Thomas W Gaither1, Mohannad A Awad2, E Charles Osterberg3, Gregory P Murphy1, Angelita Romero4, Marci L Bowers4, Benjamin N Breyer5. 1. Department of Urology, University of California-San Francisco, San Francisco, California. 2. Department of Urology, University of California-San Francisco, San Francisco, California; Department of Surgery, King Abdulaziz University, Rabigh, Saudi Arabia. 3. Division of Urology, Dell Medical School, University of Texas, Austin, Texas. 4. Department of Gynecological Surgery, Bay Area Reproductive Healthcare and Mills Peninsula Hospital, Burlingame, California. 5. Department of Urology, University of California-San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California. Electronic address: Benjamin.breyer@ucsf.edu.
Abstract
PURPOSE: Studies of surgical complications of penile inversion vaginoplasty are limited due to small sample sizes. We describe postoperative complications after penile inversion vaginoplasty and evaluated age, body mass index and years on hormone replacement therapy as risk factors for complications. MATERIALS AND METHODS: We retrospectively reviewed the records of male-to-female patients who presented for primary penile inversion vaginoplasty to a high volume surgeon (MLB) from 2011 to 2015. Complications included granulation tissue, vaginal pain, wound separation, labial asymmetry, vaginal stenosis, fistula formation, urinary symptoms including spraying stream or dribbling, infection, vaginal fissure or vaginal bleeding. We classified complications by Clavien-Dindo grade. Multivariable logistic regression was performed to determine the independent effects of age, body mass index and hormone replacement therapy on postoperative surgical complications. RESULTS: A total of 330 patients presented for primary penile inversion vaginoplasty. Median age at surgery was 35 years (range 18 to 76). Median followup in all patients was 3 months (range 3 to 73). Of the patients 95 (28.7%) presented with a postoperative complication. Median time to a complication was 4.4 months (IQR 1-11.5). Rectoneovaginal fistulas developed in 3 patients (0.9%). A total of 30 patients (9.0%) required a second operation. There were no complications greater than Clavien-Dindo grade IIIB. Age, body mass index and hormone replacement therapy were not associated with complications. CONCLUSIONS: Penile inversion vaginoplasty is a relatively safe procedure. Most complications due to this surgery develop within the first 4 months postoperatively. Age, body mass index and hormone replacement therapy are not associated with complications and, thus, they should not dictate the timing of surgery.
PURPOSE: Studies of surgical complications of penile inversion vaginoplasty are limited due to small sample sizes. We describe postoperative complications after penile inversion vaginoplasty and evaluated age, body mass index and years on hormone replacement therapy as risk factors for complications. MATERIALS AND METHODS: We retrospectively reviewed the records of male-to-female patients who presented for primary penile inversion vaginoplasty to a high volume surgeon (MLB) from 2011 to 2015. Complications included granulation tissue, vaginal pain, wound separation, labial asymmetry, vaginal stenosis, fistula formation, urinary symptoms including spraying stream or dribbling, infection, vaginal fissure or vaginal bleeding. We classified complications by Clavien-Dindo grade. Multivariable logistic regression was performed to determine the independent effects of age, body mass index and hormone replacement therapy on postoperative surgical complications. RESULTS: A total of 330 patients presented for primary penile inversion vaginoplasty. Median age at surgery was 35 years (range 18 to 76). Median followup in all patients was 3 months (range 3 to 73). Of the patients 95 (28.7%) presented with a postoperative complication. Median time to a complication was 4.4 months (IQR 1-11.5). Rectoneovaginal fistulas developed in 3 patients (0.9%). A total of 30 patients (9.0%) required a second operation. There were no complications greater than Clavien-Dindo grade IIIB. Age, body mass index and hormone replacement therapy were not associated with complications. CONCLUSIONS: Penile inversion vaginoplasty is a relatively safe procedure. Most complications due to this surgery develop within the first 4 months postoperatively. Age, body mass index and hormone replacement therapy are not associated with complications and, thus, they should not dictate the timing of surgery.
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