Department of Urology, Imperial College Healthcare NHS Trust, London, UK; Department of Urology, University College London Hospitals, London, UK.
Department of Urology, Imperial College Healthcare NHS Trust, London, UK; Newcastle University, Newcastle upon Tyne, UK.
Eur Urol Focus. 2021 Mar;7(2):464-471. doi: 10.1016/j.euf.2020.01.004. Epub 2020 Feb 13.
Genital reconstructive surgery (GRS) is a necessary part of transitioning for many transwomen, and there is evidence of positive effects on a person's well-being and sexual function. Surgical techniques have evolved, from pursuing aesthetic outcome to now functional outcome with natal females as the standard.
To systematically review the evidence, identifying the surgical techniques used in primary GRS, their complications, functional outcomes, and the tools used to assess them.
The clinical question was designed using the standard PICOS format. The search complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 statement and was performed by two independent reviewers.
Europe, USA, and Thailand favour the penoscrotal technique for vaginoplasty, whereas in the UK, the penile inversion (PI) technique predominates. Primary vaginoplasty using a segment of bowel is less common, and all three techniques have comparable rates of intraoperative rectal injury. The incidence of rectovaginal fistula is reportedly higher in the PI technique. Wound haematoma and vaginal prolapse rates are comparable. Higher rates of clitoral necrosis, urethral meatal stenosis, and wound infection are reported in PI. However, the ability to orgasm, ability to have penetrative sexual intercourse, and satisfaction with aesthetic result are better with PI.
The evidence for GRS complications and functional outcomes is of low level. Standardised nomenclature reporting of adverse events and robust patient-reported outcome measures (PROMs) are lacking. PROMs are a powerful assessment tool, and standardised definitions of adverse events and functional outcomes should be a priority of future research.
We looked at all studies published on genital reconstructive surgery from 1950 to the present day. We assessed each surgical technique and their associated complication rates, sexual and urinary function outcomes, and how they were reported. We found the evidence to be low and weak. We suggest more robust ways of reporting complications, and the impact on patients' quality of life should be investigated.
生殖器重建手术（GRS）是许多跨性别女性过渡过程中的必要部分，有证据表明其对个人的幸福感和性功能有积极影响。手术技术已经发展，从追求美学效果到现在以自然女性为标准追求功能效果。
系统回顾证据，确定 GRS 中使用的主要手术技术、其并发症、功能结果以及用于评估这些技术的工具。
使用标准 PICOS 格式设计临床问题。搜索符合 2009 年系统评价和荟萃分析的首选报告项目声明，并由两名独立审查员进行。
欧洲、美国和泰国赞成使用阴股沟技术进行阴道成形术，而在英国，阴茎倒置（PI）技术占主导地位。使用肠段进行原发性阴道成形术的情况较少，所有三种技术的术中直肠损伤发生率相当。据报道，PI 技术的直肠阴道瘘发生率较高。血肿和阴道脱垂的发生率相当。PI 报告的阴蒂坏死、尿道尿道口狭窄和伤口感染发生率较高。然而，PI 的性高潮能力、进行阴道性交的能力和对美学效果的满意度更好。
GRS 并发症和功能结果的证据水平较低。缺乏不良事件的标准化命名报告和强大的患者报告结局测量（PROM）。PROM 是一种强大的评估工具，应优先考虑标准化不良事件和功能结果的定义。
我们查阅了自 1950 年以来发表的所有关于生殖器重建手术的研究。我们评估了每种手术技术及其相关并发症发生率、性和尿功能结果，以及它们的报告方式。我们发现证据水平较低且薄弱。我们建议以更强大的方式报告并发症，并应调查对患者生活质量的影响。
