Post Penile Inversion Vaginoplasty Clinical Examination: Considerations and Techniques.
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ABSTRACT:
SUBMITTER: Bruce LK
PROVIDER: S-EPMC9126509 | biostudies-literature | 2022 May
REPOSITORIES: biostudies-literature
Publications
Post Penile Inversion Vaginoplasty Clinical Examination: Considerations and Techniques.
Bruce Lauren K LK Morris Martin P MP Swanson Marco M Kuzon William M WM Morrison Shane D SD
Plastic and reconstructive surgery. Global open 20220520 5
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Project description:IntroductionPenile inversion vaginoplasty (PIV) remains the gold standard technique for vaginoplasty, a gender-affirming feminizing surgery, but has been associated with urinary complications; however, there is little literature synthesizing urinary complications after PIV surgery, and there is a need to compile these complications to counsel patients pre- and postoperatively on managing surgical expectations. In this systematic review, we summarize the prevalence of urinary complications following PIV.MethodsWe searched the MEDLINE, EMBASE, CINAHL, and Scopus databases in July 2020. The primary outcome was the prevalence of urinary and surgical complications in patients after penile inversion vaginoplasty. Pooled prevalence was determined from extrapolated data. ROBINS-I tool was used to assess study quality. The study was prospectively registered on PROSPERO (CRD 42020204139).ResultsOf 843 unique records, 27 articles were pooled for synthesis, with 3388 patients in total. Overall patient satisfaction ranged from 80-100%. The most common urological complications included poor/splayed stream (11.7%, 95% confidence interval [CI] 5.7-19.3), meatal stenosis (6.9%, 95% CI 2.7-12.7), and irritative symptoms (frequency, urgency, nocturia) (11.5%, 95% CI 2.6-25.1). Other urinary complications included retention requiring catheterization (5.1%, 95% CI 0.3-13.8), incontinence (8.7%, 95% CI 3.4-15.6), urethral stricture (4.6%, 95% CI 1.2-9.8), and urinary tract infection (5.6%, 95% CI 2.7-9.4). Most pooled studies had moderate risk of bias.ConclusionsThe available evidence suggests that there is a low prevalence of urinary complications following PIV. Overall, there is a need for standardization of data in transgender surgical care to better understand surgical outcomes and improve postoperative management.
| S-EPMC10073518 | biostudies-literature
Project description: Not available
| S-EPMC9732695 | biostudies-literature
Project description:BackgroundThere is a growing interest in reporting satisfaction levels of transgender women undergoing vaginoplasty surgery. The lack of information regarding satisfaction during the initial experience of the vaginoplasty technique, and the moderate morbidity related to the surgery, could discourage the immersion of new groups in initiating a program of this kind. Therefore, we aim to report patients' level of satisfaction during our initial experience in the penile inversion vaginoplasty technique.MethodsRetrospective study of patients who underwent penile inversion vaginoplasty in our center between September 2019 and August 2021. Surgery technique, demographic data, preoperative clinical variables, and short and long-term follow-up are described. Six months after surgery, a survey elaborated by the research team was conducted by phone. The score goes from 1 to 5, and it evaluates satisfaction on esthetics, functional, psychosocial, and global aspects.ResultsTwenty patients underwent penile inversion vaginoplasty in our center during the described period. The average age was 35.6 years old, the mean body mass index (BMI) was 24.7 kg/m2, and they presented low comorbidity. Half of the patients presented at least one complication, most of which were minor. One patient was urgently reoperated due to bleeding, and three patients were reoperated on a scheduled basis from minor surgeries. 90% of the patients answered the questionnaire. The most common answers to all four areas covered (esthetics, functional, psychosocial, and global) were satisfied or very satisfied, resulting in a mean over four points in each one of the sections. Lastly, 94.4% of the patients reported being satisfied with their choice of having undergone surgery.ConclusionsOur initial experience in penile inversion vaginoplasty reveals good satisfaction results at short follow up.
| S-EPMC9459541 | biostudies-literature
Project description:Introduction: Although more and more transgender individuals are receiving gender-affirming medical interventions, there are limited data on patient-reported outcome measures (PROMs). We assessed PROMs in patients who received genital gender affirmation surgery (gGAS) with vaginoplasty by conventional penile inversion (PI) or urethral flap (UF). Methods: Consecutive patients undergoing vaginoplasty by PI or UF between 2015 and 2021 were candidates for this questionnaire-based cohort study. PROMs including satisfaction with body image and overall quality of life, esthetic, sensory, and functional parameters, including urological and sexual outcomes, and decision for surgery were assessed by using the Gender Congruence and Life Satisfaction scale, the Hamburg Body Drawing Scale, the Inclusive Sexual Function Inventory, and additional questions, and responses from PI and UF groups were compared. Results: With a response rate of 64%, total 41 patients were included in the study. Overall, patients reported high satisfaction with body image and quality of life after PI and UF. Patients with UF were significantly more comfortable being naked in front of a sexual partner compared to those with PI, but satisfaction with esthetics was high in both groups. The UF group had a significantly higher frequency of sanguineous discharge from the neovagina. Functional urological problems were rare in both groups, but urgency was reported more frequently in PI than in UF. Both groups reported generally high interest in sexual activity, and both frequently needed lubrication for neovaginal penetration. There were few regrets about the decision to undergo gGAS in either group. Conclusion: Patient satisfaction regarding body image, quality of life, functionality, sexuality, and decision for surgery was reasonably high, and UF seems to be a valid alternative to PI.
| S-EPMC11837940 | biostudies-literature
Project description: Not available
| S-EPMC8261425 | biostudies-literature
Project description:Penile amputations are uncommon injuries, therefore, the management and outcome of these patients have been compiled from solitary case studies or short reviews. Accidental trauma during circumcision, injury inflicted by a partner following marital discord, and genital self-mutilation observed in patients with deep psychosis, account for a majority of the presentations. Initially, patients with total penile amputations were managed by resuturing the penile structures without repairing the vessels. A high incidence of skin and glans necrosis, urethral strictures, and a failure of sensory recovery were observed, though the penile shaft sometimes survived. Presently, microsurgical replantation has markedly improved the results, though issues of skin loss and urethral stricture still persist. A series of three patients with penile amputation is presented (complete = 2, partial = 1); the technical considerations and outcomes are discussed.
| S-EPMC3842340 | biostudies-other
Project description:Placement of an inflatable penile prosthesis (IPP) is the mainstay of surgical treatment for patients with Peyronie's disease (PD) and concomitant medication-refractory erectile dysfunction. Special considerations and adjunctive surgical techniques during the IPP procedure are often required for patients with PD to improve residual penile curvature, as well as postoperative penile length. The surgical outcomes and various adjunctive techniques are not significantly different from one another, and selection of the appropriate technique must be tailored to patient-specific factors including the extent of the deformity, the degree of penile shortening, and preoperative patient expectations. The aims of this review were to assess the current literature on published outcomes and surgical techniques involving IPP placement in the treatment of PD. Patient satisfaction and preferences are reported, along with the description and patient selection for surgical techniques that include manual penile modeling, management of refractory curvature with concurrent plication, and correction of severe residual curvature and penile shortening with tunica release and plaque incision and grafting. A thorough description of the available techniques and their associated outcomes may help guide surgeons to the most appropriate choice for their patients.
| S-EPMC4524455 | biostudies-other
Project description:Background: Rectovaginal fistula (RVF) remains a complex complication following gender-affirming vaginoplasty. This review aims to evaluate RVF repair techniques and outcomes following vaginoplasty. Methods: A systematic review was performed per PRISMA guidelines. Ovid MEDLINE, Ovid EMBASE, Cochrane, and Web of Science were queried for records pertaining to RVF repair following vaginoplasty. Study characteristics, operative details, and demographics were collected. Outcomes included RVF repair method, recurrence rate, and complications. Results: Among 282 screened citations, 17 articles representing 41 patients were included. Rectovaginal fistula repair methods identified included 4 conservative management approaches (n = 12 patients), primary closure with or without fistulectomy and ostomy (n = 22), 10 reconstructive surgical techniques (n = 18). The most common reconstructive techniques were V-Y full-thickness advancement with rectal flap (n = 5) and infragluteal fasciocutaneous flap (n = 4). Median time to recurrence was 6 months (interquartile range 7.5). Reported RVF repair complications included RVF recurrence (n = 5, 14.7%) and wound complication or dehiscence (n = 2, 5.88%). Three cases of RVF recurred after primary closure with or without fistulectomy and ostomy, while 2 cases of recurrence followed reconstruction. Conclusion: There remains a high level of variability in the approach to RVF repair following vaginoplasty. Reconstructive surgical techniques may be a more optimal solution without necessitating ostomies, but this decision must be considered in the context of RVF location, individual patient expectations, and clinical presentation.
| S-EPMC11770714 | biostudies-literature
Project description:A broad overview is provided of the normal anatomy of the male genitalia to offer the best surgical outcomes in cases related to congenital abnormalities, trauma, cancer-related extirpation, and aesthetics. Neural and vascular anatomy is discussed in depth due to its critical role in maintaining function and in assuring tissue viability.
| S-EPMC3312188 | biostudies-other
Project description:BackgroundTransgender and gender diverse individuals (TGDIs) are people whose gender identity is not in line with their sex assigned at birth, but current surveys used for cisgender patients addressing sexual satisfaction and function (SFS) do not fit the needs of this unique population.AimThe authors of this project sought to create and validate a new comprehensive survey in North American English that differs from the current options for TGDI post-vaginoplasty.Materials and methodsUsing the current literature on SFS as a foundation, a 26-item survey was created and distributed to 16 TGDI at least 3 months post-vaginoplasty. Feedback and review for content validity took place in the forms of interviews with the 16 TGDI, an expert panel, and the creation of a community advisory board.OutcomesFeedback was incorporated to transform the original 26-item questionnaire into a 32-question survey with eight domains, named the SatisFunction Survey Post-Vaginoplasty, which represents the preliminary development and content validity of the survey, with its clinical use not recommended until further validation steps are completed.ResultsFeedback focused on improving the clarity of questions to address sexual vs non-sexual behaviors, providing definitions of terms in the question stems for improved user understanding, including more questions on specific anatomic locations, addressing gender dysphoria as it relates to genital self-image, specifying type of vaginoplasty and only including questions relevant to those with or without a vaginal canal.Clinical implicationsThe authors foresee clinical use of the survey for recurrent assessment in the postoperative period as well as post-revision.Strength and limitationsCommunity-based research is essential in developing an assessment tool tailored to the unique needs of a specific population. This study presents the findings of preliminary content validation but requires further validation before clinical use, and is limited by a small sample size from a single-site institution.ConclusionFuture directions involve completing the validation process for the survey with distribution to a larger TGDI population with other validated surveys with a subsequent cohort interview to address construct and divergent validity as well as reliability.
| S-EPMC11890106 | biostudies-literature