Division of Reproductive Endocrinology and Infertility, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Division of Reproductive Endocrinology and Infertility, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
J Sex Med. 2020 Sep;17(9):1787-1794. doi: 10.1016/j.jsxm.2020.05.032. Epub 2020 Jul 12.
Given the burgeoning demand for gender affirmation surgery, there are few studies examining both surgical process variables and patient outcome variables. Knowing the learning curve for surgical teams who are beginning to perform this procedure will be important for patient safety and presurgical patient counseling as more institutions open transgender surgical programs.
The purpose of this study was to determine the demographics of patients pursuing penoscrotal vaginoplasty, to determine their postoperative course, and to determine a learning curve for the surgical team performing penoscrotal vaginoplasty.
We retrospectively reviewed charts of all 43 patients who underwent penoscrotal vaginoplasty from the commencement of a new male-to-female penoscrotal vaginoplasty program in March 2018 through July 2019.
Primary outcomes included mean hemoglobin decrease from surgery and operative time. Mean time to neoclitoral sensation, length of hospital admission, complication rates, reoperation rates, length of narcotic use after surgery, and demographics were also evaluated. Associations between surgical team experience and outcomes were assessed with Spearman's rho and Cox regression, and curve-fitting procedures were applied to determine the relationship.
The mean operative time from initial incision to procedure finish was 225 minutes, and the mean decrease in hemoglobin was 3.3 g/dL. The mean time to neoclitoral sensation was 0.72 months. The time until neoclitoral sensation decreased as the surgical cases performed increased (Spearman's rho, -0.577 [P < .001]), with a power function best describing the learning curve. Operative time did not change with case number (Spearman's rho, 0.062 [P = .698]) but overall time in the operating room did (Spearman's rho, 0.631 [P < .001]). Mean length of hospital admission was 2.9 days. There were no intraoperative complications. 18 patients (42%) experienced a postoperative complication. 8 of 43 patients underwent reoperation (20%). Narcotics were used a mean of 9.5 days after surgery.
A learning curve can be demonstrated in penoscrotal vaginoplasty for time to neoclitoral sensation and overall time in the operating room, plateauing between 30 and 40 cases.
Strengths include assessing a learning curve for time to neoclitoral sensation, length of hospital stay, and length of postoperative narcotic use after penoscrotal vaginoplasty, which, to our knowledge, has not been reported elsewhere. Limitations include our overall low number of patients.
Despite a low number of cases, length of hospital stay was short and the postoperative complication rate was similar to that of long-standing penoscrotal vaginoplasty programs. Whynott RM, Summers K, Mickelsen R, et al. A Retrospective Cohort Study Evaluating Surgical Aptitude Over Time in a New Male-To-Female Penoscrotal Vaginoplasty Program. J Sex Med 2020;17:1787-1794.
鉴于对性别肯定手术的需求不断增长，很少有研究同时检查手术过程变量和患者结果变量。了解开始进行此手术的手术团队的学习曲线对于患者安全和术前患者咨询非常重要，因为越来越多的机构开设了跨性别手术项目。
本研究旨在确定接受阴茎阴囊阴道成形术的患者的人口统计学特征，确定他们的术后过程，并确定进行阴茎阴囊阴道成形术的手术团队的学习曲线。
我们回顾性分析了自 2018 年 3 月新的男性到女性阴茎阴囊阴道成形术计划开始至 2019 年 7 月期间接受阴茎阴囊阴道成形术的所有 43 名患者的图表。
主要结果包括手术血红蛋白降低和手术时间的平均值。还评估了新阴蒂感觉时间、住院时间、并发症发生率、再手术率、术后使用麻醉药的时间和人口统计学数据。使用 Spearman 的 rho 和 Cox 回归评估手术团队经验与结果之间的关联，并应用曲线拟合程序确定关系。
尽管病例数量较少，但住院时间短，术后并发症发生率与长期阴茎阴囊阴道成形术项目相似。Whynott RM、Summers K、Mickelsen R 等人。一项新的男性到女性阴茎阴囊阴道成形术计划中随时间推移评估手术能力的回顾性队列研究。J Sex Med 2020;17:1787-1794。
