Andrology Unit, University Hospital S.Orsola-Malpighi, Bologna.
Arch Ital Urol Androl. 2020 Oct 1;92(3). doi: 10.4081/aiua.2020.3.186.
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.
本研究旨在比较阴茎阴囊皮瓣阴道成形术与带蒂尿道扩张的阴茎皮瓣阴道成形术的结果，这是一项单中心经验。回顾了 2003 年 5 月至 2014 年 1 月期间进行的阴道成形术的数据。根据所采用的手术技术，将受试者分为两组：会阴-阴囊皮瓣阴道成形术（A 组）和带蒂尿道扩张的阴茎皮瓣阴道成形术（B 组）。所有患者均在术前进行心理分析。功能随访基于改良的经验证的女性性功能指数。总体而言，67 名平均（SD）年龄为 34（±9.38）岁的患者接受了手术。41 例患者纳入 A 组，26 例患者纳入 B 组。A 组和 B 组的平均手术时间分别为 316（±101.65）和 594（±89.06）分钟（p<0.0001）。B 组的术后住院时间较长（14 天±4.51），A 组为 10 天±2.49（p<0.0001）。B 组患者贫血发生率较高（p=0.00014）和压迫性神经病（p=0.038）。此外，B 组有 8 例患者报告了皮瓣坏死（p<0.0001）。包括综合功能随访数据；A 组 82.4%的患者没有报告自发性阴道润滑，而 B 组 12.5%的患者报告了自发性阴道润滑（p=0.0085）。与阴茎阴囊皮瓣阴道成形术相比，带蒂尿道扩张的阴茎皮瓣阴道成形术的并发症风险增加，但报告的自发性阴道润滑更高。在这种情况下，性学支持至关重要。
