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Vaginoplastia: 26 series de casos de baja calidad; estenosis la complicación más común; calidad de vida medida una vez

Resultado de la vaginoplastia en transgénero de hombre a mujer: una revisión sistemática de las técnicas quirúrgicas

Revisiones sistemáticas y de evidenciaCirugía
Authors
Sophie E.R. Horbach, Mark-Bram Bouman, Jan Maerten Smit, Müjde Özer, Marlon E. Buncamper, Margriet G. Mullender
Journal
The Journal of Sexual Medicine
Year
2015
Source
https://doi.org/10.1111/jsm.12868

Summary

Surgeons from the Amsterdam gender clinic reviewed studies published from 1995 onwards on ways to surgically create a vagina in trans women. They found 26 studies. Almost all looked back at patients of a single surgical team, covering 1,461 operations using penile skin and 102 using a piece of bowel. Narrowing of the new vagina was the most common problem with both methods. Sex life and satisfaction were judged generally acceptable, but every study measured them differently, and only one measured quality of life. The authors concluded that the penile skin method is the best studied, the bowel method does not seem worse, and better-planned studies that follow patients forward with standard measures are essential. In plain terms, the review shows how weak the evidence was: it cannot reliably say how often problems or dissatisfaction happen, or which method is better.

Key findings

  • La revisión buscó en dos bases de datos médicas estudios desde 1995 en adelante e incluyó 26 estudios sobre los resultados de la vaginoplastia en mujeres trans.
  • La mayoría de los estudios eran informes de calidad baja o media que miraban atrás a los pacientes pasados de un cirujano, sin grupo de comparación.
  • Se informó de los resultados del método de la piel del pene en 1.461 personas, y del método intestinal en solo 102.
  • El estrechamiento o cierre de la nueva vagina fue el problema más común con ambos métodos.
  • La vida sexual y la satisfacción se describieron como globalmente aceptables, pero los estudios usaron muchos cuestionarios distintos, a menudo nunca comprobados en cuanto a su precisión.
  • Solo uno de los 26 estudios informó sobre la calidad de vida tras la cirugía.
  • Los autores concluyeron que son esenciales métodos estándar y estudios que sigan a los pacientes hacia delante en el tiempo para juzgar y comparar los resultados de la vaginoplastia.

Abstract

INTRODUCTION: Gender reassignment surgery is the keystone of the treatment of transgender patients. For male-to-female transgenders, this involves the creation of a neovagina. Many surgical methods for vaginoplasty have been opted. The penile skin inversion technique is the method of choice for most gender surgeons. However, the optimal surgical technique for vaginoplasty in transgender women has not yet been identified, as outcomes of the different techniques have never been compared.

AIM: With this systematic review, we aim to give a detailed overview of the published outcomes of all currently available techniques for vaginoplasty in male-to-female transgenders.

METHODS: A PubMed and EMBASE search for relevant publications (1995-present), which provided data on the outcome of techniques for vaginoplasty in male-to-female transgender patients.

MAIN OUTCOME MEASURES: Main outcome measures are complications, neovaginal depth and width, sexual function, patient satisfaction, and improvement in quality of life (QoL).

RESULTS: Twenty-six studies satisfied the inclusion criteria. The majority of these studies were retrospective case series of low to intermediate quality. Outcome of the penile skin inversion technique was reported in 1,461 patients, bowel vaginoplasty in 102 patients. Neovaginal stenosis was the most frequent complication in both techniques. Sexual function and patient satisfaction were overall acceptable, but many different outcome measures were used. QoL was only reported in one study. Comparison between techniques was difficult due to the lack of standardization.

CONCLUSIONS: The penile skin inversion technique is the most researched surgical procedure. Outcome of bowel vaginoplasty has been reported less frequently but does not seem to be inferior. The available literature is heterogeneous in patient groups, surgical procedure, outcome measurement tools, and follow-up. Standardized protocols and prospective study designs are mandatory for correct interpretation and comparability of data.

Conclusion

The penile skin inversion technique is the most researched surgical procedure. Outcome of bowel vaginoplasty has been reported less frequently but does not seem to be inferior. The available literature is heterogeneous in patient groups, surgical procedure, outcome measurement tools, and follow-up. Standardized protocols and prospective study designs are mandatory for correct interpretation and comparability of data.