MP02-12 A NOVEL SURGICAL TECHNIQUE TO CREATE A NATURAL-APPEARING RECESSED VAGINAL INTROITUS WITH GENDER-AFFIRMING SHALLOW-DEPTH VAGINOPLASTY

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP02-12 A NOVEL SURGICAL TECHNIQUE TO CREATE A NATURAL-APPEARING RECESSED VAGINAL INTROITUS WITH GENDER-AFFIRMING SHALLOW-DEPTH VAGINOPLASTY Jenna Stelmar, Shannon Smith, Nance Yuan, Michael Zaliznyak, Sandeep Sandhu, and Maurice Garcia Jenna StelmarJenna Stelmar More articles by this author , Shannon SmithShannon Smith More articles by this author , Nance YuanNance Yuan More articles by this author , Michael ZaliznyakMichael Zaliznyak More articles by this author , Sandeep SandhuSandeep Sandhu More articles by this author , and Maurice GarciaMaurice Garcia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A key genital gender affirming surgery (gGAS) option for transfeminine patients is vaginoplasty without creation of a vaginal canal, commonly referred to as ‘shallow-depth vaginoplasty' (SDV), which is an alternative to full-depth vaginoplasty (FDV). Together with the advantages of SDV (lower complications, no need for dilation/douching), achieving “normal appearing” anatomy is typically important for patients. However, no surgical technique for how to create a recessed vaginal introitus has been published. We aim to: 1. Assess patient decision-making priorities when choosing SDV over FDV; and 2. Describe a novel surgical technique to create a recessed vaginal introitus regardless of penile shaft length and 3. Patients’ perception of how it compares to a cis-gender vulva. METHODS: Of the 110 patients who underwent primary feminizing gGAS at our institution between 4/2017 and 7/2022, 35 (32%) underwent SDV and were emailed a link to an anonymous, electronic Qualtrics® survey querying decision-making and satisfaction.Our technique is described. RESULTS: Prioritites: Achieving external appearance “comparable to” a cis-vagina was the second-highest ranked priority for patients (after “elimination of male genital anatomy”) (Figure 1a) Surgical Technique: To achieve a recessed skin-lined introitus, we place gathering sutures to create a “dimple” on the penile or scrotal skin to be used, and then tether this dimple to two structures: the tendon of the Bulbospongiosus muscle, and diffuse perineal body tissue behind the urethral bulb. (Figure 1, b-d) Attractiveness: When asked how patients perceive their vagina compared to a cisgender woman’s of similar age and weight, 3/29 (10%) reported they “do not know what a cisgender woman’s vagina looks like” and were excluded from further analyses. The remaining 19/26 (73%) reported their vagina was “similar in appearance” and 7/26 (27%) “somewhat similar in appearance.” 21/26 (81%) found their vagina to be “similarly attractive”; 3/26 (10%) “more attractive”; and 2/26 (8%) “less attractive” than a cis-gender woman’s vagina. CONCLUSIONS: For women to choose SDV, it is essential that the cosmetic appearance of the vulva be as indistinguishable as possible from a cis-gender woman’s vulva. The surgical technique presented appears to offer this. Source of Funding: Richard Onofrio, MD Research Grant to the CSMC Transgender Surgery & Health Program © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e15 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jenna Stelmar More articles by this author Shannon Smith More articles by this author Nance Yuan More articles by this author Michael Zaliznyak More articles by this author Sandeep Sandhu More articles by this author Maurice Garcia More articles by this author Expand All Advertisement PDF downloadLoading ...