Outcomes and Predictors of Revision Labiaplasty and Clitoroplasty after Gender-Affirming Genital Surgery.
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
entrez:
26
11
2019
pubmed:
26
11
2019
medline:
3
3
2020
Statut:
ppublish
Résumé
Penile inversion vaginoplasty is the most common gender-affirming procedure for transfeminine patients. Patients undergoing this procedure may require revision labiaplasty and clitoroplasty. This study describes complications and outcomes from the largest reported cohort in the United States to undergo penile inversion vaginoplasty with subsequent revision labiaplasty and/or clitoroplasty. A retrospective chart review was performed of a single surgeon's experience with penile inversion vaginoplasty with or without revision labiaplasty and/or clitoroplasty between July of 2014 and June of 2016 in a cohort of gender-diverse patients assigned male at birth. Patient demographic data, complications, and quality of life data were collected. Univariate and multivariate comparisons were completed. A total of 117 patients underwent penile inversion vaginoplasty. Of these, 28 patients (23.9 percent) underwent revision labiaplasty and/or clitoroplasty, with nine patients (7.7 percent) undergoing both procedures. Patients who underwent penile inversion vaginoplasty necessitating revision were significantly more likely to have granulation tissue (p = 0.006), intravaginal scarring (p < 0.001), and complete vaginal stenosis (p = 0.008). The majority of patients who underwent revision labiaplasty and/or clitoroplasty reported satisfaction with their final surgical outcome (82.4 percent) and resolution of their genital-related dysphoria (76.5 percent). Patients who developed minor postoperative complications following penile inversion vaginoplasty were more likely to require revision surgery to address functional and aesthetic concerns. Patients responded with high levels of satisfaction following revision procedures, with the majority of patients reporting resolution of genital-related dysphoria. Transfeminine patients who undergo penile inversion vaginoplasty should be counseled on the possibility of revisions during their postoperative course. Therapeutic, III.
Sections du résumé
BACKGROUND
Penile inversion vaginoplasty is the most common gender-affirming procedure for transfeminine patients. Patients undergoing this procedure may require revision labiaplasty and clitoroplasty. This study describes complications and outcomes from the largest reported cohort in the United States to undergo penile inversion vaginoplasty with subsequent revision labiaplasty and/or clitoroplasty.
METHODS
A retrospective chart review was performed of a single surgeon's experience with penile inversion vaginoplasty with or without revision labiaplasty and/or clitoroplasty between July of 2014 and June of 2016 in a cohort of gender-diverse patients assigned male at birth. Patient demographic data, complications, and quality of life data were collected. Univariate and multivariate comparisons were completed.
RESULTS
A total of 117 patients underwent penile inversion vaginoplasty. Of these, 28 patients (23.9 percent) underwent revision labiaplasty and/or clitoroplasty, with nine patients (7.7 percent) undergoing both procedures. Patients who underwent penile inversion vaginoplasty necessitating revision were significantly more likely to have granulation tissue (p = 0.006), intravaginal scarring (p < 0.001), and complete vaginal stenosis (p = 0.008). The majority of patients who underwent revision labiaplasty and/or clitoroplasty reported satisfaction with their final surgical outcome (82.4 percent) and resolution of their genital-related dysphoria (76.5 percent).
CONCLUSIONS
Patients who developed minor postoperative complications following penile inversion vaginoplasty were more likely to require revision surgery to address functional and aesthetic concerns. Patients responded with high levels of satisfaction following revision procedures, with the majority of patients reporting resolution of genital-related dysphoria. Transfeminine patients who undergo penile inversion vaginoplasty should be counseled on the possibility of revisions during their postoperative course.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, III.
Identifiants
pubmed: 31764668
doi: 10.1097/PRS.0000000000006282
pii: 00006534-201912000-00043
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1451-1461Références
De Cuypere G, T’Sjoen G, Beerten R, et al. Sexual and physical health after sex reassignment surgery. Arch Sex Behav. 2005;34:679–690.
Morrison SD, Vyas KS, Motakef S, et al. Facial feminization: Systematic review of the literature. Plast Reconstr Surg. 2016;137:1759–1770.
Morrison SD, Perez MG, Nedelman M, Crane CN. Current state of female-to-male gender confirming surgery. Curr Sex Health Rep. 2015;7:38–48.
Berli JU, Capitán L, Simon D, Bluebond-Langner R, Plemons E, Morrison SD. Facial gender confirmation surgery: Review of the literature and recommendations for Version 8 of the WPATH Standards of Care. Int J Transgend. 2017;18:264–270.
Selvaggi G, Monstrey S, Ceulemans P, T’Sjoen G, De Cuypere G, Hoebeke P. Genital sensitivity after sex reassignment surgery in transsexual patients. Ann Plast Surg. 2007;58:427–433.
Buncamper ME, van der Sluis WB, van der Pas RS, et al. Surgical outcome after penile inversion vaginoplasty: A retrospective study of 475 transgender women. Plast Reconstr Surg. 2016;138:999–1007.
Horbach SE, Bouman MB, Smit JM, Özer M, Buncamper ME, Mullender MG. Outcome of vaginoplasty in male-to-female transgenders: A systematic review of surgical techniques. J Sex Med. 2015;12:1499–1512.
Raigosa M, Avvedimento S, Yoon TS, Cruz-Gimeno J, Rodriguez G, Fontdevila J. Male-to-female genital reassignment surgery: A retrospective review of surgical technique and complications in 60 patients. J Sex Med. 2015;12:1837–1845.
Krege S, Bex A, Lümmen G, Rübben H. Male-to-female transsexualism: A technique, results and long-term follow-up in 66 patients. BJU Int. 2001;88:396–402.
Goddard JC, Vickery RM, Qureshi A, Summerton DJ, Khoosal D, Terry TR. Feminizing genitoplasty in adult transsexuals: Early and long-term surgical results. BJU Int. 2007;100:607–613.
Hage JJ, Goedkoop AY, Karim RB, Kanhai RC. Secondary corrections of the vulva in male-to-female transsexuals. Plast Reconstr Surg. 2000;106:350–359.
Hage JJ, Karim RB. Sensate pedicled neoclitoroplasty for male transsexuals: Amsterdam experience in the first 60 patients. Ann Plast Surg. 1996;36:621–624.
Hage JJ, Karim RB, Bloemena E. Labial masses following vaginoplasty in male transsexuals: The differential diagnosis. Plast Reconstr Surg. 1996;97:1226–1232.
Van der Sluis WB, Bouman MB, Buncamper ME, Mullender MG, Meijerink WJ. Revision vaginoplasty: A comparison of surgical outcomes of laparoscopic intestinal versus perineal full-thickness skin graft vaginoplasty. Plast Reconstr Surg. 2016;138:793–800.
Karim RB, Hage JJ, Bouman FG, de Ruyter R, van Kesteren PJ. Refinements of pre-, intra-, and postoperative care to prevent complications of vaginoplasty in male transsexuals. Ann Plast Surg. 1995;35:279–284.
Eldh J. Construction of a neovagina with preservation of the glans penis as a clitoris in male transsexuals. Plast Reconstr Surg. 1993;91:895–900; discussion 901–903.
Fang RH, Chen CF, Ma S. A new method for clitoroplasty in male-to-female sex reassignment surgery. Plast Reconstr Surg. 1992;89:679–682; discussion 683.
Perovic SV, Stanojevic DS, Djordjevic ML. Vaginoplasty in male transsexuals using penile skin and a urethral flap. BJU Int. 2000;86:843–850.
Wagner S, Greco F, Hoda MR, et al. Male-to-female transsexualism: Technique, results and 3-year follow-up in 50 patients. Urol Int. 2010;84:330–333.
Reed HM. Aesthetic and functional male to female genital and perineal surgery: Feminizing vaginoplasty. Semin Plast Surg. 2011;25:163–174.
Rossi Neto R, Hintz F, Krege S, Rubben H, Vom Dorp F. Gender reassignment surgery: A 13 year review of surgical outcomes. Int Braz J Urol. 2012;38:97–107.
Sigurjonsson H, Rinder J, Möllermark C, Farnebo F, Lundgren TK. Male to female gender reassignment surgery: Surgical outcomes of consecutive patients during 14 years. JPRAS Open 2015;6:69–73.
Massie JP, Morrison SD, Van Maasdam J, Satterwhite T. Predictors of patient satisfaction and postoperative complications in penile inversion vaginoplasty. Plast Reconstr Surg. 2018;141:911e–921e.
Massie JP, Morrison SD, Smith JR, Wilson SC, Satterwhite T. Patient-reported outcomes in gender confirming surgery. Plast Reconstr Surg. 2017;140:236e–237e.
Hage JJ, Chami SZ. Conversion of the “kangaroo pouch” neovagina to a skin inversion vaginoplasty in male-to-female transsexuals: Two unusual cases. Plast Reconstr Surg. 1998;101:445–450; discussion 451–452.
Buncamper ME, van der Sluis WB, de Vries M, Witte BI, Bouman MB, Mullender MG. Penile inversion vaginoplasty with or without additional full-thickness skin graft: To graft or not to graft? Plast Reconstr Surg. 2017;139:649e–656e.
Buncamper ME, Honselaar JS, Bouman MB, Özer M, Kreukels BP, Mullender MG. Aesthetic and functional outcomes of neovaginoplasty using penile skin in male-to-female transsexuals. J Sex Med. 2015;12:1626–1634.
van der Sluis WB, Bouman MB, de Boer NK, et al. Long-term follow-up of transgender women after secondary intestinal vaginoplasty. J Sex Med. 2016;13:702–710.
Bouman MB, van der Sluis WB, van Woudenberg Hamstra LE, et al. Patient-reported esthetic and functional outcomes of primary total laparoscopic intestinal vaginoplasty in transgender women with penoscrotal hypoplasia. J Sex Med. 2016;13:1438–1444.
Morrison SD, Satterwhite T, Grant DW, Kirby J, Laub DR Sr, VanMaasdam J. Long-term outcomes of rectosigmoid neocolporrhaphy in male-to-female gender reassignment surgery. Plast Reconstr Surg. 2015;136:386–394.
Herbenick D, Reece M. Development and validation of the female genital self-image scale. J Sex Med. 2010;7:1822–1830.
Opsomer D, Gast KM, Ramaut L, et al. Creation of clitoral hood and labia minora in penile inversion vaginoplasty in circumcised and uncircumcised transwomen. Plast Reconstr Surg. 2018;142:729e–733e.
Rehman J, Melman A. Formation of neoclitoris from glans penis by reduction glansplasty with preservation of neurovascular bundle in male-to-female gender surgery: Functional and cosmetic outcome. J Urol. 1999;161:200–206.
Jarolím L, Šedý J, Schmidt M, Naňka O, Foltán R, Kawaciuk I. Gender reassignment surgery in male-to-female transsexualism: A retrospective 3-month follow-up study with anatomical remarks. J Sex Med. 2009;6:1635–1644.
Sigurjónsson H, Möllermark C, Rinder J, Farnebo F, Lundgren TK. Long-term sensitivity and patient-reported functionality of the neoclitoris after gender reassignment surgery. J Sex Med. 2017;14:269–273.
Hess J, Hess-Busch Y, Kronier J, Rübben H, Rossi Neto R. Modified preparation of the neurovascular bundle in male to female transgender patients. Urol Int. 2016;96:354–359.
Giraldo F, Esteva I, Bergero T, et al.; Andalusia Gender Team. Corona glans clitoroplasty and urethropreputial vestibuloplasty in male-to-female transsexuals: The vulval aesthetic refinement by the Andalusia Gender Team. Plast Reconstr Surg. 2004;114:1543–1550.
Smith JR, Washington AZ III, Morrison SD, Gottlieb LJ. Assessing patient satisfaction among transgender individuals seeking medical services. Ann Plast Surg. 2018;81:725–729.
Morrison SD, Massie JP, Crowe CS, Smith JR. Patient-reported outcomes needed for chest masculinization. Ann Plast Surg. 2018;80:90–91.
Klassen AF, Kaur M, Johnson N, et al. International phase I study protocol to develop a patient-reported outcome measure for adolescents and adults receiving gender-affirming treatments (the GENDER-Q). BMJ Open 2018;8:e025435.