Penile Flap Inversion Vaginoplasty in Transgender Women: Contemporary Morbidity and Learning-Curve Analysis From a High-Volume Reconstructive Center.

Valentin Maurer,Roland Dahlem,Inga Feldmann,Armin Soave,Marian Howaldt,Christian P Meyer,Margit Fisch,Philipp Gild,Tim Ludwig,Sylvia Weis,Silke Riechardt,Phillip Marks,Malte W Vetterlein

doi:10.3389/fsurg.2022.836335

Valentin Maurer, Roland Dahlem + Show 11 more

Open Access

https://doi.org/10.3389/fsurg.2022.836335

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Abstract

ObjectivesNumbers of PIV are rising. The aim of this study is to analyze the surgical learning-curve (LC) on the grounds of perioperative complications.Patients and Methods108 PIVs, performed by a single surgeon between 2015 and 2018 have been analyzed. Learning-curve analysis was based on three factors: operating time, vaginal depth and complications.ResultsThe median FU was 6.3 months. Median age at surgery was 36 years, median time of hormone treatment was 36 months. The median CI was 0.3 and the median BMI was 25 kg/cm3. Median CCI® was 8.08. 40.7% of the patients developed short-term complications, more than half of which were Clavien I. Overall only 1.9% had Clavien IIIb complications. There were no Clavien IV or V complications. 17.6% of patients had wound infections, 13% wound dehiscence, 9.3% introitus strictures, 13.9% suffered from atrophy of the neovagina, i.e. loss of depth or width, and 8.3% from meatus urethrae strictures. Duration of hormonal therapy, BMI and CI had no impact on surgical outcome. Age had a significant impact on CCI®, as younger patients had a higher risk for complications. Use of scrotal skin and surgeries performed had a significant influence. LC analysis via CUSUM analysis showed that after 32 surgeries, the PIV is performed safely.ConclusionThe PIV is a safe GAS-technique, associated with minor complications leading to low rates of revision surgery. Younger age, the use of scrotal skin and surgeon's experience has significant impact on complications. Duration of hormonal therapy, circumcision and BMI has no impact on complications.

Highlights

Over the last decade, gender-affirming surgery (GAS) has gained center stage, given that medical and surgical needs of patients presenting with gender dysphoria (GD) are more frequently recognized [1, 2]
The importance of multidisciplinary care in this context has been recently elucidated by a systematic literature review showing that patients benefitted with regard to psychological well-being [3]
To the best of our knowledge, no complication analysis has been published using the Comprehensive Complication Index (CCI R ) [6], which allows for an in-depth complication analysis, given that it mirrors the cumulative morbidity burden [5, 6] as opposed to only reporting the highest grade complication by the Clavien Dindo Classification (CDC) [7]

Summary

Introduction

Gender-affirming surgery (GAS) has gained center stage, given that medical and surgical needs of patients presenting with GD are more frequently recognized [1, 2]. In a recent granular systematic review of the literature from 2009 to 2019, estimates of self-reported “transgender” identity ranged from 0.3 to 2.7% [1]. This is reflected by a rising number of Morbidity and Learning-Curve of Penoscrotal Inversion Vaginoplasty. The importance of multidisciplinary care in this context has been recently elucidated by a systematic literature review showing that patients benefitted with regard to psychological well-being [3]. To the best of our knowledge, no complication analysis has been published using the Comprehensive Complication Index (CCI R ) [6], which allows for an in-depth complication analysis, given that it mirrors the cumulative morbidity burden [5, 6] as opposed to only reporting the highest grade complication by the CDC [7]

Objectives

Results

Conclusion