Abstract: PD63-10
Sources of Funding: None

Introduction

Female-to-male gender confirmation surgery (GCS) includes removal of breasts and female genitalia, as well as complete genital and urethral reconstruction. With multidisciplinary approach, all these procedures can be performed in one stage, enabling avoidance of multi-staged surgeries. Our aim was to present our experience in one-stage sex reassignment surgery in female-to-male transsexuals.

Methods

During the period of 8 years (2008-2016), totally 485 patients (mean age 29.5 years) underwent metoidioplasty. Out of them, 140 (29%) had also a hysterectomy performed, and 79 (16.3%) underwent one-stage GCS comprising of bilateral mastectomy, total transvaginal hysterectomy with bilateral adnexectomy, vaginectomy, metoidioplasty, urethral lengthening, scrotoplasty and implantation of bilateral testicular prostheses. All surgeries were performed by gynecology and gender surgeons team, simultaneously.

Results

The mean follow-up was 44 months (ranged from 14 to 92). Mean surgery time was 260 minutes (range 215-325). Postoperative hospital stay was 3-6 days (mean 4 days). Complications occurred in 22 patients (27.8%) in total. There were 8 cases (10%) with complications related to mastectomy: one patient had revision surgery because of the breast hematoma, 3 patients experienced partial nipple graft necrosis and 4 patients developed hypertrophied scars. Two patients underwent conversion of transvaginal hysterectomy to abdominal approach. One patient received blood transfusion due to excessive bleeding caused by the newly discovered Von Willebrand disease. There were 8 complications (10%) related to urethroplasty, including 4 fistulas, 3 strictures and 1 diverticulum. Two patients had testicular implant rejection, while one patient had testicular implant displacement. In the group of patients who experienced urethral complications, 5 patients required minor revision surgery along with the ones having complications with testicular implants.

Conclusions

Through multidisciplinary approach of experienced teams, one-stage gender confirmation surgery presents a viable, time and cost saving procedure. Complication rates do not differ from reported rates in multi-staged surgeries.

Funding

None