detrans.ai 

Back to studies

Översikt av vaginoplastik: 26 mestadels lågkvalitativa fallserier; stenos vanligast; livskvalitet mättes en gång

Utfall av vaginoplastik hos man-till-kvinna-transpersoner: en systematisk översikt av kirurgiska tekniker

Systematiska översikterKirurgi
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

  • Översikten sökte i två medicinska databaser efter studier från 1995 och framåt och inkluderade 26 studier om resultaten av vaginoplastik hos transkvinnor.
  • De flesta studier var låg- eller medelkvalitativa rapporter som tittade bakåt på en kirurgs tidigare patienter, utan jämförelsegrupp.
  • Resultat för penishudsmetoden redovisades för 1 461 personer, och för tarmmetoden för bara 102.
  • Förträngning eller igenväxning av den nya slidan var det vanligaste problemet med båda metoderna.
  • Sexliv och nöjdhet beskrevs som överlag acceptabla, men studierna använde många olika frågeformulär, ofta sådana som aldrig testats för noggrannhet.
  • Bara en av de 26 studierna redovisade livskvalitet efter operationen.
  • Författarna drog slutsatsen att standardmetoder och studier som följer patienter framåt i tiden är nödvändiga för att bedöma och jämföra resultaten av vaginoplastik.

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.