V07-02 AN ALTERNATIVE OPTION FOR GENDER-AFFIRMING REVISION VAGINOPLASTY: THE TUBULARIZED URACHUS-PERITONEAL HINGE FLAP

Abstract

You have accessJournal of UrologySexual Dysfunction & Transgender (V07)1 Sep 2021V07-02 AN ALTERNATIVE OPTION FOR GENDER-AFFIRMING REVISION VAGINOPLASTY: THE TUBULARIZED URACHUS-PERITONEAL HINGE FLAP Nance Yuan, Amit Gupta, and Maurice Garcia Nance YuanNance Yuan More articles by this author , Amit GuptaAmit Gupta More articles by this author , and Maurice GarciaMaurice Garcia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002034.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peritoneal vaginoplasty has been reported for congenital and primary gender-affirming cases, but few have reported its use to treat post-op neovaginal shortening after penile-inversion vaginoplasty (PIV). Recent adaptations of peritoneal vaginoplasty are modifications of the Davydov procedure, wherein peri-rectal/peri-vesical peritoneum are incorporated to lengthen the vaginal canal. Here we describe our alternative technique using a single urachus-peritoneal hinge flap and discuss proposed advantages. METHODS: We performed retrospective review of all trans-women with post-PIV vaginal canal shortening who underwent revision surgery with our technique. All cases were performed via combined trans-perineal and robotic-laparoscopic approaches. Pre-op and post-op neovaginal circumference and depth were recorded. With a dilator in the canal, the peritoneum and terminal canal-end were incised and spatulated. The anterior canal-remnant epithelial edge was sutured to the anterior peritoneal edge. A midline, inferiorly based peritoneal flap (min. 12-cm width) was elevated craniocaudally from the umbilicus to the mid-posterior bladder. The flap’s free end was flipped posteriorly and sutured to the posterior edge of the open canal remnant, to create a peritoneum-lined pouch. The pouch’s lateral edges were sutured together. We confirmed water-tight closure. Patients resumed dilation on POD 8 and douching on POD 10. RESULTS: Five patients underwent peritoneal vaginoplasty with our technique from 5/2019 to 8/2020. Mean age was 32. Pre-op: mean canal girth was >12 cm, and depth was 8.6 (±1.8) cm. Immediate post-op: mean girth was still >12 cm; depth was 16.8 (±1.2) cm (mean increase: 8.2 cm). At mean follow-up of 1 year: mean girth was 11-12 cm, and depth was 13.5 (±1.8) cm (mean increase: 4.9 cm). There were no immediate complications. One patient developed anastomotic stenosis at 6 weeks post-op, managed conservatively with dilation under anesthesia. All 5 patients endorse satisfactory sexual function; 3/5 report vaginal receptive intercourse. CONCLUSIONS: Early results suggest that our peritoneal vaginoplasty technique is a safe and effective option to treat neovaginal shortening. Advantages over existing techniques include: 1. No intra-op or post-op resting tension on peritoneal sutures, 2. Option for layered closure with omental interposition, and 3. Total exclusion of the rectum. Due to limited available peritoneum, we reserve this technique for cases where there is adequate residual canal girth and at least 6-7 cm of residual depth. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e551-e551 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nance Yuan More articles by this author Amit Gupta More articles by this author Maurice Garcia More articles by this author Expand All Advertisement Loading ...