Abstract
ObjectivesTo describe UTI risk 3-months post-vaginoplasty (VP) in transgender women (TW) compared to cis women (CW). MethodsUsing TriNetX (TriNetX, Inc., Cambridge, MA, USA), we built cohorts of 2,041 TW and 48,374,745 CW. Outcomes were ≥1 instance of UTI or Cystitis, and assessed from 3-6, 3-12, 3-36 months, and 3 months-10 years post-VP. TW and CW were age-cohorted (18-39, 40-59, 60-74) and compared at each time interval. Kaplan-Meier was used to account for loss to follow up, along with Hazard Ratios (HR) and log-rank tests to determine significance (p<0.05). ResultsFor all time intervals and age ranges, TW had a significantly (p<0.0001-p=0.0088) higher probability of developing a UTI compared to CW. The largest difference was ages 40-59 ten-years post-vaginoplasty. In this analysis, CW and TW had a 12.96% and 29.34% cumulative outcome incidence, respectively.Cox proportional hazard analysis demonstrated increased hazard for TW compared to CW. HRs between CW and TW ranged from 1.363 (ages 18-39 at 10 years, 95%CI:1.119,1.660) to 3.522 (ages 60-74 at 12 months, 95%CI:1.951,6.360). ConclusionsWe found a significantly higher probability of TW developing UTIs compared to age-cohorted CW.Contributing factors may include difficulties with neovaginal perineal hygiene, lack of commensal bacteria and vaginal mucosa, larger urethral meatus, high rates of meatal stenosis, and nonnative bacteria introduced through dilators and douching. These findings may help improve quality of post-operative care in TW.
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