A Simple Guide for Simple Orchiectomy in Transition-Related Surgeries

Francis, Courtney E.; Grober, Ethan; Potter, Emery; Blodgett, Nolan; Krakowsky, Yonah

doi:10.1016/j.sxmr.2019.11.004

Cited by 8 publications

(10 citation statements)

References 11 publications

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“…Based on an individual patient's gender journey and plan for transition, gender-affirming orchiectomy can be performed in isolation, as a bridge to vaginoplasty, or concurrently with vaginoplasty. [9][10][11][12][13] Understanding the surgical risk of these procedures as well as the various approaches is critical for preoperative risk counseling, especially among TGNB patients desiring orchiectomy and considering concurrent versus staged vaginoplasty. The decision to proceed with an isolated orchiectomy, staged procedure, or concurrent O&V is ultimately the decision of the patient after informed counseling in conjunction with their surgeon.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Removal of endogenous testosterone reduces the need for additional estrogen supplementation and testosterone suppression, and current data suggests it to be cost-effective from a health care systems practice. [10][11][12][13] One study found orchiectomy procedures had a less than 10% complication rate, consistent with the findings from our study. 9 For vaginoplasty procedures, most studies often cite minor complication rates between 4% and 33%, including urinary retention, urinary tract infections, postoperative bleeding, and minor wound dehiscence, depending on the various studies.…”

Section: Discussionmentioning

confidence: 99%

“…15 Bilateral orchiectomy is a safe, minimally invasive, and usually outpatient procedure that immediately decreases endogenous testosterone. 11,12 Removal of endogenous testosterone reduces the need for additional estrogen supplementation and testosterone suppression, and current data suggests it to be cost-effective from a health care systems practice. [10][11][12][13] One study found orchiectomy procedures had a less than 10% complication rate, consistent with the findings from our study.…”

Section: Discussionmentioning

confidence: 99%

“…Orchiectomy can be performed in isolation, as a bridge to vaginoplasty, or concurrently with vaginoplasty. [9][10][11][12][13] Some institutions routinely perform orchiectomy with vaginoplasty (O&V), while others recommend that orchiectomy should be routinely offered as a bridge to vaginoplasty. 10,12,14 This highlights the variability in practice between health care providers and institutions, and while the final surgical decision should ultimately be made based on the patient's desires, there are little data to guide decision making.…”

mentioning

confidence: 99%

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Complications After Orchiectomy and Vaginoplasty for Gender Affirmation: An Analysis of Concurrent Versus Separate Procedures Using a National Database

Russell¹,

Hong²,

Fairchild³

et al. 2023

UROGC

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Importance Gender-affirming orchiectomy may be performed in isolation, as a bridge to vaginoplasty, or concurrently with vaginoplasty for transgender and nonbinary persons, although there is a paucity of data on immediate postoperative outcomes on the various procedural approaches.Objective The aim of the study is to compare 30-day surgical outcomes after gender-affirming orchiectomy and vaginoplasty as separate and isolated procedures. Study Design This was a retrospective cohort study of patients in the American College of Surgeons National Surgical Quality Improvement Program database to compare surgical outcomes of orchiectomy alone and vaginoplasty alone to concurrent orchiectomy with vaginoplasty using bivariate and adjusted multivariable regression statistics. Results Concurrent orchiectomy and vaginoplasty were associated with greater 30-day surgical complications compared with orchiectomy alone (15.4% vs 2.9%, P < 0.01) and similar odds of 30-day surgical complications compared with vaginoplasty alone (15.4% vs 11.1%, P = 0.15). On multivariable logistic regression analysis, compared with orchiectomy alone, concurrent orchiectomy and vaginoplasty were associated with higher increased odds of 30-day surgical complications (adjusted odds ratio, 6.48; 95% confidence interval, 2.83-14.86) as well as vaginoplasty alone (adjusted odds ratio 4.30; 95% confidence interval, 1.85-10.00). Conclusions This study highlights the perioperative outcomes for isolated versus concurrent gender-affirming orchiectomy and vaginoplasty, demonstrating lower morbidity for orchiectomy alone and similar morbidity for vaginoplasty alone when compared with concurrent procedures. These data will aid health care providers in preoperative counseling and surgical planning for gender-affirming genital surgery, particularly for patients considering concurrent versus staged orchiectomy and vaginoplasty.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Complications After Orchiectomy and Vaginoplasty for Gender Affirmation: An Analysis of Concurrent Versus Separate Procedures Using a National Database

Russell¹,

Hong²,

Fairchild³

et al. 2023

UROGC

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“…The modern surgical approach to feminizing genital surgery is the penoscrotal inversion vaginoplasty (PIV), although secondline and older alternatives including enteric vaginoplasty are also occasionally performed. Components of transfeminine surgery include penectomy, orchiectomy and penoscrotal inversion vaginoplasty, or increasingly less commonly, enteric vaginoplasty [24].…”

Section: Goals and Techniquesmentioning

confidence: 99%

Imaging in Gender Affirmation Surgery

2021

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Purpose of Review This review summarizes recent developments in gender affirmation surgery, imaging findings in patients undergoing these surgeries, focusing on common postoperative radiologic appearances, complications, and pitfalls in interpretation. Recent Findings The imaging workup of masculinizing and feminizing genitourinary surgeries uses multiple modalities in presurgical planning and within the immediate and long-term postoperative period. CT and MRI can help identify immediate and remote postoperative complications. Fluoroscopic examinations can diagnose postoperative urethral complications after gender affirmation surgeries. Lastly, the patients can undergo imaging for unrelated acute and chronic pathology, and knowledge of these imaging findings can be very helpful. Summary Imaging plays a significant role in the care of transgender patients and, particularly, in those pursuing gender affirmation surgery. As insurance coverage expands for these surgical procedures, radiologists should be prepared to encounter, understand, and interpret pre and postoperative findings.

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