MP04-19 PROSTATIC METAPLASIA OF THE VAGINA IN TRANSGENDER MEN

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP04)1 Sep 2021MP04-19 PROSTATIC METAPLASIA OF THE VAGINA IN TRANSGENDER MEN David Diamond, Richard Yu, Joseph Borer, Rena Xu, William Anderson, and Sara Vargas David DiamondDavid Diamond More articles by this author , Richard YuRichard Yu More articles by this author , Joseph BorerJoseph Borer More articles by this author , Rena XuRena Xu More articles by this author , William AndersonWilliam Anderson More articles by this author , and Sara VargasSara Vargas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001971.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Gender-affirming surgery (GAS) of the reproductive tract in transgender males includes vaginectomy. In most centers, this is achieved by colpocleisis, with cautery ablation of the vaginal mucosa & suture ablation of the vaginal lumen. Having seen complications due to residual vaginal tissue following colpocleisis, we changed our technique to complete vaginectomy with full-thickness excision of vaginal tissue, allowing its histopathologic examination. Our institution recently reported prostatic metaplasia of vaginal epithelium in the first 6/7 patients treated in this manner. Having accrued 11 additional patients, we extend the analysis of this novel observation. METHODS: The study was IRB approved. Pathology archives were searched for vaginectomy specimens as part of GAS from 1/1/18-2/15/21. Gross features were reviewed. Hematoxylin-and-eosin-stained slides were examined in all cases. The majority were immunohistochemically stained for NKX3.1, prostate-specific antigen (PSA) and androgen receptor. 3 control cases of vaginal tissue from patients without clinical evidence of androgen supplementation were compared. RESULTS: 18 patients, ages 20-34, underwent vaginectomy or excision of vaginal remnants. Each had been assigned female gender at birth without history of endocrine or genetic abnormality. All had received long-term testosterone cypionate treatment (range, 26-60 mos). Grossly, there were no mucosal lesions identified at surgical or pathological examination. Microscopically, 17/18 cases demonstrated a patchy intraepithelial glandular proliferation along the basement membrane; the 18th had a nodular collection of prostate-type tissue within subepithelial stroma. Atrophy & transitional metaplasia of squamous epithelium was also seen. The glandular proliferation was positive for NKX3.1 (15/15; 100%), PSA (9/11; 82%), and androgen receptor (8/8; 100%). Control vaginal tissue showed no evidence of prostatic metaplasia or atrophy. CONCLUSIONS: This study further characterizes the occurrence of prostatic-type tissue in the vagina of transgender men. Prostatic tissue was present in 18/18 transgender men receiving androgen therapy and our findings are consistent with a form of androgen-associated prostatic metaplasia. This finding may have important clinical implications since some transgender men may elect to retain their vaginas, while those who do undergo GAS may have residual tissue left behind, particularly if colpocleisis is performed. Long-term follow-up of this population, with recognition of this entity, is in order. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e74-e74 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Diamond More articles by this author Richard Yu More articles by this author Joseph Borer More articles by this author Rena Xu More articles by this author William Anderson More articles by this author Sara Vargas More articles by this author Expand All Advertisement Loading ...