Maurer Valentin, Howaldt Marian, Feldmann Inga, Ludwig Tim, Vetterlein Malte W, Gild Philipp, Weis Sylvia, Marks Phillip, Soave Armin, Meyer Christian P, Fisch Margit, Dahlem Roland, Riechardt Silke
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Front Surg. 2022 Feb 23;9:836335. doi: 10.3389/fsurg.2022.836335. eCollection 2022.
Numbers of PIV are rising. The aim of this study is to analyze the surgical learning-curve (LC) on the grounds of perioperative complications.
108 PIVs, performed by a single surgeon between 2015 and 2018 have been analyzed. Learning-curve analysis was based on three factors: operating time, vaginal depth and complications.
The median FU was 6.3 months. Median age at surgery was 36 years, median time of hormone treatment was 36 months. The median CI was 0.3 and the median BMI was 25 kg/cm3. Median CCI® was 8.08. 40.7% of the patients developed short-term complications, more than half of which were Clavien I. Overall only 1.9% had Clavien IIIb complications. There were no Clavien IV or V complications. 17.6% of patients had wound infections, 13% wound dehiscence, 9.3% introitus strictures, 13.9% suffered from atrophy of the neovagina, i.e. loss of depth or width, and 8.3% from meatus urethrae strictures. Duration of hormonal therapy, BMI and CI had no impact on surgical outcome. Age had a significant impact on CCI®, as younger patients had a higher risk for complications. Use of scrotal skin and surgeries performed had a significant influence. LC analysis CUSUM analysis showed that after 32 surgeries, the PIV is performed safely.
The PIV is a safe GAS-technique, associated with minor complications leading to low rates of revision surgery. Younger age, the use of scrotal skin and surgeon's experience has significant impact on complications. Duration of hormonal therapy, circumcision and BMI has no impact on complications.
阴茎阴道成形术（PIV）的数量正在增加。本研究的目的是基于围手术期并发症分析手术学习曲线（LC）。
分析了一位外科医生在2015年至2018年间进行的108例阴茎阴道成形术。学习曲线分析基于三个因素：手术时间、阴道深度和并发症。
中位随访时间为6.3个月。手术时的中位年龄为36岁，激素治疗的中位时间为36个月。中位阴茎头周长（CI）为0.3，中位体重指数（BMI）为25kg/cm³。中位Charlson合并症指数（CCI®）为8.08。40.7%的患者出现短期并发症，其中一半以上为Clavien I级。总体而言，只有1.9%的患者出现Clavien IIIb级并发症。没有Clavien IV级或V级并发症。17.6%的患者发生伤口感染，13%伤口裂开，9.3%阴道口狭窄，13.9%新阴道萎缩，即深度或宽度丧失，8.3%尿道外口狭窄。激素治疗持续时间、BMI和CI对手术结果没有影响。年龄对CCI®有显著影响，因为年轻患者并发症风险更高。阴囊皮肤的使用和所进行的手术有显著影响。累积和（CUSUM）分析的学习曲线分析表明，在32例手术后，阴茎阴道成形术可以安全进行。
阴茎阴道成形术是一种安全的性别确认手术技术，并发症较少，导致翻修手术率较低。年轻、阴囊皮肤的使用和外科医生的经验对并发症有显著影响。激素治疗持续时间、包皮环切术和BMI对并发症没有影响。
