Penile Inversion Neovaginoplasty: A Single Institution's Six Year Experience
Daniel J. Koh, BA1, Annie Heyman, BA1, Nikhil Sobti, MD2, Pamela Klein, RN, MSN3, Daniel S. Roh, MD, PhD4, Ricardo Munarriz, MD5, Jaromir Slama, MD4, Robert Oates, MD5.
1The Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA, 2Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA, 3Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, MA, USA, 4Division of Plastic and Reconstructive Surgery, Boston Medical Center, Boston, MA, USA, 5Division of Urology, Boston Medical Center, Boston, MA, USA.
BACKGROUND: Penile inversion neovaginoplasty (NVG) is the most common genital procedure performed for male-to-female gender affirmation. NVG includes orchiectomy, urethroplasty, clitoroplasty, labiaplasty, and creation of a neovagina. While the complications and outcomes following NVG have been described, our study aims to further contribute to the growing body of literature describing patient demographics, surgical characteristics, intra- and post-operative complications, and rates of revision using a robust patient population cohort. METHODS: Patients over the age of 18 who received gender affirming NVG from January 1, 2016 to January 1, 2022 were included in this retrospective study, all who had greater than 30 days of follow-up. The average follow-up length was 460 days. Patient characteristics, surgical details, complications, and revision rates were recorded for all patients. All intra-operative and post-operative adverse events were graded using the five tier Clavien-Dindo classification system. RESULTS: A total of 143 patients were included in this study. The average age was 38.42±13.45 years. The mean BMI was 27.43±4.79 kg/m2. The estimated blood loss was 262±103 milliliters. The average length of surgery was 335.29±36.11 minutes. Intraoperative and postoperative Grade I/II complications occurred in 26 patients. Intraoperative and postoperative Grade IIIb complications occurred in 14 patients. No patients experienced Grade IV or V complications. Of the Grade IIIb complications, four required re-operative intervention for excessive granulation tissue, while another three required re-operative intervention for wound dehiscence. Rectovaginal fistula, rectoperineal fistula, meatal stenosis, vaginal prolapse, hematoma, necrosis, and skin graft loss contributed once each to the incidence of Grade IIIb complications. Patient desired revisions occurred in 54.5% of patients, of which 44.9% were addressing bothersome stenosis of the neovaginal opening. Urethromeatoplasty with mucosal advancement was desired by 26.6% of patients to optimize the directionality of the urinary stream. CONCLUSION: This study represents a longitudinal description of the demographics, surgical characteristics, intra- and post-operative complications, and revision rates following penile inversion neovaginoplasty. Our findings further solidify that NVG is a safe and effective procedure for male-to-female gender affirmation based on a single institution's fairly large database.
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