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A Multi-center analysis on surgical technique, outcomes and learning curve of male-to-female penoscrotal vaginoplasty

Cocci, A1; Polloni, G2; Delle Rose, A1; Grisanti Caroassai, S1; Cito, G1; Serni, S1; Carini, M1; Matteucci, V2; Morelli, G3

1: Careggi Hospital, Florence, Italy; 2: Clinical Sexologist, Milan, Italy; 3: University of Pisa, Dept. Of Urology, Cisanello Hospital, Pisa, Italy

Objectives: We evaluated patients underwent to a penoscrotal Vaginoplasty for a male to female dysphoria in 2 center.

Materials and Methods: We retrospectively reviewed clinical records of 90 patients who underwent PSV from January 2005 to January 2017. Two validated methods were used: a scatterplot representation and a splitting group. We selected as primary outcomes the operative time and vaginal depth. Surgical outcomes including blood losses, hospital stay, and postoperative complications such as vaginal stenosis or atresia or urethral meatus stenosis were also evaluated.

Results: The overall median operative time was 245 minutes. Severe intraoperative complications were not reported. The overall incidence of postoperative major complications was 21.7 %, most of them being urethral issues. The splitting group analysis revealed a statistically remarkable difference between groups for the operative time (P < .01), the vaginal depth (P = .01), the hospital stay (P < .01), and the intraoperative complication rate (P = .01). On the contrary, no differences were evidenced between the cohorts for the amount of blood loss (P = .08). The scatterplot logarithmic analysis demonstrated a clear visible LC for most parameters. The operative time showed a sharp decrease within the first 20-30 cases, reaching a plateau after 40 cases. Considering the analysis of the vaginal depth, the logarithmic scatterplot curve evidenced a slight increase within the first 10 cases, reaching a clear stabilization after nearly 30-40 cases.

Conclusions: An evident LC for PSV is detectable, consisting of at least 40 cases needed to the surgical team to develop adequate skills to guarantee a safe and high-quality procedure.

Figure 1: Postoperative complications


Work supported by industry: no.

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