Introduction: Despite rising numbers of gender reassignment surgery, literature with respect to complications, risk factors and a surgical learning curve of the PIV is rare. The aim of this study was to retrospectively assess surgical outcomes and complication rates as well as to perform a learning curve (LC) analysis based on these parameters.
Methods: A retrospective analysis of 113 patients who had undergone a gender reassignment male-to-female at our institution with a PIV between 2015 and 2018 was performed. The operation was performed in a two-staged procedure. The second surgery was performed 6 months after the initial conversion by a single surgeon. Follow-up (FU) consisted of a standardized postoperative treatment and regular check-ups with physical examinations (incl. uroflowmetry, assessment of neovag. depth) after 1 and 6 months. Complications were assessed according to Clavien-Dindo and Comprehensive Complications Index (CCI). Predictive parameters such as age, time of hormonal therapy, Charlson Comorbidity Index and BMI were assessed. Finally, a LC analysis was performed based on functional parameters (neovag. depth) and complications (CCI).
Results: 113 patients were available for analysis. Median FU was 6.1 months. Median age was 37 years, median hormonal therapy was 36 months, median Charlson score was 0.3, median BMI was 25kg/cm3 and median CCI was 8.63. Most complications were Clavien I and II. There were only few complications requiring surgical interventions (2 Clavien IIIa; 4 Clavien IIIb). 17% and 12% of patients suffered from wound infections and dehiscence, respectively. There were 2 cases of bleedings requiring surgical intervention. After 6 months, 10% showed introitus strictures, 9% neovag. atrophy or meatal stricture and 4% had a clitoral necrosis. 4 patients had a recto-neovag. fistula. With respect to functional outcomes, median neovag. depth was 163mm. Postoperatively, 70% of the patients were able to have an orgasm. Regression analysis showed a significant correlation between age and CCI (p=0.02). Interestingly younger patients developed more complications. Hormonal therapy, comorbidities, status after circumcision requiring a scrotal skin transplant and BMI had no significant influence on surgical outcome. LC analysis revealed, that operation time reduces significantly from initially 162min to 126min after about 56 operations (p<0.001). During the same time span complications were reduced significantly (p=0.03) and the neovag. depth increased significantly (p=0.04). After 56 operations a plateau was reached.
Conclusions: PIV is a safe operation with few Clavien III+ complications. In our cohort, younger age was identified as the only significant risk factor for complications. Learning curve analysis based on time, functional parameters and complications showed that after about 56 operations a plateau is reached. Source of