Male-to-Female Gender Reassignment Surgery: An Institutional Analysis of Outcomes, Short-term Complications, and Risk Factors for 240 Patients Undergoing Penile-Inversion Vaginoplasty.

Autor: Levy JA; Hahnemann University Hospital, Department of Urology, Philadelphia, PA. Electronic address: jasonlevy89@gmail.com., Edwards DC; Hahnemann University Hospital, Department of Urology, Philadelphia, PA., Cutruzzula-Dreher P; Hahnemann University Hospital, Department of Urology, Philadelphia, PA., McGreen BH; Hahnemann University Hospital, Department of Urology, Philadelphia, PA., Akanda S; Philadelphia College of Osteopathic Medicine, Philadelphia, PA., Tarry S; Hahnemann University Hospital, Department of Urology, Philadelphia, PA., Belkoff LH; Hahnemann University Hospital, Department of Urology, Philadelphia, PA., Rumer KL; Hahnemann University Hospital, Department of Urology, Philadelphia, PA.
Jazyk: angličtina
Zdroj: Urology [Urology] 2019 Sep; Vol. 131, pp. 228-233. Date of Electronic Publication: 2019 Jun 14.
DOI: 10.1016/j.urology.2019.03.043
Abstrakt: Objective: To report outcomes, complications, and risk factors of a population cohort undergoing male-to-female gender affirmation surgery via penile-inversion vaginoplasty by a single surgeon at a large academic institution. As gender dysphoria awareness increases among the medical community, so does the population of patients seeking gender-affirmation surgery.
Materials and Methods: A prospectively maintained database of patients undergoing penile-inversion vaginoplasty was retrospectively queried for all available patients with at least 1 week of postoperative follow-up. Univariate and multivariate analyses were performed using Fisher's exact test and logistic regression, respectively, in order to evaluate relationship of risk factors to complications at 30, 60, and 90 days, as well as the likelihood of revision/reoperation.
Results: From November 2016 to April 2018, 240 penile-inversion vaginoplasties were performed. Median follow-up was 87 days. When accounting for competing risk factors, only noncompliance with postoperative dilation regimen and activity restriction was significantly associated with increased risk of complications or reoperation/revision. Overall incidence of reoperation/revision was 7.9% (n = 19). Reasons for reoperation included cosmesis (3.8%; n = 9), neovaginal stenosis (2.1%; n = 5), and wound dehiscence (0.8%; n = 2), with less than 0.5% (n = 1) reoperations for meatal stenosis, hematoma or rectovaginal fistula, respectively. Incidence of Clavien IIIa-b complications was 1.7% (n = 4). There were no Clavien IV-V complications.
Conclusion: At short-term follow-up, gender-affirmation surgery is associated with low rates of reoperation and revision and few major complications when performed by an experienced, high-volume surgeon. Patient selection and compliance is imperative. Increased reporting among surgeons is necessary to continue to improve patient outcomes.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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