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Chapter 34 - Prevention and Management of Neovaginal Stenosis and Other Related Complications of Vaginoplasty

from Section G - Screening and Prophylaxis

Published online by Cambridge University Press:  22 December 2022

By
Kelsey Mumford ,
Rixt AC Luikenaar  and
Richard A. Santucci
Edited by
Mick van Trotsenburg ,
Rixt A. C. Luikenaar  and
Maria Cristina Meriggiola
Mick van Trotsenburg
Affiliation:
Sigmund Freud PrivatUniversität, Wien
Rixt A. C. Luikenaar
Affiliation:
Rebirth Health Center, Utah
Maria Cristina Meriggiola
Affiliation:
Università di Bologna
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Summary

Neovaginal stenosis is one of the most reported complications of vaginoplasty. In this chapter, we review methods to prevent this complication during penile inversion vaginoplasty and the potential use of experimental techniques like biomaterials to avoid its development. Surgical and nonsurgical repair options are outlined for patients who experience neovaginal stenosis after vaginoplasty, as well as solutions to other potential postoperative complications that can arise after the procedure. These include dehiscence, postoperative bleeding, fistula formation, urinary symptoms, unique complications following intestinal vaginoplasty, and chronic pain.

Keywords

male-to-femaleMTFvaginoplastygenital gender-affirming surgeryGASgender-confirmation surgerygender dysphoriacomplicationsbottom surgery
Type
Chapter
Information
Context, Principles and Practice of TransGynecology
Managing Transgender Patients in ObGyn Practice
 , pp. 251 - 260
Publisher: Cambridge University Press
Print publication year: 2022

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References

Dreher, PC, Edwards, D, Hager, S, et al. Complications of the neovagina in male-to-female transgender surgery: a systematic review and meta-analysis with discussion of management. Clin Anat 2018;31(2):191–199.Google Scholar
Horbach, SE, Bouman, MB, Smit, JM, et al. Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques. J Sex Med 2015;12(6):1499–1512.CrossRefGoogle ScholarPubMed
Pendergrass, PB, Reeves, CA, Belovicz, MW, Molter, DJ, White, JH. Comparison of vaginal shapes in Afro-American, Caucasian and Hispanic women as seen with vinyl polysiloxane casting. Gynecol Obstet Invest 2000;50(1):54–59. https://doi.org/10.1159/000010281. PMID 10895030. S2CID 37395321Google Scholar
Slater, MW, Vinaja, X, Aly, I, et al. Neovaginal construction with pelvic peritoneum: reviewing an old approach for a new application. Clin Anat 2018;31(2):175–180.Google Scholar
Levy, JA, Edwards, DC, Cutruzzula-Dreher, P, et al. Male-to-female gender reassignment surgery: an institutional analysis of outcomes, short-term complications, and risk factors for 240 patients undergoing penile-inversion vaginoplasty. Urology 2019;131:228–233.CrossRefGoogle ScholarPubMed
Chen, ML, Reyblat, P, Poh, MM, Chi, AC. Overview of surgical techniques in gender-affirming genital surgery. Transl Androl Urol 2019;8(3):191–208.Google Scholar
Ferrando, CA. Vaginoplasty complications. Clin Plast Surg 2018;45(3):361–368.Google Scholar
Mukai, Y, Watanabe, T, Sugimoto, M, Kimata, Y, Namba, Y. Vaginoplasty with a pudendal-groin flap in male-to-female transsexuals. Acta Med Okayama 2017;71(5):399–405.Google ScholarPubMed
Selvaggi, G, Bellringer, J. Gender reassignment surgery: an overview. Nat Rev Urol 2011;8(5):274–282.Google Scholar
Lawrence, AA. Patient-reported complications and functional outcomes of male-to-female sex reassignment surgery. Arch Sex Behav 2006;35(6):717–727.Google Scholar
Gaither, TW, Awad, MA, Osterberg, EC, et al. Postoperative complications following primary penile inversion vaginoplasty among 330 male-to-female transgender patients. J Urol 2018;199(3):760–765.Google Scholar
Ives, GC, Fein, LA, Finch, L et al. Evaluation of BMI as a risk factor for complications following gender-affirming penile inversion vaginoplasty. Plast Reconstr Surg Glob Open 2019;7(3):e2097.Google Scholar
Amies Oelschlager, AM, Kirby, A, Breech, L. Evaluation and management of vaginoplasty complications. Curr Opin Obstet Gynecol 2017;29(5):316–321.CrossRefGoogle ScholarPubMed
Leong, A. Sexual dimorphism of the pelvic architecture: a struggling response to destructive and parsimonious forces by natural & mate selection. Mcgill J Med 2006;9(1):61–66.Google ScholarPubMed
Raigosa, M, Avvedimento, S, Yoon, TS, et al. Male-to-female genital reassignment surgery: a retrospective review of surgical technique and complications in 60 patients. J Sex Med 2015;12(8):1837–1845.CrossRefGoogle ScholarPubMed
Li, JS, Crane, CN, Santucci, RA. Vaginoplasty tips and tricks [published online ahead of print, 2020 Aug 25]. Int Braz J Urol 2020;46. https://doi.org/10.1590/S1677-5538.IBJU.2020.0338Google Scholar
Perovic, S, Djinovic, R. Genitoplasty in male-to-female transsexuals. Curr Opin Urol 2009;19(6):571–576.CrossRefGoogle ScholarPubMed
Haedersdal, M, Matzen, P, Wulf, HC-More. Laserepilering: En systematisk oversigt over evidensbaserede kliniske resultater [Laser epilation: a systematic review of evidence-based clinical results]. Ugeskrift for laeger 2000;162(50):6809–6815.Google Scholar
Pariser, JJ, Kim, N. Transgender vaginoplasty: techniques and outcomes. Transl Androl Urol 2019;8(3):241–247.Google Scholar
Greaves, NS, Iqbal, SA, Hodgkinson, T, et al. Skin substitute-assisted repair shows reduced dermal fibrosis in acute human wounds validated simultaneously by histology and optical coherence tomography. Wound Repair Regen 2015;23(4):483–494.Google Scholar
Snyder, DL, Sullivan, N, Schoelles, KM. Skin Substitutes for Treating Chronic Wounds [Internet]. Rockville, MD: Agency for Healthcare Research and Quality (US); December 18, 2012. AHRQ Technology Assessments. PMID: 25356454 NBK248353Google Scholar
Drinane, JJ, Santucci, R. What urologists need to know about male to female genital confirmation surgery (vaginoplasty): techniques, complications and how to deal with them. Minerva Urol Nefrol 2020;72(2):162–172.Google Scholar
Sheikh, ES, Sheikh, ES, Fetterolf, DE. Use of dehydrated human amniotic membrane allografts to promote healing in patients with refractory non healing wounds. Int Wound J 2014;11(6):711–717.CrossRefGoogle ScholarPubMed
Davydov, SN. Colpopoeisis from the peritoneum of the uterorectal space. Akusherstvo i ginekologiia 1969;45(12):55.Google ScholarPubMed
Wroblewski, P, Gustafsson, J, Selvaggi, G. Sex reassignment surgery for transsexuals. Curr Opin Endocrinol Diabetes Obes 2013;20(6):570–574.Google Scholar
Grimes, MD, Tesdahl, BA, Schubbe, M, et al. Histopathology of anterior urethral strictures: toward a better understanding of stricture pathophysiology. J Urol 2019;202(4):748–756.Google Scholar
Boas, SR, Ascha, M, Morrison, SD, et al. Outcomes and predictors of revision labiaplasty and clitoroplasty after gender-affirming genital surgery. Plast Reconstr Surg 2019;144(6):1451–1461.Google Scholar
Li, FY, Xu, YS, Zhou, CD, et al. Long-term outcomes of vaginoplasty with autologous buccal micromucosa. Obstet Gynecol 2014;123(5):951–956.Google Scholar
Gupta, A, Francis, S, Stewart, R, Hobson, D, Meriwether, KV. Repair of colonic neovaginal stenosis using a biological graft in a male-to-female transgender patient. Int Urogynecol J 2019;30(4):661–663.Google Scholar
van der Sluis, W, Bouman, M-B, Buncamper, M, et al. Clinical characteristics and management of neovaginal fistulas after vaginoplasty in transgender women. Obstet Gynecol 2016;127(6):1118–1126. https://doi.org/10.1097/AOG.0000000000001421CrossRefGoogle ScholarPubMed
Crisp, CC, Vaccaro, CM, Estanol, MV, et al. Intra-vaginal diazepam for high-tone pelvic floor dysfunction: a randomized placebo-controlled trial. Int Urogynecol J 2013;24:1915–1923.Google Scholar
Holland, MA, Joyce, JS, Brennaman, LM, et al. Intravaginal diazepam for the treatment of pelvic floor hypertonic disorder: a double-blind, randomized, placebo-controlled trial. Female Pelvic Med Reconstr Surg 2019;25(1):76–81.Google Scholar

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