Poster Session 11: Sexual Health, Infertility

Introduction: Robotic-assisted peritoneal flap vaginoplasty (PFV) for feminizing gender-affirmation surgery is an alternative to penile inversion vaginoplasty (PIV) for transgender females (TF).There is little data on comparative outcomes complicating preoperative discussions to help direct patient choice.We compared perioperative and postoperative outcomes in patients undergoing PFV and PIV at a single institution.Methods: Forty-one TF who underwent primary PIV were compared to 41 TF who underwent PFV at a single center.Retrospective data was collected to assess preoperative penile skin length to the coronal sulcus, vaginal depth 1 month and 6 months postoperatively, operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), perioperative complications, 30-day emergency department visits, and late complications requiring surgical revision.Variables were directly compared for PFV and PIV using parametric t-tests. Results:The PFV and PIV groups were similar in age, BMI, and presence of circumcision (61% vs. 58%, respectively).The PFV group had shorter penile length to coronal sulcus (7.0 cm 1.0-11 vs. 9.0 cm 6.0-13), less EBL (250 cc 150-500 vs. 300 cc 150-700), and similar LOS (3 days 1-18 vs 3 days 2-6) and OT (339 min 269-447 vs. 365 min 249-524) compared to the PIV group.Intraoperatively, there were 3 rectal injuries (RI) during PIV and none during PFV.Among the three patients with RI, 1 underwent diverting ileostomy.PFV patients had a lower risk of transfusions than PIV (2.44% vs. 9.75%).PFV and PIV experienced similar 30-day ED visits (17.1 vs. 17.1%),hospital readmissions (7.32 vs. 7.32%), and late complications requiring surgical revision (12.2 vs. 14.6%).The PFV group had deeper vaginal depth after 1 month (18 cm 13-20 vs. 15 cm 4.0-23) and 6 months (18 cm 7.6-20 vs. 15 cm 2.5-19).The ratio of vaginal depth after 1 month compared to penile length was greater in the PFV group (2.5 0-18 vs. 1.7 0.46-2.5).Conclusions: In this cohort, PFV led to improved vaginal depth as compared to PIV, despite shorter preoperative penile skin length.These findings suggest PFV is advantageous in TF with shorter penile length desiring greater vaginal depth.Bowel complications were lower among TF who underwent PFV vs. PIV.PFV may confer an advantage in operative time and blood loss compared to PIV, with a reduced need for transfusion in the postoperative setting.Further studies are needed to determine long-term outcomes of vaginal depth, the comparable safety profile in this study supports the use of primary PFV as an alternative to PIV.