Postoperative complications of male to female sex reassignment surgery: a 9 years French retrospective study

Evaluation of post-operative complications after male to female (MTF) sex reassignment surgery (SRS) includes various fields. In primary MTF SRS, the inverted skin penile technique can be considered as the gold standard. The... [ view full abstract ]

Evaluation of post-operative complications after male to female (MTF) sex reassignment surgery (SRS) includes various fields.
In primary MTF SRS, the inverted skin penile technique can be considered as the gold standard.
The most frequent functional outcomes reported after MTF SRS are neo-vaginal stenosis and urinary meatal stenosis as well as secondary revision surgery.

We aimed to retrospectively analyze postoperative functional and anatomical complications, as well as secondary procedures required after MTF SRS by penile skin inversion, performed in our department. [ view full abstract ]

We aimed to retrospectively analyze postoperative functional and anatomical complications, as well as secondary procedures required after MTF SRS by penile skin inversion, performed in our department.

All patients operated on for MTF SRS with the inverted penile skin technique, by the same surgeon in our department, during a nine-year period from June 2006 to July 2015, with a follow-up of at least one year, were... [ view full abstract ]

All patients operated on for MTF SRS with the inverted penile skin technique, by the same surgeon in our department, during a nine-year period from June 2006 to July 2015, with a follow-up of at least one year, were retrospectively reviewed. Soft post-operative dilatation protocol was prescribed until vagina complete healing. No long-term hard dilatation was systematically prescribed in our protocol. Possible neo-vagina stenosis was primarily treated by further dilation with hard bougie. All post-operative events and complications were recorded.

Patients demographics, events occurring during hospitalization, and all postoperative immediate or delayed complications were recorded. During each postoperative visit, vagina size, urinary meatus and clitoris aspect, as well... [ view full abstract ]

Patients demographics, events occurring during hospitalization, and all postoperative immediate or delayed complications were recorded.
During each postoperative visit, vagina size, urinary meatus and clitoris aspect, as well as cosmetic appearance of the genitalia were noticed. Patients were asked about their lubrication needing or pain occurring during sexual intercourse, and any urinary dysfunction was noted.
All secondary functional or cosmetic surgical revisions were recorded.
No specific satisfaction questionnaire was conducted, neither any quality of life evaluation, in this observational study.
The terms of the Helsinki declaration were followed.

124 patients were included. Concerning peri-operative complications, 3 recto-vaginal wall perforations were recorded. Regarding early post-operative complications, 56.5% of repeated compressive dressings, 45% of blood... [ view full abstract ]

124 patients were included.
Concerning peri-operative complications, 3 recto-vaginal wall perforations were recorded.
Regarding early post-operative complications, 56.5% of repeated compressive dressings, 45% of blood transfusions, 18 % of hematomas, 27 % of early infectious complications were counted.
Delayed vagina post-operative complications were: partial necrosis (17,8%), short-depth neovagina requiring additional hard dilatation (17,8%), with a 95,5% success rate. Secondary vaginoplasty rate was 7,2% (4,8% of skin graft and 2,4% of bowel plasty). One recto-vaginal fistula occurred after an excessive self hard dilation (0,8%).
Secondary functional meatoplasty for delayed urinary meatal stenosis occurred in 1,6% of cases.
Secondary cosmetic clitoroplasty, meatoplasty for hypertrophy, and labioplasty rates were respectively of 14,5% , 4,8%, and 30,6%
52% of patients needed supplemental lubrication for sexual intercourse.
Other medical complications occurred in 7,2% of cases.

Comparing with literature data, we showed a higher rate of post-operative bleeding events, but we observed a lower rate of secondary functional meatoplasty, maybe explained by less aggressive haemostatic peri-operative... [ view full abstract ]

Comparing with literature data, we showed a higher rate of post-operative bleeding events, but we observed a lower rate of secondary functional meatoplasty, maybe explained by less aggressive haemostatic peri-operative manoeuvres. Our secondary vaginoplasty global rate is also lower than other previous studies published, and this could be explained by the successful use of hard dilation in specific cases of short-depth vagina. Cosmetic secondary procedures rates are almost similar to other published data.
In our experience, after MTF SRS by skin penile inversion, patients should be informed of frequent bleeding events, or the possible short depth neovagina and its treatment by sequential hard dilatation protocol. Functional meatoplasties were rare. Cosmetic secondary procedures like labioplasty, commissuroplasty, clitoroplaty and meatoplasty for hypertrophy are frequent. Majority of patients need a life-time lubrication for sexual intercourse.