Systematic Review and Meta Analysis of Complications and Patient Reported Outcomes in Male to Female Vaginoplasty- Where We Are Today
Oscar J. Manrique, MD1, Kian Adabi, BA1, Kidakorn Kiranantawat, MD1, Jorys Martinez-Jorge, MD1, Pedro Ciudad, MD, PhD2, Zhen Wang, PhD1.
1Mayo Clinic Rochester, Rochester, MN, USA, 2China Medical University Hospital, Taichung, Taiwan.
Purpose: There is an increased need for evidence-based practices in male to female gender (MTF) vaginoplasty. While there are a multitude of surgical techniques, there is a paucity of data comparing these procedures. A systematic review of retrospective studies on the outcomes of MTF vaginoplasty was conducted to summarize evidence of MTF vaginoplasty.
Methods: Applying the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA), a comprehensive search of several databases from 1985 to November 7th, 2017, any language, was conducted. The databases included PubMed, Ovid MEDLINE Epub Ahead of Print, Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, and Web of Science. The resulting publications were screened, and those that met our specified inclusion/exclusion criteria analyzed. The DerSimonian and Laird random effects model was used to pool complications and patient-reported outcomes.
Results: A total of 471 articles were initially identified, of which 46 met our eligibility criteria. A total of 3716 cases were analyzed. Overall incidence of complications included 2% (95% CI 1% to 6%) fistula, 14% (95% CI 10% to 18%) stenosis and strictures, and 1% (95% CI 0% to 6%) tissue necrosis, and 4% (95% Cl 2% to 10%) prolapse. Patient reported outcomes included a satisfaction rate of 93% (95% Cl 79% to 100%) with overall results, 87% (95% Cl 75% to 96%) with function outcome, and 90% (95% Cl 79% to 98%) with aesthetic outcome. Ability to have orgasm was reported in 70% (95% Cl 54% to 84%) of patients. The regret rate was 1% (95% Cl 0% to 3%). The width of the vaginal cavity was 12.5 cm (95% Cl 6.3 cm to 14.4 cm).
Conclusion: Multiple surgical techniques have demonstrated safe and reliable means of male to female vaginoplasty with low overall complication rates, and significant improvements in patient quality of life. Studies utilizing different techniques in a similar population and standardized patient-reported outcomes are required to further analyze outcomes among the different procedures and to establish best-practice guidelines.
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