Rectal Injury during Penile Inversion Vaginoplasty: An Algorithmic Approach to Prevention and Management

Morris, Martin P.; Wang, Chien-Wei; Holan, Cole; Lane, Megan; Sluiter, Emily C.; Morrison, Shane D; Kuzon, William M.

doi:10.1097/prs.0000000000010246

Cited by 3 publications

(3 citation statements)

References 32 publications

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“…56 The most common cause of RNVF fistula is rectal injury during vaginoplasty. 57 In the largest published series of RNVF to date, 17.4% of known rectal injuries progressed to RNVF. 56 It is likely that several cases are due to occult rectal injury or local ischemia, as the majority of cases present in the immediate postoperative period.…”

Section: Gender-affirming Vaginoplasty and Recto-neovaginal Fistulamentioning

confidence: 99%

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Considerations for the Treatment of Sexual and Gender Minority Individuals in Colon and Rectal Surgery

Roblee,

Jacobson,

Lane

et al. 2024

Clin Colon Rectal Surg

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Sexual and gender minorities (SGMs) experience critical barriers to health care access and have unique health care needs that are often overlooked. Given the rise in individuals identifying as lesbian, gay, bisexual, transgender, and queer, colorectal surgeons are likely to care for increasing numbers of such individuals. Here, we discuss key barriers to health care access and research among SGM populations and outline approaches to address these barriers in clinical practice. We also highlight two specific topics relevant to SGM populations that colorectal surgeons should be familiar with: current approaches to anal cancer screening among men who have sex with men, and transgender individuals, as well as the management of recto-neovaginal fistula in transfeminine individuals.

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Section: Gender-affirming Vaginoplasty and Recto-neovaginal Fistulamentioning

confidence: 99%

“…56 It is likely that several cases are due to occult rectal injury or local ischemia, as the majority of cases present in the immediate postoperative period. [56][57][58] Other reported causes of RNVF include dilation injury, tissue necrosis, and cancer; however, these causes are significantly less common. 56,59,60…”

Section: Recto-neovaginal Fistulamentioning

confidence: 99%

Considerations for the Treatment of Sexual and Gender Minority Individuals in Colon and Rectal Surgery

Roblee,

Jacobson,

Lane

et al. 2024

Clin Colon Rectal Surg

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“…Within the Section of Plastic Surgery, physicians affiliated with the UMCGSP have published extensively on key topics in gender-affirming surgery, including gender-affirming vaginoplasty, [31][32][33][34] facial gender-affirming surgery, 35 genderaffirming chest surgery, [36][37][38] gender-affirming phalloplasty and metoidioplasty, 39,40 and care models in gender-affirming surgery. 41 In the Department of Obstetrics and Gynecology, research projects on the impacts of hormone therapy on fertility 42 and on care models for gender-affirming care provision 43,44 have been conducted.…”

Section: Improvement Of Care Through Gender-affirming Researchmentioning

confidence: 99%

A History of Gender-Affirming Surgery at the University of Michigan: Lessons for Today

Roblee,

Keyes,

Blasdel

et al. 2024

Semin Plast Surg

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The University of Michigan has played an important role in advancing gender-affirming surgery programs in the United States. The University of Michigan was home to a little-known gender identity clinic shortly after the opening of the first such clinic at Johns Hopkins. Since 1995, the University of Michigan Comprehensive Services Program (UMCGSP) has been continually offering surgical services to transgender and gender diverse patients. Here, we present the history of both programs, drawn from program documents and oral history, and explore their implications for the future sustainability of gender-affirming surgery programs. The original gender identity clinic opened in 1968, and operated in a multidisciplinary fashion, similar to other clinics at the time. Eventually, the clinic was closed due to disinvestment and lack of sufficient providers to maintain the program, problems which are being increasingly recognized as barriers for similar programs. The modern program, UMCGSP is perhaps the longest continually running gender-affirming surgical program at an academic center. In spite of challenges, key investments in education, statewide community engagement, and the development of a comprehensive care model have helped UMCGSP avoid the pitfalls of the earlier clinic and remain relevant throughout its nearly 30-year history. In the face of rising challenges to gender-affirming care in the United States, much can be learned from the sustainability of the UMCGSP. Institutions seeking to maintain gender-affirming surgery programs should ensure the availability of comprehensive care and promote the education of the health care workforce.

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Penile inversion vulvo-vaginoplasty with scrotal graft for trans women: surgical technique and results of initial experience

Sabbagh,

Richard,

Bourillon

et al. 2024

The Journal of Sexual Medicine

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Background A significant proportion of trans women is demanding for a genital gender-affirming surgery, with vulvo-vaginoplasty being the most frequently requested procedure. The gold standard for primary vaginoplasty in trans women is the penile skin inversion technique with scrotal skin graft, which allows for increased depth of the vaginal cavity. Aims The assessment of vulvo-vaginoplasty outcomes utilizing penile skin inversion and scrotal skin graft in individuals assigned male at birth in the surgeon’s learning curve involves evaluating aesthetics, functionality, and sexual aspects. Methods A total of 76 individuals assigned male at birth were included in 2 French university hospitals from 2020 to 2022. They underwent vulvo-vaginoplasty following 8 key steps: scrotal skin excision; bilateral orchiectomy; dissection between the rectum, bladder, and prostate; penile dissection; clitoroplasty; urethroplasty; penile skin inversion with scrotal skin graft; labioplasty. The average follow-up period was 12.4 months, with participants averaging 35.7 years of age. Each patient was invited to complete a questionnaire during follow-up. Outcomes The study’s outcomes encompassed the assessment of both early and late surgical complications, postoperative sexuality, aesthetic results, and voiding satisfaction. Results Of the total patients, 15.8% experienced major early postoperative complications, while 3% encountered major late postoperative complications. No complication was classified 4 or 5 in Clavien–Dindo scale. Most early complications were related to issues in vulvar healing, which did not compromise long-term aesthetic results. Patients-reported satisfaction was 82% after the procedure. Clinical implications Vulvo-vaginoplasty utilizing penile skin inversion and scrotal skin graft for individuals assigned male at birth is a reproductive surgery procedure that can be successfully performed by experienced urologist. It achieves high patient-reported satisfaction even during the learning curve. Strengths and limitations The surgical procedures were consistent, and the sizable cohort of patients accurately reflects the learning curve of both surgeons. However, extrapolating long-term complications is challenging due to the relatively brief follow-up period. Additionally, there is a lack of self-reported sexual function data, and the scales used to assess patient-reported quality of life and urinary satisfaction are not specifically validated for transgender patients. Conclusion Vulvo-vaginoplasty utilizing penile skin inversion and scrotal skin graft for individuals assigned male at birth is a complex surgical procedure. It appears to be achievable by experienced urologists during their learning curve, resulting in similar functional and surgical outcomes, along with high patient satisfaction.

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Rectal Injury during Penile Inversion Vaginoplasty: An Algorithmic Approach to Prevention and Management

Cited by 3 publications

References 32 publications

Considerations for the Treatment of Sexual and Gender Minority Individuals in Colon and Rectal Surgery

Considerations for the Treatment of Sexual and Gender Minority Individuals in Colon and Rectal Surgery

A History of Gender-Affirming Surgery at the University of Michigan: Lessons for Today

Penile inversion vulvo-vaginoplasty with scrotal graft for trans women: surgical technique and results of initial experience

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