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Neovaginal Canal Dissection in Gender-Affirming Vaginoplasty

2020; Lippincott Williams & Wilkins; Volume: 205; Issue: 4 Linguagem: Inglês

10.1097/ju.0000000000001516

1527-3792

Poone Shoureshi, Geolani W. Dy, Daniel Dugi,

LGBTQ Health, Identity, and Policy

No AccessJournal of UrologyAdult Urology1 Apr 2021Neovaginal Canal Dissection in Gender-Affirming VaginoplastyThis article is commented on by the following:Editorial CommentEditorial Comment Poone Shoureshi, Geolani W. Dy, and Daniel Dugi Poone ShoureshiPoone Shoureshi Oregon Health and Science University, Department of Urology, Portland, Oregon , Geolani W. DyGeolani W. Dy Oregon Health and Science University, Department of Urology, Portland, Oregon , and Daniel DugiDaniel Dugi *Correspondence: Departments of Urology and Plastic and Reconstructive Surgery; Transgender Health Program, Oregon Health and Science University, 3303 SW Bond Ave., CH-10-U, Portland, Oregon 97210 E-mail Address: [email protected] Oregon Health and Science University, Department of Urology, Portland, Oregon View All Author Informationhttps://doi.org/10.1097/JU.0000000000001516AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Gender-affirming vaginoplasty creates the vulva and vaginal canal for individuals assigned male sex at birth who have gender dysphoria. Dissection of the neovaginal space can be particularly challenging, with risk of injury to the anal and urethral sphincters, urethra and rectum. We present an anatomically based technique for vaginal canal dissection. Materials and Methods: We retrospectively analyzed a cohort of patients who underwent gender-affirming vaginoplasty by a single surgeon between May 2016 and July 2019. We describe our technique for dissection and report relevant outcomes. Results: We performed 200 vaginoplasty procedures during the study period. Patient age ranged from 15–70 years (median 41). Body mass index ranged from 16–50.5 kg/m2 (median 27). The vaginal depth ranged from 10–16 cm, with a median of 14 cm and a mean of 13.7 cm. Vaginal depth was slightly greater for patients with a body mass index of ≥30 vs <30 kg/m2 (p=0.0145). Operative complications were observed in 2 patients (1.0%) with a full thickness rectal injury and in 3 (1.5%) with a partial thickness rectal injury. Two of these patients (1.0%) had progression to a rectovaginal fistula (1 full and 1 partial thickness injury), 1 patient (0.5%) had a urethral injury, 8 patients (4.0%) had vaginal stenosis, 3 patients (1.5%) had introital stenosis and 10 patients (5.0%) had stress urinary incontinence that later resolved. Conclusions: Neovaginal canal dissection in gender-affirming vaginoplasty is technically challenging. An anatomically based approach is associated with a low complication rate at our center. References 1. : Conservative perineal prostatectomy: presentation of new instruments and technic. JAMA 1903; 41: 999. Google Scholar 2. : Complications of the neovagina in male‐to‐female transgender surgery: a systematic review and meta‐analysis with discussion of management. Clin Anat 2018; 31: 191. Google Scholar 3. : Postoperative complications following primary penile inversion vaginoplasty among 330 male-to-female transgender patients. J Urol 2018; 199: 760. 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Dy Oregon Health and Science University, Department of Urology, Portland, Oregon More articles by this author Daniel Dugi Oregon Health and Science University, Department of Urology, Portland, Oregon *Correspondence: Departments of Urology and Plastic and Reconstructive Surgery; Transgender Health Program, Oregon Health and Science University, 3303 SW Bond Ave., CH-10-U, Portland, Oregon 97210 E-mail Address: [email protected] More articles by this author Expand All Advertisement Loading ...