Pd31-10 Impact of Vaginectomy Technique on the Safety and Outcomes of Transmasculine Gender Affirming Surgery

You have accessJournal of UrologyReconstruction: External Genitalia and Urotrauma (including transgender surgery and traumatic fistula) I (PD31)1 May 2024PD31-10 IMPACT OF VAGINECTOMY TECHNIQUE ON THE SAFETY AND OUTCOMES OF TRANSMASCULINE GENDER AFFIRMING SURGERY Patrick Ho, Emily Schmidt-Beuchat, Michaela Sljivich, Ethan Nyein, Miroslav Djordjevic, and Rajveer Purohit Patrick HoPatrick Ho , Emily Schmidt-BeuchatEmily Schmidt-Beuchat , Michaela SljivichMichaela Sljivich , Ethan NyeinEthan Nyein , Miroslav DjordjevicMiroslav Djordjevic , and Rajveer PurohitRajveer Purohit View All Author Informationhttps://doi.org/10.1097/01.JU.0001009432.48553.4f.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The optimal approach for vaginectomy in transmasculine surgery has not been well-defined. One common technique is to perform sharp excision of the vaginal epithelium, whereas another includes complete electrocautery fulguration of the vaginal mucosa prior to vaginal closure. An incomplete vaginectomy risks various post-operative complications including formation of vagino-cutaneous fistulae, urinary fistula, or persistence of vaginal remnant. This study aims to compare the outcomes of both vaginectomy approaches in patients undergoing transmasculine surgery. METHODS: We performed a retrospective review of patients who underwent transmasculine surgery from 2021 to 2023 at a single institution. All had concomitant metoidioplasty with vaginectomy, with or without a simultaneous hysterectomy. Based on vaginectomy technique, the incidence of post-operative vagino-cutaneous fistulae, recurrence of vaginal remnants, and rates of re-operation were measured. Estimated blood loss (EBL) and operating room (OR) time were also compared between the two techniques. RESULTS: Of the 71 patients included in this study, 50 patients (70%) had vaginectomy by epithelial excision and 21 patients (30%) by fulguration of the vaginal mucosa. The rates of post-operative vagino-cutaneous fistulae were identical (10%) between the two cohorts. In the epithelial excision group, 4 patients (8%) had recurrence of a vaginal remnant compared to one patient (5%) in the fulguration group (p=0.63). One patient (2%) in the epithelial excision group had to undergo repeat vaginectomy compared to one patient (5%) in the fulguration group (p=0.53). In patients undergoing vaginectomy without hysterectomy, mean EBL was 254 mL in the epithelial excision group compared to 88 mL in the fulguration group (p<0.01). For the same patients without hysterectomy, mean OR time was 303 minutes in the epithelial excision group compared to 226 minutes in the fulguration group (p=0.06). CONCLUSIONS: Vaginectomy technique is not standardized in transmasculine surgery. Our data suggest that a complete fulguration approach, when compared to an epithelial excision approach, reduces blood loss and OR time without compromising rates of vagino-cutaneous fistulae or vaginal remnants requiring re-operation. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e634 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Patrick Ho More articles by this author Emily Schmidt-Beuchat More articles by this author Michaela Sljivich More articles by this author Ethan Nyein More articles by this author Miroslav Djordjevic More articles by this author Rajveer Purohit More articles by this author Expand All Advertisement PDF downloadLoading ...