Background Penile prostheses may be used as a component of genital gender affirmation surgery for the purpose of achieving penile rigidity after phalloplasty, and transgender individuals experience higher complication rates than cisgender individuals. Aim To observe complications with transmasculine penile prosthesis surgery over time and across surgical conditions. Methods Retrospective chart review of all transmasculine patients with phalloplasty undergoing penile prosthesis placement between 4/14/2017 and 2/11/2020 (80 patients). Outcomes Independent variables include implant type, previous genital surgeries, and simultaneous genital surgeries. Dependent variables include prosthesis infection and mechanical complication (device malfunction, dislodgement, erosion). Results There was an overall complication requiring surgery rate of 36% and infection rate of 20% (15/67 for inflatable prostheses and 1/13 for semirigid), with 14% (11/80) experiencing infection requiring removal. Differences in infection rates appeared insignificant across categories of previous surgery or with simultaneous surgery, but we did notice a markedly lower rate for semirigid prostheses compared to inflatable. There was a significant relationship between infection and case number, with the probability of infection decreasing over time. Device loss at 9 months was 21% overall. Preoperative conditions of the neophallus such as prior stricture correction and perioperative factors such as simultaneous clean and clean-contaminated procedures seemed to pose no additional increase in complication rates. Clinical Implications Type and number of prior and simultaneous non-prosthetic surgeries should not be considered as a risk factor for penile prosthesis after phalloplasty for transmasculine patients, even those that are clean-contaminated Strengths & Limitations Our cohort size is large compared to currently available studies, although not large enough to generate sufficient power for group comparisons. We have reported every genital surgical step between phalloplasty and penile prosthesis placement and recorded complications with subsequent devices after failure. Patient-reported outcomes were not collected. Conclusion We demonstrate that preoperative conditions of the neophallus, such as prior stricture correction, and perioperative factors, such as simultaneous clean and clean-contaminated procedures, seem to pose no additional increase in complication rates. Our data suggest that surgical experience may further decrease complications over time.

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Model organisms such as Danio rerio are used to explore physiological reactions to stress and disease. Immune response is measured by quantifying lymphocyte presence and the production of mRNA encoding different immunoglobulin proteins. Since the method through which D. rerio is exposed to an antigen affects its immune response and the degree to which immunity is developed, we will compare the immune response after visceral or mucosal introduction of dinitrophenol hapten conjugated to Keyhole Limpet hemocyanin (DNP-KLH) in D. rerio, for which there is no published data. We will either combine DNP-KLH with Freund’s incomplete adjuvant and inject the mixture into the fish (100 uL at 1 mg/mL) or combine DNP-KLH with cholera toxin and introduce the mixture to their water (35 mg/L). Tissue samples will be collected from the immunized fish and two control groups of fish at weekly points throughout the experiment and will be analyzed for lymphocyte versus granulocyte ratios and expression of IgM, IgZ-1, and IgZ-2 levels via qPCR. We expect an increase in lymphocyte percentages for both immunized groups compared to the control groups, with a higher lymphocyte ratio in the mucosal group than the visceral group. Furthermore, we expect more mucosal IgZ isotypes in the mucosal group and higher levels of the IgM, IgZ-1, and IgZ-2 antibodies in the visceral group than in the mucosal group. For future experiments, we intend to test broader data sets, including exposure to multiple antigens.

INTRODUCTION AND OBJECTIVE:In the last 20 years, techniques in vaginal restorative surgery have evolved. Studies evaluating post-operative outcomes following contemporary surgical approaches in congenital adrenal hyperplasia (CAH) patients with variation in genital anatomy (VGA) remain scarce. Vaginal stenosis (VS) is a complication of vaginal restorative surgery and requires specialized care and management. We reviewed our surgical experience with CAH patients to understand patterns of occurrence, classification, and management of VS at our institution.METHODS: We retrospectively reviewed CAH patients with VGA who underwent primary vaginoplasty from 1996 to 2016. Patient demographics, procedure characteristics, occurrence of VS, and subsequent management were recorded. Prader score was further stratified to a 7-point genital stage. Annual physical exam was performed from post-op to toilet training then after menarche unless clinically indicated. VS was defined as narrowing at the vaginal introitus or inability to use tampons/have penetrative intercourse. VS was further categorized as Suspected (minor narrowing observed on exam without clinical impact, S-VS) or Clinically Significant (severe narrowing requiring intervention once menarche is achieved, CS-VS). Patients without a vaginoplasty or one performed at another institution, identified as male, lost to follow up, or without follow up records were excluded.RESULTS: 130 patients were included for evaluation. Mean age was 3.5 years (0.32-34.5 years). Classic CAH occurred in 94.4%. A genital score of 3 (Prader III) predominated (39,7%). Mean anesthesia and surgery time was 4.3 (2-9.5) and 3.1 (1.1-8.0) hrs, respectively. Mean admission and follow up length was 3.2 days and 4.5 (0.01-17.6) years. S-VS and CS-VS occurred in 13 and 14 patients, respectively. Management of CS-VS included redo vaginoplasty (5, 1 planned but lost to follow-up), expectant management (8). The development of S-VS correlated with procedure type (flap alone p[0.012 and PT þ flap p[0.043) and genital score 7 (p[0.022). CS-VS was only associated with PT (p[0.035). Logistic regression to predict VS was not statistically significant.CONCLUSIONS: VS remains a concern following vaginal restorative surgery in CAH patients. This descriptive study at a CAH center of excellence is an initial step toward characterization of VS. Higher genital score and procedure type was associated with the development of VS. In the future, standardization of the definition of VS will help assess clinical outcomes, defining risk factors, and tailoring management.