Ileal vaginoplasty as vaginal reconstruction in transgender women and patients with disorders of sex development: an international, multicentre, retrospective study on surgical characteristics and outcomes

Sluis, Wouter B. van der; Pavan, Nicola; Liguori, Giovanni; Bucci, Stefano; Bizic, M.; Kojović, V.; Heß, Jochen; Meijerink, W.J.H.J.; Mullender, Margriet G.; Özer, Müjde; Smit, Jan Maerten; Buncamper, Marlon E.; Krege, Susanne; Djordjević, Miroslav L.; Trombetta, Carlo; Bouman, Mark Bram

doi:10.1111/bju.14155

Cited by 31 publications

(13 citation statements)

References 23 publications

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“…Secondary vaginoplasty using an intestinal segment had long-term sexual satisfaction rates ranging from 78% to 91% in some studies ( 7 , 8 ). However, these procedures involve major surgeries with violation of the abdominal cavity, possible complications such as dehiscence of anastomosis, adhesions and intestinal obstructions, risk of long-term carcinoma, excessive mucus production, prolapse, and a 25% chance of needing a second operation.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the surgical and functional outcomes of secondary vaginoplasties with free skin mesh graft in patients following transfeminine genital reconstructive surgery

Abboud¹,

Silva²,

Görgen³

et al. 2022

Transl Androl Urol

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Background: Gender-affirming surgery is classically done using the penile inversion vaginoplasty technique, however in some patients it may not promote adequate depth. In patients whose vaginal conduits became short or stenotic, we propose to perform a secondary vaginoplasty using an abdominal free skin mesh graft. In this study, we present ours results of a series of cases using this technique.Methods: A retrospective review of patients undergoing secondary vaginoplasty with free skin mesh graft from 2000 to 2017 at our hospital was performed. Demographic data, surgical characteristics, complications, personal satisfaction and neovagina functionality (defined as the ability to have satisfactory sexual intercourse) were evaluated.Results: Of 186 patients who were submitted to primary vaginoplasty, 36 patients (19.3%) were then submitted to secondary vaginoplasty. This study sample included 35 patients. The average age of patients was 41.0 years (37.0 to 50.5) and the average time between gender affirmation surgery and secondary vaginoplasty was 6 months (4-24). Ten patients (28.6%) developed postoperative complication, the most frequent being: neovagina introitus stenosis (22.9%), rectal fistula (8.6%), tissue dehiscence (2.9%), and urethral fistula (2.9%). Subjective personal satisfaction and neovagina functionality of patients was reported by 77.1% of the sample.Conclusions: Our study demonstrates that secondary vaginoplasty surgery using a free skin mesh graft has good results and is a functional option with low complexity and low rate of serious complications.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the surgical and functional outcomes of secondary vaginoplasties with free skin mesh graft in patients following transfeminine genital reconstructive surgery

Abboud¹,

Silva²,

Görgen³

et al. 2022

Transl Androl Urol

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“…The well-established techniques used for vaginoplasty include grafting with split-thickness skin [1–4], peritoneum [19], bowel, free jejunal autograft, ileum [20], or sigmoid colon [21]. The Vecchietti technique has been used as a less-invasive approach to surgical vaginoplasty or as modified technique of Brucker, Rall, and Wallwiener [5, 6] using vagino-abdominal blunt perforation without vesicorectal tunnelling.…”

Section: Discussionmentioning

confidence: 99%

Clinical pilot study to evaluate the neovaginal PACIENA prosthesis® for vaginoplasty without skin grafts in women with vaginal agenesis

et al. 2019

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BackgroundTo evaluate the feasibility and clinical outcomes of vaginoplasties using a neovaginal polylactic acid prosthesis made with 3-dimensional (3D) printing technology as an intraneovaginal mould.MethodsThis was an interventionist, prospective, and multicentre clinical pilot investigation of a sanitary product (PACIENA prosthesis®) aiming to recruit and operate on 8 patients over 6 months with a follow-up period of 6 months. Only six patients with Rokitansky syndrome and one patient with Morris syndrome (7 patients in total) were operated on in two university hospitals: “La Fe”, Valencia (H1) and “Arrixaca”, Murcia (H2). Interventions: Extensive surgical dissection of a defined space between the urethra and bladder in the front and of the rectum in the back as well as insertion of the PACIENA prosthesis® covered with Interceed® were performed. After 12 days, the prosthesis was changed to the silicone-covered version for daily application.ResultsIn the 6 patients with Rokitansky syndrome (86%), the primary endpoint (satisfactory vaginal outcome in terms of appearance, function, and sensation without relevant additional morbidity) was achieved, although only 2 patients (28%) were sexually active at the end of 6 months of follow-up. The patient with Morris syndrome withdrew from the study after 1 month. Patients without bacterial colonization showed positive Schiller tests at 1 month, and subsequent biopsies showed adequate keratinization and epidermization. Epithelization and iodopositivity were delayed in the patients who developed inflammatory granulomas.ConclusionsGood anatomical and functional results can be achieved with the PACIENA prosthesis® for vaginoplasties without skin grafts. However, adequate patient selection and education, good surgical techniques and haemostasis, postoperative support, and prevention of bacterial colonization are important.Trial registrationThis clinical study was approved by the Ethical Clinical Investigation Committee of San Juan University Hospital on September 27, 2016, to be conducted in the participating centres; it was authorized by the Spanish Agency of Medicines and Health Products (AEMPS) on April 24, 2017 (exp. no. 585/16/EC), to be carried out in that hospitals.

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“…Both skin graft and intestinal vaginoplasty have demonstrated good outcomes in revision procedures. [53][54][55][56] Intestinal vaginoplasty can be particularly useful with full-length compromise of the vaginal canal associated with rectovaginal and/or urethrovaginal fistulae. In revision vaginoplasty, peritoneal flaps provide vascularized tissue to line the deepened canal 30 ; however, outcomes data from larger revision samples with this technique are needed.…”

Section: Revision Vaginoplastymentioning

confidence: 99%

Vaginal Canal Reconstruction in Penile Inversion Vaginoplasty with Flaps, Peritoneum, or Skin Grafts: Where Is the Evidence?

Salibian

Schechter

Kuzon

et al. 2021

Plastic &Amp; Reconstructive Surgery

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ender-affirming genital surgery is indicated as one treatment for gender dysphoria and has been shown to improve quality of life and sexual health in transgender patients. 1,2 Penile skin inversion vaginoplasty remains the most common technique for vaginoplasty since described for gender affirmation in the 1950s. 3,4 Studies have demonstrated low rates of major complications 5 and high patient satisfaction, 6,7 although standardization of techniques and outcome evaluation is ongoing.Neovaginal dimensions are a leading outcome measure in vaginoplasty, as achieving maximal vaginal depth is of significant importance for patients 8 ; however, ideal neovaginal dimensions are not established. Neovaginal stenosis is also one of the most common complications after penile inversion vaginoplasty. 5 Neovaginal depth and width are anatomically limited by the potential space between the prostate anteriorly, the

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Ileal vaginoplasty as vaginal reconstruction in transgender women and patients with disorders of sex development: an international, multicentre, retrospective study on surgical characteristics and outcomes

Abstract: Ileal vaginoplasty can be performed with few intra- and postoperative complications. It appears to have similar complication rates when compared to sigmoid vaginoplasty. It now seems to be used predominantly for revision procedures.

Cited by 31 publications

References 23 publications

Evaluation of the surgical and functional outcomes of secondary vaginoplasties with free skin mesh graft in patients following transfeminine genital reconstructive surgery

Evaluation of the surgical and functional outcomes of secondary vaginoplasties with free skin mesh graft in patients following transfeminine genital reconstructive surgery

Clinical pilot study to evaluate the neovaginal PACIENA prosthesis® for vaginoplasty without skin grafts in women with vaginal agenesis

Vaginal Canal Reconstruction in Penile Inversion Vaginoplasty with Flaps, Peritoneum, or Skin Grafts: Where Is the Evidence?

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