ObjectiveWendler's glottoplasty (WG) is a pitch‐elevating surgery performed by laryngologists providing gender‐affirming care. The surgery creates an anterior glottic web that could theoretically cause airway concerns, either perioperatively or at the time of future procedures; such concerns are not well‐described in the literature. We seek to assess surgeon opinions on airway concerns regarding WG.MethodA survey of laryngologists assessing opinions on airway considerations in glottoplasty.ResultsA total of 19 physicians responded, representing approximately 193 surgeries. 52.6% performed glottoplasty and the remainder responded based on experience with anterior glottic webs. Two perioperative airway complications were reported, both mild stridor that did not prevent same‐day discharge. No long‐term sequela was reported. All surveyed laryngologists endorsed an altered general anesthetic approach for future procedures, with 73.7% advocating for use of a smaller endotracheal tube. 72.2% did not have “major concerns” about future intubations, and only 5.3% thought the immediate risk of airway compromise was a “real concern.” 91.9% counsel their patients routinely but briefly on airway concerns. Open‐ended comments conveyed themes of concern for post‐operative disruption of the web more than of airway compromise.ConclusionBecause glottoplasty is performed in the anterior glottis and does not significantly impact airway patency, the risk of serious airway complications appears to be minimal. Laryngologists believe future intubations require a modified approach with a smaller tube, partly due to concern for glottic web trauma. Based on this pilot study, the topic deserves greater work to standardize care and anesthetic alterations for patients with WG.Level of Evidence5

Objective: The objective of this study was to investigate patient satisfaction and stress urinary incontinence (SUI) cure rates in females who underwent a midurethral I-Stop ® sling insertion. It is well established in current literature that midurethral sling insertion is a highly efficacious treatment for female SUI. The challenge with sling insertion is to find a product that addresses SUI caused by both urethral hypermobility and intrinsic sphincter deficiency (ISD). Thus, this study aims to highlight the success of an I-Stop ® midurethral slings for treatment of SUI in females with ISD and urethral hypermobility, while demonstrating low patient morbidity. Methods: Three hundred females who underwent midurethral I-Stop ® sling insertion from August 2011 through December 2019 were included in this retrospective chart review. Females with diagnosed SUI and ISD were included in this study. Females with ISD underwent retropubic sling insertion approach while all other patients diagnosed with SUI underwent a transobturator (TO) approach. Patients scheduled follow-up visits 2-, 6-, 12-, and 24-weeks post-procedure and then yearly thereafter. Statistical analysis was completed with a paired t-test. Results: This retrospective review yielded 300 females who underwent sling insertion with a mean age of 66.6 years and median follow up of 37 months. Satisfaction rate was rated 4 or 5 on a 5-point Likert scale by 91.7% of patients, and SUI correction rate was 95%. Highest satisfaction rates were reported by patients in the 65-75-year-old age group. No statistical significance was identified between any of the variables analyzed with the exception of reported SUI after sling insertion and satisfaction rate, p=0.048. Nine patients (3.0%) required sling lysis secondary to inability to void or difficulty voiding resulting in elevated post-void residual values >200cc. Ten patients had sling exposure requiring revision. No vaginal, urethral, or vesical perforations, and no persistent pain post-procedure was reported. Conclusion: Midurethral I-Stop ® sling insertion results in high patient satisfaction and SUI cure rates while maintaining low post-operative complications.