Penile-scrotal flap vaginoplasty versus inverted penile skin flap expanded with spatulated urethra: A multidisciplinary single-centre analysis

Abstract

This study is aimed to compare outcomes of penile-scrotal flap vaginoplasty to inverted penile skin flap expanded with spatulated urethra as a singlecentre experience. Data regarding vaginoplasty performed between May 2003 and January 2014 were reviewed. Subjects were divided into two groups according to the surgical technique performed: perineal- scrotal flap vaginoplasty (Group A), and inverted penile skin flap expanded with spatulated urethra vaginoplasty (Group B). All patients underwent to psychological analysis before surgery. Functional follow-up was based on a modified validated Female Sexual Function Index. Overall, 67 patients with a mean (SD) age of 34 (±9.38) years underwent to surgery. 41 patients were included into the Group A and 26 into the Group B. Mean operative time among Groups A and B was 316 (±101.65) and 594 (±89.06) minutes, respectively (p<0.0001). Longer postoperative hospitalization was shown in Group B (14 days ± 4,51) than in Group A (10 days ± 2,49); (p<0.0001). Group B patients showed a higher anemization rate requiring blood transfusion (p=0.00014) as well as compressive neuropathy (p=0.038). In addition to this, necrosis of the skin flap was reported in 8 patients of Group B (p<0.0001). Comprehensive functional follow-up data was included; spontaneous vaginal lubrication was not reported in 82.4% of Group A vs 12.5% cases of Group B (p=0.0085). When compared to penile-scrotal flap vaginoplasty, inverted penile skin flap expanded with spatulated urethra technique shows an increased risk of complications with comparable satisfaction rates whereas a higher spontaneous vaginal lubrication is reported. Sexological support is of utmost importance in this setting.

Sexual health after vaginoplasty: A systematic review

“…28 studies showed outcomes of arousal. [31][32][33][34][35][36][39][40][41][42][43][46][47][48][49][50][51][52][53][54][55][56][63][64][65][66][67][68][69] Arousal encompassed "urge" and any measurable physiological changes reported during arousal. 18 studies encompassed arousal within a standardized questionnaire (FSFI, BISF-W, Q-SF).…”

“…18 studies encompassed arousal within a standardized questionnaire (FSFI, BISF-W, Q-SF). [31][32][33][34][35][36][39][40][41][46][47][48][49][52][53][54][55][56] Studies reported between 46.9% and 100% of patients able to be aroused postoperatively (median 85.7%). [31][32][33]35,51,64,65,67,68 Kerckhof et al (2019) found that a significantly lower percentage of patients (15.9%) had difficulties with sexual arousal postoperatively when compared with preoperative patients while controlling for hormone treatment.…”

“…36 studies presented outcomes on self-lubrication, secretions, and ejacu lations. [31][32][33]35,36,[39][40][41][42][43][44][46][47][48][49][50][51][52][53][54][55][56]58,73,75,83,85,91,102,104,108,116,118,141,142,152 FSFI and Q -SF measured lubrication in 18 studies. [31][32][33]35,36,[39][40][41][46][47][48][49][52][53][54][55]…”

“…49,75,102 WHOQ OL-100, and Q-SF. 25,[31][32][33][34][35][36][37][38][39][40][41][46][47][48][49][53][54][55][56][59][60][61]106 Of the studies with the highest levels of evidence (1b, prospective-cohort studies), Lothstein (1980) and Zavlin et al (2018) showed that the majority of patients following vaginoplasty experienced improved sex lives and satisfaction with intercourse. 45,102 3.8.1 | Post-operative PIV Between 64 and 98% (median 81%) of 353 patients postoperative primary PIV were satisfied with their general sexual satisfaction.…”

“…20 articles measured desire within an aggregated final score with validated questionnaires, including the FSFI, Brief Index of Sexual Function for Women (BISF-W), World Health Organization Quality of Life (WHOQOL-100) or Quality of Sexual Function (Q-SF). 25,[31][32][33][34][35][36][37][38][39][40][41][46][47][48][49][53][54][55][56][59][60][61] Kerckhof et al (2019) presented that 18.3% of women postoperatively reported low sexual desire, and Rehman et al (1999) observed that 7.1% of women postoperatively loss their desire for sex completely. 42,50 4.5% reported too strong of sexual desire.…”