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. 2021 Mar 19;9(3):e3510.
doi: 10.1097/GOX.0000000000003510. eCollection 2021 Mar.

Complications and Patient-reported Outcomes in Transfemale Vaginoplasty: An Updated Systematic Review and Meta-analysis

Samyd S Bustos  1 , Valeria P Bustos  2 , Andres Mascaro  3 , Pedro Ciudad  4 , Antonio J Forte  2   5 , Gabriel Del Corral  6 , Oscar Javier Manrique  7
Affiliations

Complications and Patient-reported Outcomes in Transfemale Vaginoplasty: An Updated Systematic Review and Meta-analysis

Samyd S Bustos et al. Plast Reconstr Surg Glob Open. .

Abstract

Vaginoplasty aims to create a functional feminine vagina, sensate clitoris, and labia minora and majora with acceptable cosmesis. The upward trend in the number of transfemale vaginoplasties has impacted the number of published articles on this topic. Herein, we conducted an updated systematic review on complications and patient-reported outcomes.

Methods: A update on our previous systematic review was conducted. Several databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus were assessed. Random effects meta-analysis and subgroup analyses were performed.

Results: After compiling the results of the update with the previous systematic review, a total of 57 studies pooling 4680 cases were included in the systematic review, and 52 studies were used in the meta-analysis. Overall pooled data including any surgical technique showed rates of 1% [95% confidence interval (CI) <0.1%-2%] of fistula, 11% (95% CI 8%-14%) of stenosis and/or strictures, 4% (95% CI 1%-9%) of tissue necrosis, and 3% (95% CI 1%-4%) of prolapse. Overall satisfaction was 91% (81%-98%). Regret rate was 2% (95% CI <1%-3%). Average neovaginal depth was 9.4 cm (7.9-10.9 cm) for the penile skin inversion and 15.3 cm (13.8-16.7 cm) for the intestinal vaginoplasty.

Conclusions: Transfemale vaginoplasty is a key component of the comprehensive surgical treatment of transfemale patients with gender dysphoria. Over time, we will see an increased demand for these procedures, so adequate surgical training, clinical/surgical experience, and research outcomes are required, as we continue to strive to provide the best care possible for a population in need.

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Conflict of interest statement

Disclosure: The authors have no financial interest to declare in relation to the content of this article. All authors have completed the ICMJE uniform disclosure form.

Figures

Fig. 1.
Fig. 1.
PRISMA flowchart.
Fig. 2.
Fig. 2.
Meta-analyses of different types of complications. Fistula (A), tissue necrosis (B), stenosis and strictures (C), and prolapse (D) are depicted.
Fig. 3.
Fig. 3.
Meta-analyses of different types of patient-reported outcomes. Overall satisfaction (A), functional outcomes (B), and aesthetic outcomes (C) are depicted.
Fig. 4.
Fig. 4.
Meta-analysis of ability to achieve orgasm.
Fig. 5.
Fig. 5.
Meta-analysis of regret rates.
Fig. 6.
Fig. 6.
Meta-analysis of depth of neovagina. Weights are from random effects analysis.
See this image and copyright information in PMC

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