Education / Lap & Robotics / Surgical Innovations
Introduction & Objective : We utilize the application of autologous platelet-rich plasma (PRP) to improve outcomes during vaginoplasty for male-to-female gender affirmation surgery (MtF-GAS), but the optimal site of application is not well-defined. This study compares site-specific application of PRP to the neo-labia (PRP-NL) versus the neo-vagina (PRP-NV) to assess risk factors and outcomes
Methods : A retrospective review of 172 patients who underwent penile inversion vaginoplasty MtF-GAS from 11/2016 to 11/2017 was performed. Data included site of PRP application, complications, operative data, age, BMI, medical comorbidities and patient compliance with postoperative care.
Results : Patients (n=172) had median follow-up of 2.99 months, median BMI of 25.2, and a median age of 38.1 years. PRP was applied to the neolabia and the neovagina in 46.5% (n=80) and 53.5% (n=92) of patients in a nonrandomized fashion. 2.9% (n=5) were undergoing revision neovaginoplasties. Median length of stay (LOS) was 2 days and median blood loss (EBL) was 100cc.
Overall, complication rates were low (Table 1). A total of 16 patients (8.7%) required reoperation/revision. PRP location did not significantly influence LOS (mean=2.0 vs 2.2, p=0.118), however there was a significant difference in EBL between the cohorts with PRP-NV associated with decreased EBL compared to PRP-NL (mean=91.2cc vs 115.6cc; p=0.003). PRP-NV was associated with a 68% reduction in the risk (Table 1) of future reoperations compared to PRP-NL. When sub-stratifying reoperations, PRP-NV was associated with an 88% reduction in the risk of reoperation for vaginal stenosis/narrowing. Location of PRP application was not significantly associated to any other complication.
Multivariate logistic regression confirmed that PRP-NV reduced the likelihood of surgical revision (OR 0.23, CI 0.05-0.99; p=0.049) compared to PRP-NL. BMI, history of prior neovaginal surgery, HIV status, diabetes, hypertension, smoking, COPD, breast augmentation, and noncompliance did not affect risk of reoperation/revision (all p>0.05).
Conclusions : Our current study demonstrates similar overall outcomes between the two cohorts, with improvements in EBL and decreased revisions necessary in the PRP-NV cohort. Future studies should prospectively evaluate the efficacy of such interventions in order to continue to achieve improved patient outcomes.