Sabbagh Paul, Richard Claire, Bourillon Alice, Cornu Jean-Nicolas, Lebret Thierry, Morel-Journel Nicolas, Peyronnet Benoît, Schirmann Aurélie, Freton Lucas, Madec François-Xavier
Urology Department, Foch Hospital, Suresnes, 92150, France.
Urology Department, Charles Nicolle Rouen University Hospital, Rouen, 76000, France.
J Sex Med. 2025 Jan 3;22(1):156-164. doi: 10.1093/jsxmed/qdae135.
A significant proportion of trans women is demanding for a genital gender-affirming surgery, with vulvo-vaginoplasty being the most frequently requested procedure. The gold standard for primary vaginoplasty in trans women is the penile skin inversion technique with scrotal skin graft, which allows for increased depth of the vaginal cavity.
The assessment of vulvo-vaginoplasty outcomes utilizing penile skin inversion and scrotal skin graft in individuals assigned male at birth in the surgeon's learning curve involves evaluating aesthetics, functionality, and sexual aspects.
A total of 76 individuals assigned male at birth were included in 2 French university hospitals from 2020 to 2022. They underwent vulvo-vaginoplasty following 8 key steps: scrotal skin excision; bilateral orchiectomy; dissection between the rectum, bladder, and prostate; penile dissection; clitoroplasty; urethroplasty; penile skin inversion with scrotal skin graft; labioplasty. The average follow-up period was 12.4 months, with participants averaging 35.7 years of age. Each patient was invited to complete a questionnaire during follow-up.
The study's outcomes encompassed the assessment of both early and late surgical complications, postoperative sexuality, aesthetic results, and voiding satisfaction.
Of the total patients, 15.8% experienced major early postoperative complications, while 3% encountered major late postoperative complications. No complication was classified 4 or 5 in Clavien-Dindo scale. Most early complications were related to issues in vulvar healing, which did not compromise long-term aesthetic results. Patients-reported satisfaction was 82% after the procedure.
Vulvo-vaginoplasty utilizing penile skin inversion and scrotal skin graft for individuals assigned male at birth is a reproductive surgery procedure that can be successfully performed by experienced urologist. It achieves high patient-reported satisfaction even during the learning curve.
The surgical procedures were consistent, and the sizable cohort of patients accurately reflects the learning curve of both surgeons. However, extrapolating long-term complications is challenging due to the relatively brief follow-up period. Additionally, there is a lack of self-reported sexual function data, and the scales used to assess patient-reported quality of life and urinary satisfaction are not specifically validated for transgender patients.
Vulvo-vaginoplasty utilizing penile skin inversion and scrotal skin graft for individuals assigned male at birth is a complex surgical procedure. It appears to be achievable by experienced urologists during their learning curve, resulting in similar functional and surgical outcomes, along with high patient satisfaction.
相当一部分跨性别女性要求进行生殖器性别确认手术，其中外阴阴道成形术是最常被要求的手术。跨性别女性初次阴道成形术的金标准是阴茎皮肤翻转技术并移植阴囊皮肤，这可增加阴道腔的深度。
在外科医生的学习曲线中，评估出生时被指定为男性的个体采用阴茎皮肤翻转和阴囊皮肤移植进行外阴阴道成形术的效果，包括评估美学、功能和性方面。
2020年至2022年，法国两家大学医院共纳入76名出生时被指定为男性的个体。他们按照8个关键步骤接受了外阴阴道成形术：阴囊皮肤切除；双侧睾丸切除术；直肠、膀胱和前列腺之间的解剖；阴茎解剖；阴蒂成形术；尿道成形术；阴茎皮肤翻转并移植阴囊皮肤；阴唇成形术。平均随访期为12.4个月，参与者平均年龄为35.7岁。每位患者在随访期间被邀请填写一份问卷。
该研究的结果包括对早期和晚期手术并发症、术后性功能、美学效果和排尿满意度的评估。
在所有患者中，15.8%经历了早期主要术后并发症，3%出现了晚期主要术后并发症。在Clavien-Dindo分级中，没有并发症被归类为4级或5级。大多数早期并发症与外阴愈合问题有关，这并未影响长期美学效果。患者报告的术后满意度为82%。
对于出生时被指定为男性的个体，采用阴茎皮肤翻转和阴囊皮肤移植进行外阴阴道成形术是一种生殖外科手术，经验丰富的泌尿科医生可以成功实施。即使在学习曲线阶段，也能获得较高的患者报告满意度。
手术操作一致，大量患者队列准确反映了两位外科医生的学习曲线。然而，由于随访期相对较短，推断长期并发症具有挑战性。此外，缺乏自我报告的性功能数据，且用于评估患者报告的生活质量和排尿满意度的量表未针对跨性别患者进行专门验证。
对于出生时被指定为男性的个体，采用阴茎皮肤翻转和阴囊皮肤移植进行外阴阴道成形术是一项复杂的外科手术。经验丰富的泌尿科医生在学习曲线阶段似乎能够实现，从而获得相似的功能和手术效果，以及较高的患者满意度。
