04 Perioperative outcomes associated with gender-affirming vaginectomy: A cohort study from a single institution

To describe perioperative outcomes of gender affirming vaginectomy at a single institution. This is a retrospective study of patients who underwent gender-affirming vaginectomy by Female Pelvic Medicine and Reconstructive Surgery surgeons at a single tertiary care center. Patients were identified using CPT codes and chart review was performed. Intraoperative and 30-day postoperative complications were abstracted. Complications were classified as major (intraoperative visceral injury, blood transfusion, deep/organ space infection, C. difficile infection, return to operating room, venous thromboembolism, or fistula) and minor (UTI, superficial site infection, or hematoma). Voiding trial (VT) outcomes were also assessed. Bivariate comparisons were made between patients with and without major complications. Pearson’s correlation was used to determine the relationship between EBL and duration of preoperative testosterone use. From October 2015 to August 2020, 35 gender-affirming vaginectomy cases were performed by 3 surgeons. Mean age was 34 ± 11 years and mean BMI was 28.75 ± 6.61 kg/m2. Patients identified as transmale (n = 27, 77.1%) or as male (n = 8, 22.8%; SC [1]). All patients used testosterone with a median length of 44 months (range = 10-180) prior to surgery. Thirty patients (85.7%) had hysterectomy and bilateral salpingo-oophorectomy (BSO) at the time of vaginectomy. Five patients (14.3%) underwent concomitant urethral reconstructive procedures. Median EBL for the vaginectomy was 320 mL (interquartile range [IQR] = 150, 575; SC [2]). Major complications occurred in six patients (17.1%) and included intraoperative blood transfusion, cystotomy, postoperative blood transfusion, C. difficile, return to the OR for bleeding, and pelvic abscess. Eight patients (22.9%) had minor postoperative complications. Of the 29 patients with VT prior to discharge, 15 (51.7%) failed their VT. EBL was 2-fold higher in patients with, versus without, a major complication (685 IQR = 21, 1,094 vs 300 IQR = 150, 470; P = 0.05). EBL was moderately correlated with length of testosterone use prior to surgery (r = 0.41, R2 = 0.17, P = 0.015). At time of gender-affirming vaginectomy, EBL was significantly correlated with duration of preoperative testosterone use and also associated with major complications. In addition, half of patients had postoperative urinary retention. This information could be useful for preoperative counseling.View Large Image Figure ViewerDownload Hi-res image Download (PPT)