed for subsequent skin grafting when wound conditions were deemed to be suboptimal. A retrospective chart review was conducted in patients who underwent this technique by a single surgeon (JM) at the authors' institution. Demographics, vaginal depth, and complications were recorded and compared. Our patient population thus far includes 178 primary vaginoplasties, of which 9 of those needing revision were treated with this approach. The age at revision mean was 47 ± 13.5 years, and the body mass index mean was 31 ± 4.1. All patients had comorbidities and five were former smokers. Eight patients had prior revision conducted without Integra®, with a mean of 1.89 ± 1.76 and the time to first revision mean was 15.89 ± 14.2 months. No long-term complications after Integra® reported and most of the patients did not require further revision. The follow-up mean was 8.48 ± 8.66 months. A mean of 6.77 ± 5.35 cm was gained after the Integra® revision (4.92 ± 4.1 cm before versus 12.54 ± 3.07 cm after). The final depth after Integra® + full-thickness skin graft mean was 13.34 ± 4.65 cm. Overall, the depth gain mean was 7.48 ± 5.77 cm; in total, seven patients gained depth after revision with an average of 78% skin graft take. Overall, Integra® presents an alternative option for revision vaginoplasty with complicated wound beds potentially aiding in the healing process before grafting.
Collapse
Affiliation(s)
| | - Eugene Zheng
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Doga Kuruoglu
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jorys Martinez-Jorge
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
6
|
Robinson IS, Cripps CN, Bluebond-Langner R, Zhao LC. Operative Management of Complications Following Intestinal Vaginoplasty: A Case Series and Systematic Review. Urology 2023; 180:105-112. [PMID: 37479146 DOI: 10.1016/j.urology.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/06/2023] [Accepted: 07/03/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE To describe the authors' experience with surgical management of complications following intestinal vaginoplasty and review the literature on incidence of complications following gender-affirming intestinal vaginoplasty. METHODS Retrospective chart review identified patients presenting with complications following prior intestinal vaginoplasty requiring operative management. Charts were analyzed for medical history, preoperative exam and imaging, intraoperative technique, and long-term outcomes. Systematic literature review was performed to identify primary research on complications following gender-affirming intestinal vaginoplasty. RESULTS Four patients presented to the senior authors' clinic requiring operative intervention for complications following intestinal vaginoplasty, all of whom underwent surgical revision. Complications included vaginal stenosis (2 patients, 50%), vaginal false passage (1 patient, 25%), and diversion colitis (1 patient, 25%). Postoperatively all patients were able to dilate successfully to a depth of at least 15 cm. Systematic review identified 10 studies meeting inclusion criteria. There were 215 complications reported across 654 vaginoplasties (33% overall complication rate). Average return to operating room rate was 18%. The most common complications were stenosis (11%), mucorrhea (7%), vaginal prolapse (6%), and malodor (5%). Six intestinal vaginoplasty segments developed vascular compromise leading to flap loss. There were 2 reported mortalities. CONCLUSION Intestinal vaginoplasty is associated with a range of complications including vaginal stenosis, mucorrhea, and vaginal prolapse. Intra-abdominal complications, including diversion colitis, anastomotic bowel leak, and intra-abdominal abscess can occur many years after surgery, be life-threatening and require prompt diagnosis and management.
Collapse
Affiliation(s)
- Isabel S Robinson
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
| | - Courtney N Cripps
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
| | - Rachel Bluebond-Langner
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY; Department of Urology, NYU Langone Health, New York, NY
| | - Lee C Zhao
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY; Department of Urology, NYU Langone Health, New York, NY.
| |
Collapse
|
7
|
Parker A, Brydges H, Blasdel G, Bluebond-Langner R, Zhao LC. Mending the Gap: AlloDerm as a Safe and Effective Option for Vaginal Canal Lining in Revision Robotic Assisted Gender Affirming Peritoneal Flap Vaginoplasty. Urology 2023; 173:204-208. [PMID: 36642117 DOI: 10.1016/j.urology.2023.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/25/2022] [Accepted: 01/02/2023] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To address instances when there is insufficient remnant tissue to perform revision following canal-deepening gender affirming vaginoplasty revisions as indicated by insufficient depth. Options for lining of the vaginal canal include skin grafts, peritoneal flaps, or intestinal segment. Our center uses robotically harvested peritoneal flaps in vaginal canal revisions. When the peritoneal flap is insufficient for full canal coverage, we use AlloDerm, an acellular dermal matrix, for additional coverage. METHODS Retrospective analysis of 9 patients who underwent revision RPV with AlloDerm was performed. Tubularized AlloDerm grafts were used to connect remnant vaginal lining to the peritoneal flaps. Revision indications, surgical and patient outcomes, and patient-reported post-op dilation were recorded. RESULTS Nine patients underwent revision RPV using AlloDerm for canal deepening. Median follow-up was 368 days (Range 186-550). Following revision, median depth and width at last follow-up were 12.1 cm and 3.5 cm, and median increase in depth and width were 9.7 cm and 0.9 cm, respectively. There were no intraoperative complications. Two patients had focal areas of excess AlloDerm that were treated with in-office excision without compromise of the caliber or depth of the otherwise healed, epithelialized canal. CONCLUSION AlloDerm is an off-the-shelf option that does not require a secondary donor site. The use of AlloDerm for a pilot cohort of patients lacking sufficient autologous tissue for revision RPV alone was demonstrated to be safe and effective at a median 1-year follow-up.
Collapse
Affiliation(s)
| | - Hilliard Brydges
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
| | - Gaines Blasdel
- Department of Urology, NYU Langone Health, New York, NY; University of Michigan Medical School, Ann Arbor, MI
| | | | - Lee C Zhao
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY; Department of Urology, NYU Langone Health, New York, NY.
| |
Collapse
|
8
|
van der Sluis WB, Schäfer T, Nijhuis THJ, Bouman MB. Genital gender-affirming surgery for transgender women. Best Pract Res Clin Obstet Gynaecol 2023; 86:102297. [PMID: 36599721 DOI: 10.1016/j.bpobgyn.2022.102297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
Transgender women may opt for genital gender-affirming surgery (gGAS), which comprises bilateral orchiectomy, gender-affirming vulvoplasty, or vaginoplasty. Vaginoplasty is chosen most frequently in this population, penile inversion vaginoplasty being the surgical gold standard. In selected cases, skin graft vaginoplasty, intestinal vaginoplasty, or peritoneal vaginoplasty may be indicated. In this article, we discuss the various types of gGAS for transgender women, (contra)-indications, intraoperative considerations, techniques, surgical outcomes, and postoperative patient-reported outcomes.
Collapse
Affiliation(s)
- Wouter B van der Sluis
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands; Gender Clinic, Bosch en Duin, the Netherlands.
| | - Tim Schäfer
- Gender Clinic, Bosch en Duin, the Netherlands; Department of Plastic Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Tim H J Nijhuis
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands; Gender Clinic, Bosch en Duin, the Netherlands; Amsterdam Public Health (APH) Research Institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
| |
Collapse
|
9
|
Principles and outcomes of gender-affirming vaginoplasty. Nat Rev Urol 2023; 20:308-322. [PMID: 36726039 DOI: 10.1038/s41585-022-00705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 02/03/2023]
Abstract
Vaginoplasty is the most frequently performed gender-affirming genital surgery for gender-diverse people with genital gender incongruence. The procedure is performed to create an aesthetic and functional vulva and vaginal canal that enables receptive intercourse, erogenous clitoral sensation and a downward-directed urine stream. Penile inversion vaginoplasty (PIV) is a single surgical procedure involving anatomical component rearrangement of the penis and scrotum that enables many patients to meet these anatomical goals. Other options include minimal-depth, peritoneal and intestinal vaginoplasty. Patient quality of life has been shown to improve drastically after vaginoplasty, but complication rates have been documented to be as high as 70%. Fortunately, most complications do not alter long-term postoperative clinical outcomes and can be managed without surgical intervention in the acute perioperative phase. However, major complications, such as rectal injury, rectovaginal fistula, and urethral or introital stenosis can substantially affect the patient experience. Innovations in surgical approaches and techniques have demonstrated promising early results for reducing complications and augmenting vaginal depth, but long-term data are scarce.
Collapse
|
10
|
Serrano S, Pereira I, Henriques A, Valentim Lourenço A. Neovagina in Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome: Vaginoplasty Using Ileal Flap. ACTA MEDICA PORT 2023. [PMID: 36599171 DOI: 10.20344/amp.18563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/23/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Surgical treatment of patients with malformations of the female genital tract is a complex problem and there are different techniques described in the literature. The goal of all these techniques is the reconstruction of a neovagina that is anatomically similar to a vagina, with adequate length to facilitate sexual functioning and with the lowest risk of possible complications. The aim of this study is to describe the surgical technique for the reconstruction of a neovagina from an ileal segment without a vascular pedicle. MATERIAL AND METHODS Description of a surgical technique developed in our tertiary university center in a patient with Mayer-Rokitansky-Küster-Hauser syndrome. RESULTS The vaginoplasty surgery using ileal flap was performed in three steps. In the first part of the intervention a laparoscopic hysterectomy with bilateral salpingectomy was performed. The second step consisted of isolating the ileal segment, ileal anastomosis and preparing the ileal segment. After the isolated segment was prepared, it was repositioned in a vagina mold to configure the neovagina. Finally, the third step included the adaptation of the vaginal mold with the ileal mucosa to the vesicorectal space. CONCLUSION Ileal vaginoplasty without a vascular pedicle is an option that can be used to reconstruct the vagina, because it provides an excellent tissue for vaginal replacement. This technique can be used in patients with genital malformations of the genital tract with absence or vaginal hypoplasia.
Collapse
Affiliation(s)
- Sílvia Serrano
- Department of Obstetrics, Gynecology and Reproductive Medicine. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
| | - Inês Pereira
- Department of Gynecology and Obstetrics. Hospital CUF Descobertas. Lisbon; Department of Gynecology and Obstetrics. Hospital CUF Torres Vedras. Torres Vedras. Portugal
| | - Alexandra Henriques
- Department of Obstetrics, Gynecology and Reproductive Medicine. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon; Lisbon School of Medicine. Lisbon Academical Medical Center. Lisbon. Portugal
| | - Alexandre Valentim Lourenço
- Department of Obstetrics, Gynecology and Reproductive Medicine. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon; Lisbon School of Medicine. Lisbon Academical Medical Center. Lisbon. Portugal
| |
Collapse
|
11
|
Pidgeon TE, Franchi T, Lo ACQ, Mathew G, Shah HV, Iakovou D, Borrelli MR, Sohrabi C, Rashid T. Outcome measures reported following feminizing genital gender affirmation surgery for transgender women and gender diverse individuals: A systematic review. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 24:149-173. [PMID: 37122823 PMCID: PMC10132236 DOI: 10.1080/26895269.2022.2147117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Background Feminizing genital gender affirmation surgery (fgGAS) may be an essential adjunct in the care of some transgender women and gender diverse individuals with gender incongruence. However, the comparison of different techniques of fgGAS may be confounded by variable outcome reporting and the use of inconsistent outcomes in the literature. This systematic review provides the most in-depth examination of fgGAS studies to date, and summarizes all reported outcomes, definitions, and the times when outcomes were assessed following these surgical interventions. Aims/Methods: This work intends to quantify the levels of outcome variability and definition heterogeneity in this expanding field and provides guidance on outcome reporting for future study authors. Candidate studies for this systematic review were sourced via an electronic, multi-database literature search. All primary, clinical research studies of fgGAS were included with no date limits. Paired collaborators screened each study for inclusion and performed data extraction to document the outcomes, definitions, and times of outcome assessment following fgGAS. Results After screening 1225 studies, 93 studies proceeded to data extraction, representing 7681 patients. 2621 separate individual outcomes were reported, 857 (32.7%) were defined, and the time of outcome assessment was given for 1856 outcomes (70.8%) but relied on nonspecific ranges of follow-up dates. "Attainment of orgasm", "Neovaginal stenosis", and "Neovaginal depth/length" were among the most commonly reported outcomes. Profound heterogeneity existed in the definitions used for these and for all outcomes reported in general. Discussion The results demonstrate a need for clear outcomes, agreed definitions, and times of outcome assessment following fgGAS in transgender women and gender diverse individuals. The adoption of a consistent set of outcomes and definitions reported by all future studies of fgGAS (a Core Outcome Set) will aid in improving treatment comparisons in this patient group. This review is the first step in that process.
Collapse
Affiliation(s)
| | | | - Andre C. Q. Lo
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | - Despoina Iakovou
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Mimi R. Borrelli
- Department of Plastic Surgery, Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Catrin Sohrabi
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Tina Rashid
- Department of Gender Surgery, Parkside Hospital, London, UK
- Department of Urology, St George’s University Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
12
|
Vazquez IM, Labanca T, Arno AI. Functional, Aesthetic and Sensory Postoperative Complications of Female Genital Gender Affirmation Surgery: a Prospective Study. J Plast Reconstr Aesthet Surg 2022; 75:4312-4320. [DOI: 10.1016/j.bjps.2022.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 06/10/2022] [Accepted: 08/16/2022] [Indexed: 11/15/2022]
|
13
|
Gender Affirmation Surgery, Transfeminine. Urol Clin North Am 2022; 49:437-451. [DOI: 10.1016/j.ucl.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
14
|
Aryanpour Z, Nguyen CT, Blunck CK, Cooper KM, Kovac S, Ananthasekar S, Peters BR. Comprehensiveness of Online Information in Gender-Affirming Surgery: Current Trends and Future Directions in Academic Plastic Surgery. J Sex Med 2022; 19:846-851. [PMID: 35288048 DOI: 10.1016/j.jsxm.2022.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/05/2022] [Accepted: 02/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite high rates of online misinformation, transgender and gender diverse (TGD) patients frequently utilize online resources to identify suitable providers of gender-affirming surgical care. AIM The objective of this study was to analyze the webpages of United States academic plastic surgery programs for the types of gender-affirming surgery (GAS) procedures offered and to determine how this correlates with the presence of an institutional transgender health program and geographic region in order to identify potential gaps for improvement. METHODS Online institutional webpages of 82 accredited academic plastic surgery programs were analyzed for the presence of the following: GAS services, specification of type of GAS by facial, chest, body and genital surgery, and presence of a concomitant institutional transgender health program. This data was analyzed for correlations with geographic region and assessed for any significant associations. OUTCOMES Frequencies of GAS services, specification of the type of GAS by facial, chest, body and genital surgery, presence of a concomitant institutional transgender health program, and statistical correlations between these items are the primary outcomes. RESULTS Overall, 43 of 82 (52%) academic institutions offered GAS. Whether an institution offered GAS varied significantly with the presence of an institutional transgender health program (P < .001) but not with geographic region (P = .329). Whether institutions that offer GAS specified which anatomic category of GAS procedures were offered varied significantly with the presence of an institutional transgender health program (P < .001) but not with geographic region (P = .235). CLINICAL IMPLICATIONS This identifies gaps for improved transparency in the practice of communication around GAS for both physicians and academic medical institutions. STRENGTHS & LIMITATIONS This is the first study analyzing the quality, content, and accessibility of online information pertaining to GAS in academic institutions. The primary limitation of this study is the nature and accuracy of online information, as current data may be outdated and not reflect actuality. CONCLUSION Based on our analysis of online information, many gaps currently exist in information pertaining to GAS in academic settings, and with a clear and expanding need, increased representation and online availability of information regarding all GAS procedure types, as well as coordination with comprehensive transgender healthcare programs, is ideal. Aryanpour Z, Nguyen CT, Blunck CK, et al., Comprehensiveness of Online Information in Gender-Affirming Surgery: Current Trends and Future Directions in Academic Plastic Surgery. J Sex Med 2022;19:846-851.
Collapse
Affiliation(s)
- Zain Aryanpour
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
| | - Christine T Nguyen
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Conrad K Blunck
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Kasey M Cooper
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Stefan Kovac
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | | | - Blair R Peters
- Division of Plastic & Reconstructive Surgery, Oregon Health Sciences University, Portland, OR, USA; Department of Urology, Oregon Health Sciences University, Portland, OR, USA
| |
Collapse
|
15
|
Genitalchirurgische Maßnahmen zur Feminisierung bei Geschlechtsdysphorie. Urologe A 2022; 61:205-213. [DOI: 10.1007/s00120-022-01783-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
16
|
Kim JK, Na W, Cho JH, Ahn EJ, Kim E, Song IG, Han EC, Lee DW, Park BK, Park YG, Kim BG. Refinement of recto-sigmoid colon vaginoplasty using a three-dimensional laparoscopic technique. Medicine (Baltimore) 2021; 100:e27042. [PMID: 34477135 PMCID: PMC8416006 DOI: 10.1097/md.0000000000027042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/11/2021] [Indexed: 01/18/2023] Open
Abstract
To investigate the feasibility, safety, and outcomes of three-dimensional (3D) laparoscopic vaginoplasty with a rectosigmoid colon flap for vaginal reconstruction.Following appropriate preoperative patient counseling, 17 consecutive patients underwent vaginoplasty using a 3D laparoscopic system. Perioperative and postoperative outcomes were retrospectively evaluated.Between September 2016 and February 2020, 17 patients underwent 3D laparoscopic vaginoplasty with a rectosigmoid colon flap. Of them, 15 (88%) were transgender female patients, and 2 (12%) were cisgender female patients with congenital deformities. Among the 15 transgender patients, 12 (80%) underwent de novo surgeries and 3 (20%) underwent re-do surgeries. The mean age at the time of operation was 33.0 years, and the mean total operation time was 529 ± 128 minutes. The initial intraoperative mean vaginal depth was 15.2 ± 1.3 cm, and the 30-day readmission rate was 5.9% (1/17 cases). The mean follow-up duration was 24.8 months.Perioperative and postoperative outcomes suggest that 3D laparoscopic rectosigmoid colon vaginoplasty is a potentially acceptable, effective, and safe method for vaginal reconstruction.
Collapse
Affiliation(s)
- Jeong-ki Kim
- Department of Surgery, National Medical Center, Seoul, Republic of Korea
- Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Woong Na
- Department of Urology, National Medical Center, Seoul, Republic of Korea
| | - Jeong Hyun Cho
- Department of Urology, National Medical Center, Seoul, Republic of Korea
| | - Eun Jung Ahn
- Department of Surgery, National Medical Center, Seoul, Republic of Korea
| | - Eunyoung Kim
- Department of Surgery, National Medical Center, Seoul, Republic of Korea
| | - In-Gyu Song
- Department of Surgery, National Medical Center, Seoul, Republic of Korea
| | - Eon Chul Han
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Busan, Republic of Korea
| | - Dong Woon Lee
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Byung Kwan Park
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Yong-Gum Park
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Beom Gyu Kim
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
17
|
Ellerkamp V, Rall KK, Schaefer J, Stefanescu D, Schoeller D, Brucker S, Fuchs J. Surgical Therapy After Failed Feminizing Genitoplasty in Young Adults With Disorders of Sex Development: Retrospective Analysis and Review of the Literature. J Sex Med 2021; 18:1797-1806. [PMID: 37057496 DOI: 10.1016/j.jsxm.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/31/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Secondary vaginal stenosis may occur after reconstruction of genital malformations in childhood or after failed vaginal aplasia repair in adults. AIM This study focusses on the results of the surgical treatment of these patients in our multidisciplinary transitional disorders/differences of sex development team of pediatric surgeons and gynecologists. METHODS A retrospective analysis was carried out on adult and female identified disorders/differences of sex development patients with vaginal stenoses treated between 2015 and 2018 in a single center with revision vaginoplasty. The underlying type of malformation, the number and surgical techniques of vaginoplasties in infancy, techniques of revision of the stenotic vagina, vaginal length and caliber, possibility of sexual intercourse, and temporary vaginal dilatation. A review of literature with regard to recommended surgical techniques of revision vaginoplasties was accomplished. OUTCOMES To describe the surgical technique, the main outcome measures of this study are vaginal calipers after revision vaginoplasty as well as ability for sexual intercourse. RESULTS Thirteen patients presented with vaginal stenosis with a median age of 19 years (range 16-31). All patients had one or more different types of vaginoplasties in their medical history, with a median age at first vaginoplasty of 15 months (0-233). Underlying anatomical conditions were urogenital sinus (n = 8), vaginal agenesis (n = 2), persistent cloacae (n = 2), and cloacal exstrophy (n = 1). The main symptoms were disability of sexual intercourse in 13 patients due to stenotic vaginal tissue. The most frequently performed surgical technique was partial urogenital mobilization with a perineal or lateral flaps (n = 10), followed by bowel vaginoplasty (n = 2), in 1 patient a revision vaginoplasty failed due to special anatomical conditions. In a median follow-up of 11 months, all but one patient presented with physiological vaginal length and width, and normal sexual intercourse in those with a partnership. CLINICAL IMPLICATIONS Perineal flap with partial urogenital mobilization should be considered as a treatment of choice in severe cases of distal vaginal stenosis and after multiple failed former vaginoplasties, while bowel vaginoplasty should be reserved only for cases of complete cicatrization or high located stenosis of the vagina. STRENGTHS & LIMITATIONS The strength of this study is the detailed description of several cases while the retrospective character is a limitation. CONCLUSION In patients after feminizing genital repair, perineal flap with partial urogenital mobilization provides a normal anatomical outcome and allows unproblematic sexual intercourse. Ellerkamp V, Rall KK, Schaefer J, et al. Surgical Therapy After Failed Feminizing Genitoplasty in Young Adults With Disorders of Sex Development: Retrospective Analysis and Review of the Literature. J Sex Med 2021;18:1797-1806.
Collapse
Affiliation(s)
- Verena Ellerkamp
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Tuebingen, Tuebingen, Germany.
| | - Kristin Katharina Rall
- Department of Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Juergen Schaefer
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Diana Stefanescu
- Department of Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Dorit Schoeller
- Department of Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Sara Brucker
- Department of Gynecology and Obstetrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Joerg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Tuebingen, Tuebingen, Germany
| |
Collapse
|
18
|
van der Sluis WB, de Nie I, Steensma TD, van Mello NM, Lissenberg-Witte BI, Bouman MB. Surgical and demographic trends in genital gender-affirming surgery in transgender women: 40 years of experience in Amsterdam. Br J Surg 2021; 109:8-11. [PMID: 34291277 PMCID: PMC10364763 DOI: 10.1093/bjs/znab213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/16/2021] [Indexed: 11/13/2022]
Abstract
This was a single-centre, retrospective study of transgender women undergoing genital gender-affirming surgery. A chart study was conducted, recording individual demographics, all genital surgical procedures, and surgical techniques. Procedure incidence, techniques employed, and demographic variations over the years were analysed.
Collapse
Affiliation(s)
- W B van der Sluis
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - I de Nie
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands.,Department of Endocrinology, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - T D Steensma
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands.,Department of Medical Psychology, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - N M van Mello
- Centre of Expertise on Gender Dysphoria, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands.,Department of Gynaecology and Obstetrics, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - B I Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - M-B Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| |
Collapse
|
19
|
Schardein JN, Nikolavsky D. Sexual Functioning of Transgender Females Post-Vaginoplasty: Evaluation, Outcomes and Treatment Strategies for Sexual Dysfunction. Sex Med Rev 2021; 10:77-90. [PMID: 34219008 DOI: 10.1016/j.sxmr.2021.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Transfeminine genital reconstructive surgery is an important part of gender affirmation for many transgender women. Sexual health post-vaginoplasty is an important aspect of quality of life that can have a significant impact on overall well-being. OBJECTIVES The objective of this review is to provide a summary of the literature on the sexual outcomes of transgender females post-vaginoplasty and identify treatment strategies for those experiencing sexual dysfunction. METHODS A literature review was conducted with a focus on sexual health outcomes in transgender females post-vaginoplasty as well as treatment options for sexual dysfunction. RESULTS Penile inversion vaginoplasty with or without free skin grafts or local tissue flaps and intestinal vaginoplasty are the options available to patients interested in transfeminine genital reconstructive surgery with a neovagina. Sexual satisfaction post-vaginoplasty is high regardless of the vaginoplasty technique, however up to 29% of patients may be diagnosed with a sexual dysfunction due to associated distress with a sexual function disturbance. Hormone treatment, pelvic floor physical therapy, sex therapy, and sex surrogacy are treatment options for patients with sexual dysfunctions. CONCLUSION Patient reported outcome measures appropriately validated for this patient population are necessary to better understand sexual function outcomes, sexual dysfunction and treatment options for post-vaginoplasty patients. Schardein JN, Nikolavsky D. Sexual Functioning of Transgender Females Post-Vaginoplasty: Evaluation, Outcomes and Treatment Strategies for Sexual Dysfunction. Sex Med Rev 2021;XX:XXX-XXX.
Collapse
Affiliation(s)
| | - Dmitriy Nikolavsky
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
| |
Collapse
|
20
|
Dy GW, Blasdel G, Shakir NA, Bluebond-Langner R, Zhao LC. Robotic Peritoneal Flap Revision of Gender Affirming Vaginoplasty: a Novel Technique for Treating Neovaginal Stenosis. Urology 2021; 154:308-314. [PMID: 33823174 DOI: 10.1016/j.urology.2021.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/13/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To present the technique and early outcomes of salvage neovaginal reconstruction using robotic dissection and peritoneal flap mobilization. METHODS Twenty-four patients underwent robotic peritoneal flap revision vaginoplasty from 2017 to 2020. A canal is dissected between the bladder and rectum towards the stenosed vaginal cavity, which is incised and widened. Peritoneal flaps from the posterior bladder and pararectal fossa are advanced and sutured to edges of the stenosed cavity. Proximal peritoneal flap edges are approximated to form the neovaginal apex. Patient demographics, comorbidities, surgical indications, and operative details are described. Outcome measures include postoperative neovaginal dimensions and complications. RESULTS Mean age at revision was 39 years (range 27-58). All patients had previously undergone PIV, with revision surgery occurring at a median 35.3 months (range 6-252) after primary vaginoplasty. Surgical indications included short or stenotic vagina or absent canal. Average procedure length was 5 hours. At mean follow up of 410 days (range 179-683), vaginal depth and width were 13.6 cm (range 10.9-14.5) and 3.6 cm (range 2.9-3.8), respectively. There were no immediate or intraoperative complications related to peritoneal flap harvest. No patient had rectal injury. One patient had post-operative canal bleeding requiring return to the operating room for hemostasis. CONCLUSIONS Robotic peritoneal flap vaginoplasty is a safe, novel approach to canal revision after primary PIV with minimal donor site morbidity.
Collapse
Affiliation(s)
- Geolani W Dy
- Department of Urology, Oregon Health & Sciences University, Portland, OR
| | - Gaines Blasdel
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Nabeel A Shakir
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Rachel Bluebond-Langner
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY
| | - Lee C Zhao
- Department of Urology, New York University Langone Medical Center, New York, NY.
| |
Collapse
|
21
|
Vaginal Canal Reconstruction in Penile Inversion Vaginoplasty with Flaps, Peritoneum, or Skin Grafts: Where Is the Evidence? Plast Reconstr Surg 2021; 147:634e-643e. [PMID: 33776039 DOI: 10.1097/prs.0000000000007779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND To optimize neovaginal dimensions, several modifications of the traditional penile inversion vaginoplasty are described. Options for neovaginal lining include skin grafts, scrotal flaps, urethral flaps, and peritoneum. Implications of these techniques on outcomes remain limited. METHODS A systematic review of recent literature was performed to assess evidence on various vaginal lining options as adjunct techniques in penile inversion vaginoplasty. Study characteristics, neovaginal depth, donor-site morbidity, lubrication, and complications were analyzed in conjunction with expert opinion. RESULTS Eight case series and one cohort study representing 1622 patients used additional skin grafts when performing penile inversion vaginoplasty. Neovaginal stenosis ranged from 1.2 to 12 percent, and neovaginal necrosis ranged from 0 to 22.8 percent. Patient satisfaction with lubrication was low in select studies. Three studies used scrotal flaps to line the posterior vaginal canal. Average neovaginal depth was 12 cm in one study, and neovaginal stenosis ranged from 0 to 6.3 percent. In one study of 24 patients, urethral flaps were used to line the neovagina. Neovaginal depth was 11 cm and complication rates were comparable to other series. Two studies used robotically assisted peritoneal flaps with or without skin grafts in 49 patients. Average neovaginal depth was approximately 14 cm, and complication rates were low. CONCLUSIONS Skin grafts, scrotal flaps, urethral flaps, and peritoneal flaps may be used to augment neovaginal canal dimensions with minimal donor-site morbidity. Further direct comparative data on complications, neovaginal depth, and lubrication are needed to assess indications in addition to advantages and disadvantages of the various lining options.
Collapse
|
22
|
Patel V, Morrison SD, Gujural D, Satterwhite T. Labial Fat Grafting After Penile Inversion Vaginoplasty. Aesthet Surg J 2021; 41:NP55-NP64. [PMID: 33400769 DOI: 10.1093/asj/sjaa431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Penile inversion vaginoplasty (PIV) has become the most commonly performed genital surgery for transfeminine patients. However, patients undergoing this procedure may still require revisions to achieve a satisfactory result. OBJECTIVES The authors report on the utilization of autologous fat grafting to the labia majora to improve results after PIV and complications that may predict the need for grafting. METHODS A retrospective chart review was conducted of a single surgeon's patients who underwent PIV between July 2014 and December 2019. Demographic information, operative information, and postoperative outcomes were abstracted from the health records. Wilcoxon rank sum tests and chi-squared test were employed for continuous variables and categorical, respectively. RESULTS A total of 182 transfeminine and gender-diverse patients underwent PIV, with 6 patients (3.3%) eventually undergoing labial fat grafting. The most common indication for labial fat grafting was flattened labia majora (83%). All fat grafting procedures were performed concurrently with other revisions of the vaginoplasty. There were no demographic or medical history differences detected between the fat grafting and non-fat grafting groups. Patients who underwent labial fat grafting were more likely to suffer from introital stenosis (33% vs 6%, P = 0.007) and prolonged granulation tissue greater than 6 weeks after initial vaginoplasty (83% vs 32%; P = 0.01). CONCLUSIONS Labial fat grafting is a safe and effective method to address defects in the labia majora after PIV. Prolonged granulation tissue and introital stenosis may predict the need for labial fat grafting, possibly due to increased scarring and contracture at the surgical site. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Viren Patel
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | | | | |
Collapse
|
23
|
Abstract
For many trans*women, the surgical assignment of the male genital into a female is a fundamental part of the transition. Erogenous sensation of the neoclitoris is achieved by meticulous preparation of the penile glans with the neurovascular bundle. Several techniques are available for the formation of a neovagina, the penile inversion technique developed by Burou in the 1950s being the gold standard. With this technique, the inverted penile shaft skin is used as a pedicled flap to line the neovaginal canal. Alternatively, free skin grafts can be used, which serve primarily as a technique for redo procedures. Another technique is the use of intestinal segments to line the vaginal canal. This method is mostly used for redo procedures, but can also be performed primarily if penile skin is too small. Due to the numerous steps involved in the preparation, a wide variety of complications must be expected. Injury to the rectum during dissection of the neovaginal space, with an incidence of 4.5%, represents the greatest challenge. The most common complications are urethra-associated; hereby both a deviation of the urinary stream and strictures of the urethra are possible. The subjective satisfaction of trans*women with the surgical outcome is high and is reported in various studies to be 72-92%. On the basis of validated questionnaires it could also be shown that gender reassignment surgery leads to an increase in the trans*specific quality of life and promotes both subjectively perceived well-being and sexual satisfaction.
Collapse
Affiliation(s)
- J Heß
- Klinik und Poliklinik für Urologie, Uroonkologie und Kinderurologie, Universitätsklinik Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
| | - M Sohn
- Klinik für Urologie, Agaplesion Markus Krankenhaus, Wilhelm-Epstein-Straße 4, 60431, Frankfurt am Main, Deutschland
| | - M Küntscher
- Klinik für Plastische Chirurgie und Handchirurgie, Evangelische Elisabeth Klinik, Lützowstraße 26, 10785, Berlin, Deutschland
| | - J Bohr
- Klinik für Urologie, Evang. Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Deutschland
| |
Collapse
|
24
|
van der Sluis WB, Steensma TD, Timmermans FW, Smit JM, de Haseth K, Özer M, Bouman MB. Gender-Confirming Vulvoplasty in Transgender Women in the Netherlands: Incidence, Motivation Analysis, and Surgical Outcomes. J Sex Med 2020; 17:1566-1573. [DOI: 10.1016/j.jsxm.2020.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/31/2020] [Accepted: 04/10/2020] [Indexed: 11/25/2022]
|
25
|
Jun MS, Bluebond-Langner R, Zhao LC. EDITORIAL COMMENT. Urology 2020; 138:172-173. [PMID: 32252949 DOI: 10.1016/j.urology.2019.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Min Suk Jun
- Department of Urology, NYU Langone Health, New York, NY
| | | | - Lee C Zhao
- Department of Urology, NYU Langone Health, New York, NY
| |
Collapse
|
26
|
van der Sluis WB, de Haseth KB, Elfering L, Özer M, Smit JM, Budding AE, van Bodegraven AA, Buncamper ME, de Boer NKH, Mullender MG, Bouman MB. Neovaginal discharge in transgender women after vaginoplasty: A diagnostic and treatment algorithm. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 21:367-372. [PMID: 34993515 PMCID: PMC8726601 DOI: 10.1080/26895269.2020.1725710] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Wouter B van der Sluis
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Kristin B de Haseth
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Lian Elfering
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Müjde Özer
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jan Maerten Smit
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Andries E Budding
- Department of Medical Microbiology and Infection Control, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Adriaan A van Bodegraven
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Gastroenterology, Geriatrics, Intensive Care and Internal Medicine, Zuyderland Medical Centre, Geleen, The Netherlands
| | - Marlon E Buncamper
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Nanne K H de Boer
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
27
|
Boas SR, Ascha M, Morrison SD, Massie JP, Nolan IT, Shen JK, Vyas KS, Satterwhite T. Outcomes and Predictors of Revision Labiaplasty and Clitoroplasty after Gender-Affirming Genital Surgery. Plast Reconstr Surg 2019; 144:1451-1461. [PMID: 31764668 DOI: 10.1097/prs.0000000000006282] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Penile inversion vaginoplasty is the most common gender-affirming procedure for transfeminine patients. Patients undergoing this procedure may require revision labiaplasty and clitoroplasty. This study describes complications and outcomes from the largest reported cohort in the United States to undergo penile inversion vaginoplasty with subsequent revision labiaplasty and/or clitoroplasty. METHODS A retrospective chart review was performed of a single surgeon's experience with penile inversion vaginoplasty with or without revision labiaplasty and/or clitoroplasty between July of 2014 and June of 2016 in a cohort of gender-diverse patients assigned male at birth. Patient demographic data, complications, and quality of life data were collected. Univariate and multivariate comparisons were completed. RESULTS A total of 117 patients underwent penile inversion vaginoplasty. Of these, 28 patients (23.9 percent) underwent revision labiaplasty and/or clitoroplasty, with nine patients (7.7 percent) undergoing both procedures. Patients who underwent penile inversion vaginoplasty necessitating revision were significantly more likely to have granulation tissue (p = 0.006), intravaginal scarring (p < 0.001), and complete vaginal stenosis (p = 0.008). The majority of patients who underwent revision labiaplasty and/or clitoroplasty reported satisfaction with their final surgical outcome (82.4 percent) and resolution of their genital-related dysphoria (76.5 percent). CONCLUSIONS Patients who developed minor postoperative complications following penile inversion vaginoplasty were more likely to require revision surgery to address functional and aesthetic concerns. Patients responded with high levels of satisfaction following revision procedures, with the majority of patients reporting resolution of genital-related dysphoria. Transfeminine patients who undergo penile inversion vaginoplasty should be counseled on the possibility of revisions during their postoperative course. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
Affiliation(s)
- Samuel R Boas
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Mona Ascha
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Shane D Morrison
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Jonathan P Massie
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Ian T Nolan
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Jacson K Shen
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Krishna S Vyas
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Thomas Satterwhite
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| |
Collapse
|
28
|
Wang Z, Zeng A, Long F, Wu M, Tan XJ, Liu ZW, Wang XJ. Use of Vaginal Reconstructive Surgery in Cervical Cancer Patients to Prevent Vaginal Stump Contracture. J INVEST SURG 2019; 34:747-753. [PMID: 31739704 DOI: 10.1080/08941939.2019.1683658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The life quality of cervical cancer patients is severely compromised due to the vaginal stump contracture after surgery combined with radiotherapy. Therefore, our study focuses on ameliorating or preventing postoperative vaginal contracture. The objectives of this study were (1) to evaluate the method of ileal graft with vascular pedicle to extend the length of vagina and (2) to investigate the effect of the operation to prevent vaginal stump contracture after cervical cancer surgery combined with radiotherapy. METHODS Twenty-five patients with vaginal stump contracture after cervical cancer radical resection with sequential radiotherapy were recruited for the study between 2011 and 2014. The therapy includes releasing the adhesion between vaginal stump and rectum as well as bladder, resecting the vaginal stump but reserving the exterior orifice of vagina, and extending the vaginal length using vascularized ileal graft. RESULTS No postoperative complications such as infection and bleeding were observed in all 25 patients. The patients were satisfied with the length and width of vagina after extension; the discharge of reconstructed vagina was acceptable. All patients had sexual intercourse on the follow-up examination, and five patients complained of vaginal bleeding during or after sexual intercourse, although no abnormality was found on colposcopy. CONCLUSIONS The patients demonstrated a high level of safety, efficacy, and satisfaction with the ileal-vaginal extension for treating vaginal stump contracture after cervical cancer surgery combined with radiotherapy, suggesting that this method is valid for broad clinical application to improve the life quality of cervical cancer patients after surgery.
Collapse
Affiliation(s)
- Zhi Wang
- Department of Plastic and Cosmetic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Ang Zeng
- Department of Plastic and Cosmetic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Fei Long
- Department of Plastic and Cosmetic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Ming Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Xian-Jia Tan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Zi-Wen Liu
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xiao-Jun Wang
- Department of Plastic and Cosmetic Surgery, Peking Union Medical College Hospital, Beijing, China
| |
Collapse
|
29
|
Real-time indocyanine green fluorescent angiography in laparoscopic sigmoid vaginoplasty to assess perfusion of the pedicled sigmoid segment. Fertil Steril 2019; 112:967-969. [PMID: 31731947 DOI: 10.1016/j.fertnstert.2019.08.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the feasibility of intraoperative use of indocyanine green (ICG) fluorescent angiography in laparoscopic intestinal vaginoplasty to determine intestinal segment perfusion and viability. DESIGN Intestinal vaginoplasty may be performed as a vaginal (re)construction procedure. During surgery, a pedicled intestinal segment is transferred caudally to line the neovaginal cavity. Most commonly, a sigmoid or ileal segment is used. In obtaining adequate mobility of the segment, arterial structures sometimes have to be sacrificed, with possible detrimental effects on segment perfusion and subsequently viability. ICG may be used as an aid to assess segment perfusion. We present a case series of six consecutive patients who underwent intestinal vaginoplasty with intraoperative use of ICG. SETTING Tertiary university hospital. PATIENT(S) Six transgender women undergoing laparoscopic sigmoid vaginoplasty with intraoperative use of ICG from October 2017 to October 2018. INTERVENTION(S) Intraoperative use of ICG in laparoscopic sigmoid vaginoplasty to determine sigmoid segment perfusion and viability. MAIN OUTCOME MEASURE(S) Value and feasibility of ICG in this reconstructive procedure. RESULT(S) Intraoperative use of ICG demonstrated segment viability in five patients. In one patient, vascularization of the segment was deemed to be inadequate and reconstruction was aborted. CONCLUSIONS ICG fluorescent angiography may be used intraoperatively to assess perfusion of the pedicled sigmoid segment during sigmoid vaginoplasty.
Collapse
|
30
|
van der Sluis WB, Tuynman JB, Meijerink WJ, Bouman MB. Laparoscopic Intestinal Vaginoplasty in Transgender Women. Urol Clin North Am 2019; 46:527-539. [DOI: 10.1016/j.ucl.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
31
|
|
32
|
Sullivan P, Trinidad J, Hamann D. Issues in transgender dermatology: A systematic review of the literature. J Am Acad Dermatol 2019; 81:438-447. [DOI: 10.1016/j.jaad.2019.03.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 10/27/2022]
|
33
|
Abstract
Among surgical procedures for constructing a neovagina, positive outcomes are reported in literature for bowel vaginoplasty for male-to-female transgenders and patients with vaginal aplasia. This systematic review shows outcomes of bowel vaginoplasty procedures, and rates the quality of evidence of the included studies. A search of the literature was performed in PubMed, Medline, Cochrane Library and SveMed+, in accordance with the PRISMA statement, between January 2016 and February 2018. The PICOS (patients, intervention, comparator, outcomes and study design) approach was used as inclusion criteria. Among 251 analyzed studies only 34 met inclusion criteria. Quality of evidence and methodology were rated according to GRADE and MINORS, respectively. Data from the included studies were extracted based on study characteristics, participants? specifics, type of intervention/treatment and type of outcome measures into data extraction forms. All studies were non-randomized with a high risk of bias and very low quality of evidence according to GRADE. Vaginal reconstruction with isolated bowel segments provides a self-lubricating neovagina with low rates of failure and revision, and without routine dilatation need. Furthermore, the use of laparoscopic techniques offers a better postoperative cosmetic appearance of the abdomen and a shorter hospital stay. Vaginoplasty using bowel segment is a safe and effective procedure that obtains excellent long-term results as reported by the included studies. Despite that further researches are needed improving methodology with larger populations, retrospective qualitative studies and report of outcome measurements using standardized evaluation tools as the Female Sexual Function Index.
Collapse
Affiliation(s)
- Konstantinos Georgas
- a Department of Plastic Surgery , Sahlgrenska Universitetssjukhuset , Göteborg , Sweden
| | - Valerio Belgrano
- b Department of Surgery, Institute of Clinical Sciences , Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - My Andreasson
- c Department of Plastic Surgery , Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg , Göteborg , Sweden
| | - Anna Elander
- d Department of Plastic Surgery , Institute of Clinical Sciences , Göteborg , Sweden
| | - Gennaro Selvaggi
- e Department of Plastic Surgery , Sahlgrenska Akademin , Gothenburg , Sweden
| |
Collapse
|
34
|
Claes KE, Pattyn P, D’Arpa S, Robbens C, Monstrey SJ. Male-to-Female Gender Confirmation Surgery. Clin Plast Surg 2018; 45:351-360. [DOI: 10.1016/j.cps.2018.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
35
|
Primary Sigmoid Vaginoplasty in Transwomen: Technique and Outcomes. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4907208. [PMID: 29862275 PMCID: PMC5971241 DOI: 10.1155/2018/4907208] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/02/2018] [Indexed: 11/18/2022]
Abstract
Background Many techniques have been described for reconstruction of the vaginal canal for oncologic, traumatic, and congenital indications. An increasing role exists for these procedures within the transgender community. Most often, inverted phallus skin is used to create the neovagina in transwomen. However, not all patients have sufficient tissue to achieve satisfactory depth and those that do must endure cumbersome postoperative dilation routines to prevent contracture. In selected patients, the sigmoid colon can be used to harvest ample tissue while avoiding the limitations of penile inversion techniques. Methods Records were retrospectively reviewed for all transwomen undergoing primary sigmoid vaginoplasty with the University of Miami Gender Reassignment service between 2014 and 2017. Results Average neovaginal depth was 13.9 +/− 2.0 centimeters in 12 patients. 67% were without complications, and all maintained tissue conducive to sexual activity. No incidences of bowel injury, anastomotic leak, sigmoid necrosis, prolapse, diversion neovaginitis, dyspareunia, or excessive secretions had occurred at last follow-up. Conclusions Sigmoid vaginoplasty is a reliable technique for achieving a satisfactory vaginal depth that is sexually functional. Using a collaborative approach, it is now our standard of care to offer this surgery to transwomen with phallus length less than 11.4 centimeters.
Collapse
|
36
|
van der Sluis WB, Pavan N, Liguori G, Bucci S, Bizic MR, Kojovic V, Hess J, Meijerink WJ, Mullender MG, Özer M, Smit JM, Buncamper ME, Krege S, Djordjevic ML, Trombetta C, Bouman MB. Ileal vaginoplasty as vaginal reconstruction in transgender women and patients with disorders of sex development: an international, multicentre, retrospective study on surgical characteristics and outcomes. BJU Int 2018; 121:952-958. [DOI: 10.1111/bju.14155] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Wouter B. van der Sluis
- Department of Plastic, Reconstructive and Hand Surgery; VU University Medical Center; Amsterdam The Netherlands
| | - Nicola Pavan
- Urology Clinic; Department of Medical, Surgical and Health Science; University of Trieste; Trieste Italy
| | - Giovanni Liguori
- Urology Clinic; Department of Medical, Surgical and Health Science; University of Trieste; Trieste Italy
| | - Stefano Bucci
- Urology Clinic; Department of Medical, Surgical and Health Science; University of Trieste; Trieste Italy
| | - Marta R. Bizic
- School of Medicine; University of Belgrade; Belgrade Serbia
| | | | - Jochen Hess
- Department of Urology; University Hospital Essen; Essen Germany
| | - Wilhelmus J.H.J. Meijerink
- Department of Gastro-Intestinal Surgery and Advanced Laparoscopy; VU University Medical Center; Amsterdam The Netherlands
- Department of Operation Rooms; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Margriet G. Mullender
- Department of Plastic, Reconstructive and Hand Surgery; VU University Medical Center; Amsterdam The Netherlands
| | - Müjde Özer
- Department of Plastic, Reconstructive and Hand Surgery; VU University Medical Center; Amsterdam The Netherlands
| | - Jan Maerten Smit
- Department of Plastic, Reconstructive and Hand Surgery; VU University Medical Center; Amsterdam The Netherlands
| | - Marlon E. Buncamper
- Department of Plastic, Reconstructive and Hand Surgery; VU University Medical Center; Amsterdam The Netherlands
| | - Susanne Krege
- Department of Urology; Kliniken Essen Mitte; Essen Germany
| | | | - Carlo Trombetta
- Urology Clinic; Department of Medical, Surgical and Health Science; University of Trieste; Trieste Italy
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery; VU University Medical Center; Amsterdam The Netherlands
| |
Collapse
|
37
|
Cornelisse VJ, Jones RA, Fairley CK, Grover SR. The medical care of the neovagina of transgender women: a review. Sex Health 2017; 14:442-450. [DOI: 10.1071/sh17044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/05/2017] [Indexed: 11/23/2022]
Abstract
For transgender women, genital adjustment surgery involves removal of the natal reproductive organs and creation of a neovagina, vulva and clitoris. We conducted a review of the medical literature in order to summarise the issues that can affect the health of the neovagina in the long term, and to make recommendations on how to manage these issues.
Collapse
|