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Título

INITIAL MULTI-DISCIPLINARY EXPERIENCE IN PENILE INVERSION WITH SKIN GRAFT VAGINOPLASTY IN A SAFETY-NET HOSPITAL

Resumo

Background
Gender confirming surgeries (GCS) are medically indicated treatments for gender dysphoria and covered by many health insurance providers. GCS is performed by few providers in the United States. Training available for surgeons interested in providing GCS is scarce. In May 2018 Denver Health, a safety net hospital system, launched a program to provide penile inversion vaginoplasty with skin graft to transgender patients utilizing a proctorship model to train two gynecologists and one urologist. The aim of this study is to perform a quality improvement review of peri-operative and short-term outcomes of the first 40 cases of a new program at a safety-net hospital.
Methods
We conducted a retrospective review of 40 patients who underwent vaginoplasty in our hospital from May, 01 of 2018 to February, 28 of 2019. Chart review was used to collect patient demographic, peri-operative, and follow-up information. Microsoft excel was used for descriptive statistics including counts, average, median, range, and interquartile range (IQR).
Results
During the study period, 40 patients underwent vaginoplasty. The median age was 31.5 years with follow-up ranging 7 to 181 days. Ten patients (35%) presented with post-operative complications, including granulation tissue (n=3), vaginal stenosis (n=2), postoperative bleeding requiring blood transfusion (n=2), wound dehiscence (n=1), urinary retention (n=1) and urinary tract infection (n=1). Four patients required re-operation – two for bleeding, one for vaginal stenosis, and one for removal of granulation tissue. The ten operations performed with a proctor had lower median OR times (3:50 vs 4:26hr) and lower estimated blood loss (300 vs 450mL; however, these did not undergo statistical analysis to determine clinical significance. One of the re-operations for vaginal stenosis had the initial surgery performed with a proctor.
Conclusions
The results show safe implementation of a vaginoplasty program in its first year with outcomes similar to those reported in the literature. The current cohort will need to be tracked longitudinally to assess longer-term functional, cosmetic, and patient satisfaction outcomes.

Palavras Chave ( separado por ; )

transgender; vaginoplasty; quality improvement

Área

Trauma / Uretra / Urologia Reconstrutora

Instituições

Denver Health - - Estados Unidos, Univerdsity of Colorado - - Estados Unidos

Autores

Rodrigo Donalisio da Silva, Matheus Miranda Paiva, Fernando J Kim