17. SHARING THE MONTREAL GENDER AFFIRMING VAGINOPLASTY: A 25 YEAR AND 2500 CASES EXPERIENCE

Abstract

PURPOSE: Gender affirmation procedures have been dramatically and steadily increasing in both academic and private practices throughout the country over the past few years. While this was a long-needed change for transgender and non-binary individuals, specific training for surgeons and residents has not necessarily followed the rapid uptake in cases performed. Genital surgeries can be therefore very challenging because of possible associated serious complications, less known anatomy and overall less in-training exposure. This study aims at describing the Montreal vaginoplasty technique, its refinements over the years, and to identify means of reduction of complications for the surgeons beginning in the field. METHODS: A retrospective case review was performed of all 2500 penile inversion vaginoplasties carried out by the senior author between 2000 and 2021. Changes in the technique over the years were identified by reviewing operative protocols and postoperative pictures. Most common complications were reviewed. RESULTS: Analysis of the technique allowed to describe 10 steps suitable for teaching, and to identify changes made over the years in each step, along with a decrease in overall complication rate. CONCLUSIONS: The Montreal vaginoplasty technique is described along with insights on its evolution in both achieving better cosmetic and functional outcomes, but also with strategies identified to mitigate the most encountered complications.