MP29-18 VAGINAL CAVITY REMNANT RE-EXCISION AND RE-OBLITERATION IN TRANSGENDER MEN UNDERGOING NEOURETHRAL STRICTURE REPAIR

Abstract

INTRODUCTION AND OBJECTIVE: Transmasculine genital affirmation surgery usually involves vaginectomy and construction of a neophallus. Common urinary complications after phalloplasty include neourethral strictures and fistulae. Distal obstruction forces pressurized urine to fistulize between the neourethra and the previously obliterated vaginal cavity leading to formation of a urine-filled cavity. Patients present with post-void dribbling, pelvic pressure, pain or recurrent infections. Our objective is to determine a proportion of patients requiring cavity re-excision and re-obliteration during neourethral stricture repair as well as the histological composition of the excised tissue. METHODS: A retrospective review was performed of all transgender male patients who underwent neourethral stricture repair. Operative reports were reviewed to determine the presence of a vaginal cavity remnant that required re-excision and re-obliteration at the time of the neourethral reconstruction. Pathological H&E slides of the excised specimens were evaluated by a pathologist. RESULTS: A total of 39 consecutive transgender male patients underwent neourethral stricture repair between January 2014 and October 2019. The mean age was 38 years (23-61 years). Of those patients, 31/39 (79%) had prior phalloplasty and 8/39 (21%) had prior metoidioplasty. All patients had documented history of prior vaginectomy at the time of their initial genital affirmation surgery at other institutions. During neourethral stricture repair, a total of 15/39 (38%) were found to have a vaginal cavity remnant requiring re-excision and re-obliteration. These cavities were found in 12/31 (39%) of phalloplasty patients and 4/8 (50%) of metoidioplasty patients. Pathological evaluation of all 15 vaginal cavity remnants demonstrated the presence of vaginal epithelium. Additional findings included chronic inflammation (11), fibrosis (8), granulation tissue (2), microabscesses (1), calcification (1) and multinucleated giant cells (1). CONCLUSIONS: A high percentage of transgender men with neourethral strictures present with vaginal cavity remnants despite prior reports of vaginectomy. Pathological evaluation confirms that all vaginal cavity remnant specimens contain vaginal epithelium that was either not completely excised or regenerated. While the implications of this residual vaginal epithelium requires further investigation, total removal of vaginal tissue primarily or during reconstruction is important to possibly avoid a vaginal cavity remnant. Source of Funding: None