MP04-11 LAPAROSCOPY ASSISTED PERITONEAL PULL-THROUGH VAGINOPLASTY IN TRANSGENDER WOMEN, AN OLD TECHNIQUE IN MODERN TIME

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP04)1 Sep 2021MP04-11 LAPAROSCOPY ASSISTED PERITONEAL PULL-THROUGH VAGINOPLASTY IN TRANSGENDER WOMEN, AN OLD TECHNIQUE IN MODERN TIME Marta Bizic, Borko Stojanovic, Marko Bencic, Slavko Matic, and Miroslav Djordjevic Marta BizicMarta Bizic More articles by this author , Borko StojanovicBorko Stojanovic More articles by this author , Marko BencicMarko Bencic More articles by this author , Slavko MaticSlavko Matic More articles by this author , and Miroslav DjordjevicMiroslav Djordjevic More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001971.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The gold standard in genital gender affirming surgeries (GGAS) is penile inversion vaginoplasty. In cases in whom penile skin is lacking. Either because of medication with puberty blockers or radical circumcision, or inadequate penile skin length, different options for neovaginal reconstruction must be offered to the patients. We asses laparoscopy assisted peritoneal pull-through vaginoplasty in combination with penile skin flaps for transgender women. METHODS: During two years period (March 2018-June 2020), we performed 47 primary laparoscopy assisted peritoneal pull-through vaginoplasties in transgender women. The surgery consisted of complete penectomy to the pubic bones in all patients, bilateral orchiectomy in 42 patients (5 patients had bilateral orchiectomy, prior the GGAS), clitoroplasty, urethroplasty, vulvoplasty and vaginoplasty using peritoneal flaps in combination with inverted penile skin flap. In two patients in whom lichen sclerosis was suspected removal of the affected skin was performed before creation of the neovagina. Two peritoneal flaps were dissected from the posterior aspect of the bladder and anterior aspect of the rectum in about 5cm in width and about 7cm in length and anastomosed with interrupted sutures with asymmetrically fashioned penile skin flap in order to prevent neovaginal stenosis. Vaginal packing is placed for the period of 5 days postoperatively, together with two drains. Urinary catheter is placed for urine derivation for 2 weeks. Compressive dressing is applied. RESULTS: Follow-up ranged from 6 to 23 months (mean 13 months). All patients were instructed to perform regular dilation of their neovagina for the first 12 months postoperatively by a pelvic floor physiotherapist. Even though peritoneum was found to produce some lubrication, patients were advised to use the lubricant during the sexual intercourse. Complications occurred in 5 of our patients: 3 had prolonged hematoma of the labia majora, one had neovaginal introitus dehiscence and one had superficial necrosis of the left labia majora. None of the complications required additional surgeries. The depth of the neovagina at the control check-up in 6 months after surgery was 14.7±0.5cm, while width was about 3.4±0.4cm. Majority of patients (≈96%) were satisfied with the new genitals, sensitivity, lubrication and possibility of engaging in sexual intercourse according to self-reports. One patient required reduction of the size of her clitoris because of hypersensitivity and the other one requested laser treatment of the incisional scars. CONCLUSIONS: Albeit known for quite a long time in vaginal reconstruction for cis-women languishing over vaginal agenesis and different states of vaginal absence, peritoneal pull-through vaginoplasty offers promising outcomes in transgender women GGAS that will give self-lubricating neovagina, with insignificant scarring and complications and high degree of patient's satisfaction. Source of Funding: / © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e71-e71 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marta Bizic More articles by this author Borko Stojanovic More articles by this author Marko Bencic More articles by this author Slavko Matic More articles by this author Miroslav Djordjevic More articles by this author Expand All Advertisement Loading ...