MP02-19 MANAGEMENT AND OUTCOMES OF RECTAL INJURIES DURING GENDER AFFIRMING VAGINOPLASTY

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP02-19 MANAGEMENT AND OUTCOMES OF RECTAL INJURIES DURING GENDER AFFIRMING VAGINOPLASTY Talia Stark, Kenan Celtik, Jess Ting, Miroslav Djordjevic, and Rajveer Purohit Talia StarkTalia Stark More articles by this author , Kenan CeltikKenan Celtik More articles by this author , Jess TingJess Ting More articles by this author , Miroslav DjordjevicMiroslav Djordjevic More articles by this author , and Rajveer PurohitRajveer Purohit More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We describe incidence, management and outcomes of rectal injuries (RI) during gender affirming vaginoplasty (GAV) and revision vaginoplasty (RV) at a high volume center. METHODS: All intra-operative RI during GAV and RV are reported to a quality control committee for evaluation at our institution. We performed a retrospective review of pre-operative, intra-operative and post-operative findings of all patients with RI during GAV. RESULTS: RI occurred in 9 of 1011 (incidence 0.89%) primary GAV and during 1 RV for vaginal stenosis from January 2016-September 2022. Preoperative data are summarized in Table 1, and injury and repair characteristics in Table 2. Colorectal surgery (CRS) evaluation included sigmoidoscopy in 4 cases, an air leak test in 2, and with temporary bowel diversion in 3 (2 concomitant and 1 delayed). In 7/10 full depth GAV was completed; 3 were converted to minimal depth vaginoplasty. 3 cases had unusual adhesions, obliterated planes, or fibrosis from prior silicone implant surgery during the vaginal canal dissection. 2 had bulbospongiosus muscle interposition over the repair site. No patient had a concomitant urethral injury, 2 (20%) developed a rectovaginal fistula (RVF). Both RVF occurred in patients with prior perineal surgery, including prior vaginoplasty. Neither patient had intra-operative sigmoidoscopy done by CRS. 3 patients (43%) with full depth GAV developed vaginal stenosis postoperatively. CONCLUSIONS: Rectal injuries occur even in experienced hands with an incidence of <1% in our series of 1011 patients undergoing primary GAV. Unusual tissue dissection planes were a risk factor. If injuries were identified intra-operatively, repaired with multilayer closure and evaluated by CRS, patients did well without the development of RVF despite completion of full depth GAV. It is reasonable to complete the full depth vagina, but patients have a significant risk of post-operative vaginal stenosis. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e19 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Talia Stark More articles by this author Kenan Celtik More articles by this author Jess Ting More articles by this author Miroslav Djordjevic More articles by this author Rajveer Purohit More articles by this author Expand All Advertisement PDF downloadLoading ...