Blasdel Gaines, Kloer Carmen, Parker Augustus, Shakir Nabeel, Zhao Lee C, Bluebond-Langner Rachel
From the Department of Urology.
Duke University School of Medicine.
Plast Reconstr Surg. 2023 Apr 1;151(4):867-874. doi: 10.1097/PRS.0000000000010011. Epub 2022 Dec 9.
Insufficient genital tissue has been reported as a barrier to achieving depth in gender-affirming vaginoplasty. The authors sought to characterize vaginal depth and revision outcomes in patients with genital hypoplasia undergoing robotic peritoneal flap vaginoplasty.
Retrospective case-control analysis of patients undergoing robotic peritoneal vaginoplasty between September of 2017 and August of 2020 was used. All 43 patients identified as having genital hypoplasia (genital length <7 cm) were included with 49 random controls from the remaining patients with greater than 7 cm genital length. Baseline clinical characteristics and perioperative variables were recorded to identify potential confounders. Outcomes measured included vaginal size reported at last visit and undergoing revision surgery for depth or for vulvar appearance.
Patients were well matched other than median body mass index at the time of surgery, which was greater in the hypoplasia cohort by 3.6 kg/m 2 ( P < 0.0001). Patients had a median of 1-year of follow-up, with a minimum follow-up of 90 days. No significant differences in outcomes were observed, with a median vaginal depth of 14.5 cm (interquartile range, 13.3 to 14.5 cm), and a median width of dilator used of 3.8 cm (interquartile range, 3.8 to 3.8 cm). No depth revisions were observed, and an 11% ( n = 10) rate of external revision occurred.
Patients with genital hypoplasia had equivalent dilation outcomes in a case-control analysis with consistent follow-up past 90 days. The robotic peritoneal flap vaginoplasty technique provides vaginal depth of 14 cm or greater regardless of genital tissue before surgery. Further investigation with patient-reported outcome measures is warranted.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
据报道，生殖器组织不足是在性别确认阴道成形术中实现深度的一个障碍。作者试图对接受机器人腹膜瓣阴道成形术的生殖器发育不全患者的阴道深度和修复结果进行特征描述。
采用回顾性病例对照分析，纳入2017年9月至2020年8月期间接受机器人腹膜阴道成形术的患者。所有43例被确定为生殖器发育不全（生殖器长度<7 cm）的患者被纳入研究，并从其余生殖器长度大于7 cm的患者中随机选取49例作为对照。记录基线临床特征和围手术期变量以识别潜在的混杂因素。测量的结果包括最后一次随访时报告的阴道大小以及因深度或外阴外观而接受修复手术的情况。
除手术时的中位体重指数外，患者在其他方面匹配良好，发育不全队列中的中位体重指数比对照组高3.6 kg/m²（P<0.0001）。患者的中位随访时间为1年，最短随访时间为90天。未观察到结果有显著差异，中位阴道深度为14.5 cm（四分位间距，13.3至14.5 cm），使用的扩张器中位宽度为3.8 cm（四分位间距，3.8至3.8 cm）。未观察到深度修复，外部修复率为11%（n = 10）。
在一项病例对照分析中，生殖器发育不全的患者在90天以上的持续随访中具有相同的扩张结果。机器人腹膜瓣阴道成形术技术无论术前生殖器组织如何，均可提供14 cm或更大的阴道深度。有必要采用患者报告的结局指标进行进一步研究。
临床问题/证据水平：风险，II级。
