"Urinary Reconstruction in Genital Gender-Affirming Surgery: Checking Our Surgical Complication Blind Spots".
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:
07 Jun 2023
07 Jun 2023
Historique:
medline:
8
6
2023
pubmed:
8
6
2023
entrez:
8
6
2023
Statut:
aheadofprint
Résumé
Urologic complications in genital gender-affirming surgery (GGAS) are imperfectly measured, with existing evidence limited by "blind spots" which will not be resolved through implementation of patient-reported outcomes alone. Some blind spots are expected in a surgical field with rapidly expanding techniques, and may be exacerbated by factors related to transgender health. We provide a narrative review of systematic reviews published in the last decade to describe the current options for genital gender-affirming surgery and surgeon-reported complications, as well as contrasting peer-reviewed sources with data not reported by primary surgeon. In combination with expert opinion, these findings describe complication rates. Eight systematic reviews describe complications in vaginoplasty patients, including 5%-16.3% mean incidence of meatal stenosis and 7%-14.3% mean incidence of vaginal stenosis. Compared to surgeon-reported cohorts, vaginoplasty and vulvoplasty patients in alternate settings report higher rates of voiding dysfunction (47%-66% vs 5.6%-33%), incontinence (23%-33% vs. 4%-19.3%) and misdirected urinary stream (33%-55% vs 9.5%-33%). Outcomes in six reviews of phalloplasty and metoidioplasty included urinary fistula (14%-25%), urethral stricture and/or meatal stenosis (8%-12.2%), and ability to stand to void (73%-99%). Higher rates of fistula (39.5%-56.4%) and stricture (31.8%-65.5%) were observed in alternate cohorts, along with previously unreported complications such as vaginal remnant requiring reoperation. The extant literature does not completely describe urologic complications of GGAS. In addition to standardized, robustly validated patient-reported outcome measures, future research on surgeon-reported complications would benefit from using the IDEAL (Idea, Development, Exploration, Assessment, and Long-term Study) framework for surgical innovation.
Sections du résumé
BACKGROUND
BACKGROUND
Urologic complications in genital gender-affirming surgery (GGAS) are imperfectly measured, with existing evidence limited by "blind spots" which will not be resolved through implementation of patient-reported outcomes alone. Some blind spots are expected in a surgical field with rapidly expanding techniques, and may be exacerbated by factors related to transgender health.
METHODS
METHODS
We provide a narrative review of systematic reviews published in the last decade to describe the current options for genital gender-affirming surgery and surgeon-reported complications, as well as contrasting peer-reviewed sources with data not reported by primary surgeon. In combination with expert opinion, these findings describe complication rates.
RESULTS
RESULTS
Eight systematic reviews describe complications in vaginoplasty patients, including 5%-16.3% mean incidence of meatal stenosis and 7%-14.3% mean incidence of vaginal stenosis. Compared to surgeon-reported cohorts, vaginoplasty and vulvoplasty patients in alternate settings report higher rates of voiding dysfunction (47%-66% vs 5.6%-33%), incontinence (23%-33% vs. 4%-19.3%) and misdirected urinary stream (33%-55% vs 9.5%-33%). Outcomes in six reviews of phalloplasty and metoidioplasty included urinary fistula (14%-25%), urethral stricture and/or meatal stenosis (8%-12.2%), and ability to stand to void (73%-99%). Higher rates of fistula (39.5%-56.4%) and stricture (31.8%-65.5%) were observed in alternate cohorts, along with previously unreported complications such as vaginal remnant requiring reoperation.
CONCLUSION
CONCLUSIONS
The extant literature does not completely describe urologic complications of GGAS. In addition to standardized, robustly validated patient-reported outcome measures, future research on surgeon-reported complications would benefit from using the IDEAL (Idea, Development, Exploration, Assessment, and Long-term Study) framework for surgical innovation.
Identifiants
pubmed: 37289945
doi: 10.1097/PRS.0000000000010813
pii: 00006534-990000000-01971
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 by the American Society of Plastic Surgeons.