title: Surgical Outcome after Penile Inversion Vaginoplasty: A Retrospective Study of 475 Transgender Women.
abstract: BACKGROUND
  For many transgender women, vaginoplasty is the final stage in the gender-confirming process. Penile inversion vaginoplasty is considered the gold standard for vaginal construction in transgender women. In this study, the authors assessed intraoperative and postoperative complications after penile inversion vaginoplasty.
  
  
  METHODS
  All patients who underwent penile inversion vaginoplasty between January of 2000 and January of 2014 were identified retrospectively from the authors' hospital registry. A retrospective chart review was conducted. Outcome measures were intraoperative and postoperative complications, reoperations, secondary surgical procedures, and possible risk factors.
  
  
  RESULTS
  Between January of 2000 and January of 2014, 475 patients underwent penile inversion vaginoplasty, 405 of whom did not have and 70 of whom did have additional full-thickness skin grafts. The median patient age at surgery was 38.6 years (range, 18.1 to 70.8 years). Median follow-up was 7.8 years (range, 1.0 to 15.9 years). The most frequently observed intraoperative complication was rectal injury [n = 11 (2.3 percent)]. Short-term postoperative bleeding that required transfusion [n = 23 (4.8 percent)], reoperation [n = 7 (1.5 percent)] or both [n = 2 (0.4 percent)] occurred in some cases. Major complications comprised three (0.6 percent) rectoneovaginal fistulas, which were successfully treated. Revision vaginoplasty was performed in 14 patients (2.9 percent). Comorbid diabetes was associated with a higher risk of local infection (OR, 9.8; p = 0.003; 95 percent CI, 2.8 to 34.4), and use of psychotropic medication predisposed to postoperative urinary retention (OR, 2.1; p = 0.006; 95 percent CI, 1.2 to 3.5).
  
  
  CONCLUSIONS
  Successful vaginal construction without the need for secondary functional reoperations was achieved in the majority of patients. Intraoperative complications are scarce. Postoperative complications occur frequently but are generally minor and easily treated.
  
  
  METHODS
  Therapeutic, IV.
authors: Amsterdam, The Netherlands.|From the Department of Plastic, Reconstructive, and Hand Surgery, the Center of Expertise on Gender Dysphoria, the EMGO+ Institute for Health and Care Research, and the Department of Epidemiology and Biostatistics, VU University Medical Center; and Gender Surgery Amsterdam.
authors: Marlon E
authors: ME
authors: Buncamper
authors: Amsterdam, The Netherlands.|From the Department of Plastic, Reconstructive, and Hand Surgery, the Center of Expertise on Gender Dysphoria, the EMGO+ Institute for Health and Care Research, and the Department of Epidemiology and Biostatistics, VU University Medical Center; and Gender Surgery Amsterdam.
authors: Wouter B
authors: WB
authors: van der Sluis
authors: Amsterdam, The Netherlands.|From the Department of Plastic, Reconstructive, and Hand Surgery, the Center of Expertise on Gender Dysphoria, the EMGO+ Institute for Health and Care Research, and the Department of Epidemiology and Biostatistics, VU University Medical Center; and Gender Surgery Amsterdam.
authors: Roos S D
authors: RSD
authors: van der Pas
authors: Amsterdam, The Netherlands.|From the Department of Plastic, Reconstructive, and Hand Surgery, the Center of Expertise on Gender Dysphoria, the EMGO+ Institute for Health and Care Research, and the Department of Epidemiology and Biostatistics, VU University Medical Center; and Gender Surgery Amsterdam.
authors: Müjde
authors: M
authors: Özer
authors: Amsterdam, The Netherlands.|From the Department of Plastic, Reconstructive, and Hand Surgery, the Center of Expertise on Gender Dysphoria, the EMGO+ Institute for Health and Care Research, and the Department of Epidemiology and Biostatistics, VU University Medical Center; and Gender Surgery Amsterdam.
authors: Jan Maerten
authors: JM
authors: Smit
authors: Amsterdam, The Netherlands.|From the Department of Plastic, Reconstructive, and Hand Surgery, the Center of Expertise on Gender Dysphoria, the EMGO+ Institute for Health and Care Research, and the Department of Epidemiology and Biostatistics, VU University Medical Center; and Gender Surgery Amsterdam.
authors: Birgit I
authors: BI
authors: Witte
authors: Amsterdam, The Netherlands.|From the Department of Plastic, Reconstructive, and Hand Surgery, the Center of Expertise on Gender Dysphoria, the EMGO+ Institute for Health and Care Research, and the Department of Epidemiology and Biostatistics, VU University Medical Center; and Gender Surgery Amsterdam.
authors: Mark-Bram
authors: MB
authors: Bouman
authors: Amsterdam, The Netherlands.|From the Department of Plastic, Reconstructive, and Hand Surgery, the Center of Expertise on Gender Dysphoria, the EMGO+ Institute for Health and Care Research, and the Department of Epidemiology and Biostatistics, VU University Medical Center; and Gender Surgery Amsterdam.
authors: Margriet G
authors: MG
authors: Mullender
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D057830:Gender-Affirming Surgery / Q000379:methods*; D016038:Skin Transplantation; D019738:Surgically-Created Structures; D063106:Transgender Persons; D014189:Transsexualism / Q000601:surgery*; D016896:Treatment Outcome; D014555:Urination Disorders / Q000453:epidemiology / Q000209:etiology; D014621:Vagina / Q000601:surgery; D055815:Young Adult