Genital Hypoplasia before Gender-Affirming Vaginoplasty: Does the Robotic Peritoneal Flap Method Create Equivalent Vaginal Canal Outcomes?

Background: Insufficient genital tissue has been reported as a barrier to achieving depth in gender-affirming vaginoplasty. The authors sought to characterize vaginal depth and revision outcomes in patients with genital hypoplasia undergoing robotic peritoneal flap vaginoplasty. Methods: Retrospective case-control analysis of patients undergoing robotic peritoneal vaginoplasty between September of 2017 and August of 2020 was used. All 43 patients identified as having genital hypoplasia (genital length <7 cm) were included with 49 random controls from the remaining patients with greater than 7 cm genital length. Baseline clinical characteristics and perioperative variables were recorded to identify potential confounders. Outcomes measured included vaginal size reported at last visit and undergoing revision surgery for depth or for vulvar appearance. Results: Patients were well matched other than median body mass index at the time of surgery, which was greater in the hypoplasia cohort by 3.6 kg/m2 (P < 0.0001). Patients had a median of 1-year of follow-up, with a minimum follow-up of 90 days. No significant differences in outcomes were observed, with a median vaginal depth of 14.5 cm (interquartile range, 13.3 to 14.5 cm), and a median width of dilator used of 3.8 cm (interquartile range, 3.8 to 3.8 cm). No depth revisions were observed, and an 11% (n = 10) rate of external revision occurred. Conclusions: Patients with genital hypoplasia had equivalent dilation outcomes in a case-control analysis with consistent follow-up past 90 days. The robotic peritoneal flap vaginoplasty technique provides vaginal depth of 14 cm or greater regardless of genital tissue before surgery. Further investigation with patient-reported outcome measures is warranted. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Авторы
Blasdel Gaines 1 , Kloer Carmen2 , Parker Augustus3 , Shakir Nabeel4 , Zhao L.C. 1 , Bluebond-Langner Rachel5
Издательство
Williams & Wilkins Co.
Номер выпуска
4
Язык
Английский
Страницы
867-874
Статус
Опубликовано
Том
151
Год
2023
Организации
  • 1 Department of Urology
  • 2 Duke University School of Medicine
  • 3 New York University Grossman School of Medicine
  • 4 Vattikuti Urology Institute, Henry Ford Health System.
  • 5 Hansjorg Wyss Department of Plastic Surgery, New York University
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