Abstract: PD63-09
Sources of Funding: None

Introduction

Studies of surgical complications from penile inversion vaginoplasty are limited to small sample sizes. Risk factors for complications are unknown. We aim to describe postoperative complications after penile inversion vaginoplasty and evaluate risk factors for complications.

Methods

We conducted a retrospective review of all male-to-female (MTF) patients presenting for primary penile inversion vaginoplasty to a high-volume surgeon (MLB) from 2011-2015. We classified complications using Clavien-Dindo grades. A multivariate logistic regression was performed to determine the independent effects of age, BMI, and hormone replacement therapy (HRT) on postoperative surgical complications.

Results

In the study period, 330 patients presented for primary penile inversion vaginoplasty. The median age at time of surgery was 35 years, range (18-76). The median number of years on HRT before gender reassignment surgery (GRS) was 3 (interquartile range, IQR 2-6). The median follow-up time was 3 months (range 3 -73 months). Ninety-five patients (28.7%) presented with a postoperative complication. The median time to a complication was 4 months (IQR 1-12). The most common complication was the formation of granulation tissue in 24 (7.3%) patients. Recto-neovaginal fistulae occurred in 6 (1.8%) patients. Of the patients who presented with a surgical complication, 24 (25.3%) required a second operation. There were no complications greater than Clavien-Dindo grade IIIB. Of the 41 (12.4%) patients who presented with wound separation or granulation tissue, the adjusted odds ratio for each additional year of HRT was 1.05 (1.00-1.11), p=0.04. No preoperative or intraoperative risk factors were associated with fistulae formation.

Conclusions

The majority of complications due to MTF penile inversion vaginoplasty occur within the first four months after surgery. Years on HRT may be an independent risk factor for wound complications. Long-term use of HRT may alter tissue plasticity and healing; and therefore, puts one at risk for complications. Future prospective studies are required to investigate the long-term effects of feminizing hormones on male genital tissue.

Funding

None